Using Shared Services and Using Shared Services and Integrated Information Systems Integrated Information Systems

To Improve the Delivery of Health CareTo Improve the Delivery of Health Care

Nancy VorheesInland Northwest Health Services

Presentation OverviewPresentation Overview

• History of INHS

• Organization and Oversight

• Current Scope

• Program Highlights

• Lessons Learned

In the BeginningIn 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 region’s customers were not being well

served.

19941994

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 presidentSacred Heart Medical Center

Northwest MedStarNorthwest 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.

St. Luke’s Rehabilitation Inst.St. Luke’s Rehabilitation Inst.

The competitors also formed St. Luke’s, 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.

Information Resource ManagementInformation 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.

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.

Inland Northwest Health ServicesInland Northwest Health ServicesINHS 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

INHS ProgramsINHS Programs

– Northwest MedStar– St. Luke’s Rehabilitation Institute– Information Resource Management– Northwest TeleHealth– Community Health Education and Resources– Children’s Miracle Network– Northwest Med Direct– Northwest Med Van– Regional Outreach

Scope of SystemScope 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 region’s telemedicine network

INHS Regional Healthcare Network

LegendINHS Hospitals Telehealth Sites Helicopter Base

Affiliated Hospitals

INHS Regional Healthcare NetworkINHS Regional Healthcare Network

Organization and OversightOrganization and Oversight

• Executive Director

• Eight-Member Board of Directors – Representatives from the boards of the

sponsoring hospitals – Medical professionals– Community members

FundingFunding

• Reimbursement for healthcare services

• Fees paid by participating facilities

• Support from the sponsoring hospital systems

INHS AccomplishmentsINHS 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

Electronic Medical RecordElectronic 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

Physician EMR Views per MonthPhysician EMR Views per Month

EMR Views per MonthEMR Views per MonthOffice Staff = 36,000 Office Staff = 36,000

Physicians = 49,000Physicians = 49,000

Clinical System Usage and StrategyClinical System Usage and Strategy

Clinical Docu-

mentation

EMR Usage

Mobile Chart

CPOE Readiness

Telehealth Rural

Access

EMR Usage

Mobile Chart

CPOE Readiness

Telehealth Rural

Access

ED/ Medication

History

Imaging Systems – Rad, Card, Path/Other

INHS/IRM Community Foundation Meditech

HIS System

Text & Speech

Systems

Physicians Mercury

MD “Mobile”

PCI

Expert Systems

CPOE – Rules and Alerts

Regional Telehealth Network

Physician Office

Systems – Billing and

EMR

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

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

Physician EMR Server Farm

Source: INHS/IRM – Server Farm, Spokane Datacenter

INHS Telemedicine SystemINHS 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

TelepharmacyTelepharmacy

Currently four rural hospitals are receiving

pharmacy services from Sacred Heart in

Spokane. Four more are being added this year.

TeleERTeleERTeleER 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.

Collaborative MomentumCollaborative 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

Obstacles and ChallengesObstacles 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

Obstacles and ChallengesObstacles 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

Lessons LearnedLessons 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.

Thank You

Nancy Vorheesvorheen@inhs.org

(509)232-8104