Shared Services: A Unique Model for Addressing Health Care

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Shared Services A Unique Model for Addressing
Health Cares Challenges

• Jac Davies, MS, MPH and Douglas L. Weeks, PhD
• May 14, 2007

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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
losing money, and both recognized that the
regions customers were not being well served.
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Initial Collaborations

• 1994 Merged helicopter programs into Northwest
  MedStar, a single, financially stable service
• 1994 Incorporated INHS, a 501(c)(3), to operate
  shared services for both hospital systems
• 1995 Formed St. Lukes Rehabilitation
  Institute, a stand-alone rehabilitation hospital
• 1996 Created a joint information systems group
  within INHS and implemented a common hospital
  information system

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Inland Northwest Health Services
Northwest MedVan
Northwest TeleHealth
Northwest MedStar
Spokane MedDirect
Childrens Miracle Network
Information Resource Management
St. Lukes Rehabilitation Institute
Information Resource Management
Community Health Education And Resources
Regional Outreach and Hospital Management
Providence Health Care
Empire Health Services
Regional Hospitals
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Scope of System Today

• 34 primarily independent hospitals (over 4400
  beds) participating in the integrated information
  system with a single client identifier. Four more
  being added in CA.
• More than 20 clinics receiving data
  electronically via HL7 messaging
• More than 1000 physicians accessing patient
  records via the internet and wirelessly in
  hospitals via PDAs
• 65 hospitals, clinics and public health agencies
  connected to the INHS telehealth network

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Technology Planning Model
HIT Building Blocks
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Hospital EMR

• A common Electronic Medical Record system
  provides one standardized clinical data structure
  and presentation
• Visit Histories
• Cumulative Laboratory results
• Radiology exam profile/reports
• Transcription reports including e-Sign
• Patient Demographics
• Each patient has a unique Master Patient Index
  (MPI) one number, one regional record
  currently gt 2.6 million records in the system

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Advanced Clinical Displays
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Management Systems
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Physician Office EMR

• Electronic Medical Record Server Farm 38
  clinics, 250 providers, 1250 users
• Interfaced with hospital information systems,
  PACS, Reference Lab
• Interfaced to practice management systems
  (demographics scheduling)
• 24 x 7 help desk/data center
• Fully integrated day one

INHS/IRM Server Farm, Spokane Datacenter
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HIT in Rural Communities

• 22 of the hospitals on the INHS integrated
  information system are located in rural
  communities
• HIT in Rural Hospitals
• Admission and Billing
• Patient Records
• Modules for Different Hospital Units
• All physician offices in north Idaho are using a
  common EMR

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Leveraging the System

• Computerized Physician Order Entry
• Implemented in ERs of five rural hospitals
• One rural hospital has 100 inpatient CPOE
• Evidence-based medicine used in creation of order
  sets
• Bar-Coded Medication Verification
• Pilot testing in one rural hospital
• Reduces errors from medication administration

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INHS Telehealth System

• Nursing courses and EMS education addressing
  rural Continuing Education needs
• Remote Clinical Consults in Neurology, Wound
  Care, Psychiatric services, and many other areas
• Prison Health Services receive specialist care
• Statewide Diabetes Education Program Including
  Native American Tribes
• Rural hospital TelePharmacy program providing
  remote Pharmacist services
• TeleER program assisting rural trauma doctors
  with ER cases remotely

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TelePharmacy

• 10 rural hospitals receiving pharmacy services
  from Sacred Heart in Spokane
• 13 new sites planned
• Outcomes being measured
• Number and type of interventions
• Turn-around-time for prescription review
• Staff satisfaction

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TeleER

• Links 2 emergency depts in Spokane with 12 rural
  clinics
• Purpose trauma specialists provide consults to
  rural providers
• Outcomes being measured
• Characteristics of the consult
• Provider perception of value added from video
  consults
• Provider perception of benefit to patient

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Training for EMS Personnel

• EMS Live _at_ Nite
• Monthly TeleHealth-based program offered to sites
  in 5 states
• Continuing education targeted at rural EMS
  providers
• In past 2 years EMS Live _at_ Nite has distributed
  3,895 CMEs to providers
• 85 are volunteers holding other jobs
• 42 have a primary job that is not health care
  related
• 54 hold an EMT-Basic certification

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Center for Occupational Health and Education

• LI pilot project
• Sites in Renton and Spokane
• Goals
• Improve occupational health expertise by
  mentoring physicians who deal with injured
  workers
• Streamline the return to work process
• Improve injured worker outcomes and prevent
  disability

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Spokane COHE

• Developed patient tracking system (OMITS)
• Tracking work time loss and patient status
• Documenting patients treatment plan
• Notifying employer
• Communicating with key parties
• Developed strong relationships with key
  stakeholder groups
• Through LI offered financial incentives to
  providers for adopting best practices

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Spokane COHE Results

• Evaluation conducted by Tom Wickizer, et al
• Cost savings per claim 497
• 5,800 days of reduced disability per 1,000
  injured workers treated
• Strongest effect observed for low back injuries
  and other soft tissue injuries
• Most influence noted on primary care providers

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Community Health Education and Resources (CHER)

• Diabetes Education, Parenting Education, Smoking
  Cessation, and other types of Community Health
  Education
• Served 11,342 clients in 2006

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Diabetes Education Program Facts Figures

• Over 1,400 new patients seen and over 1,000
  follow-up visits in 2006
• Services group education for Type II DM,
  individual education for Type I II, gestational
  education, insulin pump therapy education, rural
  patient education through telehealth
• Clinical outcomes tracked A1c, blood glucose,
  weight, BF, BMI
• Behavioral outcomes tracked diet, exercise, foot
  checks, medication adherence, QOL
• Payor mix 47 Medicare, 44 commercial
  insurance, 9 Medicaid

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St. Lukes Facts Figures

• Only free-standing medical rehabilitation
  hospital in the state
• 102 bed inpatient facility that provided 21,900
  days of care in 2006
• Provided 64,000 outpatient therapy sessions in
  2006
• Medical conditions stroke, TBI, SCI, MI,
  orthopedic conditions, debility, multiple trauma,
  chronic pain
• Functional outcomes collected at admission,
  discharge, 90 days post-discharge
• Other lab/clinical data available in electronic
  medical record

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Research Efforts at INHS

• Characteristics of research at INHS
• Some projects conducted by internal
  investigators, other are collaborative efforts
  with university partners
• Prospective and retrospective
• Experimental and observational/non-experimental
• Most projects are clinical/applied
• Some projects externally-funded
• D. Weeks role internal facilitator for all
  aspects of the project (study design, funding
  proposal development, protocol implementation,
  data analysis, manuscript/presentation generation)

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Focus on INHS Research Resources

• All department/divisions of INHS available to
  participate in research
• 3 most promising resources/venues
• St. Lukes Rehabilitation Institute (SLRI)
• CHER Diabetes Education program for
  adults/children
• Information Resource Mgmt. (IRM) health IT
  network for 2.6M patient records
• Accessible for prospective research following
  patient consent
• Accessible for retrospective research following
  IRB approval
• Potential for studying impacts of HIT/HIE
• Other possible topics critical air ambulance
  services, rural health care systems, telehealth

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Examples of Research In-progress

• RCT to study optimal biofeedback schedules for
  chronic pain patients
• Psychometric study of modified mini-mental state
  exam in TBI
• Development of a diabetes knowledge test for
  medical rehabilitation patients
• Prevalence of diabetes in inpatient
  rehabilitation populations its association with
  outcomes
• Rural vs. urban differences in the influence of a
  media campaign about diabetes
• RCT to study differences in knowledge and skills
  in pre-hospital and hospital providers trained
  over telehealth vs. face-to-face

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Interested in exploring collaboration?
Please contact us
Jac Davies daviesjc_at_inhs.org [phone]
Doug Weeks weeksdl_at_inhs.org [phone]