Using Shared Services and Integrated Information Systems To Improve the Delivery of Health Care

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Using Shared Services and Integrated Information
Systems To Improve the Delivery of Health Care

• Nancy Vorhees
• Inland Northwest Health Services

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Presentation Overview

• History of INHS
• Organization and Oversight
• Current Scope
• Program Highlights
• Lessons Learned

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In the Beginning
Providence Services of Eastern Washington and
Empire Health Services were fierce competitors,
running competing hospitals, air ambulance
services and rehabilitation programs. Both were
loosing money, and both recognized that the
regions customers were not being well served.
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1994

• The two competitors began looking at
  opportunities for collaboration.
• It showed a lot of foresight and the realization
  that things could be better and less costly.
  There was a willingness of everyone involved to
  look for the common good.
• Joe Legel, retired executive vice president
• Sacred Heart Medical Center

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Northwest MedStar
The competitors came together and formed
Northwest MedStar, a single air ambulance program
that is now financially stable and serves eastern
Washington, northern Idaho, north-eastern Oregon,
and western Montana.
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St. Lukes Rehabilitation Inst.
The competitors also formed St. Lukes, a
stand-alone medical rehabilitation hospital that
each year treats about 1,500 patients with
conditions related to brain or spinal cord
injuries, neuromuscular disorders, stroke, and
trauma.
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Information Resource Management
After the first two programs, the competitors
recognized the value of collaborating on
information systems, and merged their networks to
form Information Resource Management.
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Along the way, Providence and Empire formed
Inland Northwest Health Services (INHS) to
operate the new shared programs. In succeeding
years, INHS has grown to provide services for
hospitals and physicians across the region.
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Inland Northwest Health Services

• INHS is a not-for-profit 501(c)3 corporation,
  owned by the hospitals in Spokane and serving
  residents of WA, ID, MT, OR and Canada. We
  facilitate clinical care by
• Improving clinical outcomes through information
  access and integrated clinical systems for
  physicians, hospitals, clinics and other health
  providers
• Acting as the trusted party and secure
  custodian for the regional clinical data
  repository and a community-wide electronic
  medical record
• Maintaining strict data structures and
  standardization to insure ability to share and
  compare data
• Leveraging collaborative assets to control costs
  and provide high levels of expertise using shared
  resources
• Utilizing advanced systems to increase patient
  safety

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INHS Programs

• Northwest MedStar
• St. Lukes Rehabilitation Institute
• Information Resource Management
• Northwest TeleHealth
• Community Health Education and Resources
• Childrens Miracle Network
• Northwest Med Direct
• Northwest Med Van
• Regional Outreach

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Scope of System

• 32 primarily independent hospitals, with over
  2500 beds, participating in the integrated
  information system
• More than 20 clinics receiving hospital,
  laboratory and imaging data via standard
  electronic messages
• More than 200 offices able to view hospital,
  laboratory and imaging data via a virtual private
  network.
• More than 500 physicians accessing patient
  records wirelessly in hospitals via personal
  digital assistants
• 55 hospitals, clinics and public health agencies
  connected to the regions telemedicine network

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INHS Regional Healthcare Network
INHS Regional Healthcare Network
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Organization and Oversight

• Executive Director
• Eight-Member Board of Directors
• Representatives from the boards of the sponsoring
  hospitals
• Medical professionals
• Community members

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Funding

• Reimbursement for healthcare services
• Fees paid by participating facilities
• Support from the sponsoring hospital systems

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INHS Accomplishments

• We established standard data sets, allowing
  comparison of clinical data and enhancing the
  longitudinal patient record
• We established a regional Master Patient Index
  standard that has allowed us to gather and
  distribute patient data to the caregivers in our
  region
• We created a regional integrated information
  system that connects hospitals and clinics,
  providing a community Electronic Medical Record
• We connected Physicians throughout the region,
  directly in their offices and wirelessly within
  our hospitals, providing relevant clinical data
  when and where they need it
• We enhanced care in rural areas by connecting
  residents and clinicians to specialists through
  an extensive regional telemedicine network

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Electronic Medical Record

• A common Electronic Medical Record system
  operates in all participating hospitals and
  clinics, providing one standardized clinical data
  structure and presentation
• Visit Histories
• Cumulative Laboratory results
• Radiology exam profile/reports
• Transcription reports including e-Sign
• Patient Demographics
• Computerized Physician Order Entry
• Each patient has a unique Master Patient Index
  (MPI) one number, one regional record
  currently 2, 601, 900 records in the system

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Physician EMR Views per Month
EMR Views per Month Office Staff 36,000
Physicians 49,000
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Clinical System Usage and Strategy

• The integrated information system and common MPI
  gives the region a foundation for innovative
  tools, including
• Computerized Physician Order Entry (CPOE)
• Clinical Documentation Systems for Nursing Notes
• Decision-Support Tools
• Anywhere, Anytime Physician Access to Images
• Remote Consultations and Support for Rural
  Residents

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Physician EMR Server Farm

• Collaborative server farm with 280 physician EMR
  systems managed by INHS
• Support 3 EMR systems
• GE Logician
• NextGen
• LSS
• Lower cost to physicians
• Professional IT staff for implementation and
  local support
• 24 x 7 helpdesk
• Interfaced with hospital HIS, PACS, Reference Lab
  
• Momentum and community support

Source INHS/IRM Server Farm, Spokane Datacenter
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INHS Telemedicine System

• Nursing courses and education with universities
  and community colleges addressing Nursing
  Shortages
• Rural hospital TelePharmacy program providing
  remote Pharmacist services
• TeleER program assisting rural trauma doctors
  with ER cases remotely
• Physicians provide remote Clinical Consults in
  Neurology, Pathology, Psychiatric services, and
  many other areas
• Prison Based Health Services receive specialist
  care
• Statewide Diabetes Education Program Including
  Native American Tribes

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Telepharmacy
Currently four rural hospitals are receiving
pharmacy services from Sacred Heart in Spokane.
Four more are being added this year.
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TeleER
TeleER links the Deaconess Emergency Room in
Spokane with two rural hospitals. INHS has just
received appropriations funding to expand the
system to additional rural sites.
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Collaborative Momentum

• Common mission of lowering regional healthcare
  costs
• Clinical data shared, not used as a competitive
  tool
• Technical standardization saving millions
• Developed a hot bed of healthcare technical
  expertise
• Hospitals are beginning to see themselves as
  missing out if they do not participate

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Obstacles and Challenges

• Current funding model relies in part on INHS
  sponsors
• Limited funds from rural hospitals slows their
  adoption of key clinical systems
• Minimal physician office automation has slowed
  the longitudinal electronic medical record
• Lack of healthcare industry data standards for
  data clinical exchange

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Obstacles and Challenges

• Privacy and appropriate use of health information
• All participants in network agree to protect the
  health information contained in the system.
• HIPAA has added additional layers of complexity
• Each facility as well as INHS has a HIPAA
  compliance officer
• Data exchange for clinical care is handled under
  the standard network membership agreement
• Data release for other purposes (I.e. research,
  health assessment) must be authorized through
  data sharing agreements

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Lessons Learned

• Someone has to get the collaboration started,
  including seed money.
• Collaborations must be based on real business
  needs of all participants.
• EMRs must meet business needs as well as patient
  care needs.
• Focus on developing a critical mass of EMR users
  in a community.
• If you build it, they will come.

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Thank You
Nancy Vorhees vorheen_at_inhs.org [phone]