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

1. Using Shared Services and Integrated Information Systems To Improve the Delivery of Health Care Nancy Vorhees Inland Northwest Health Services

2. Presentation Overview • History of INHS • Organization and Oversight • Current Scope • Program Highlights • Lessons Learned

3. 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 region’s customers were not being well served.

4. 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

5. 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.

6. 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.

7. 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.

8. 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.

9. 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

10. INHS 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

11. 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 region’s telemedicine network

12. Legend INHS Hospitals Telehealth Sites Helicopter Base Affiliated Hospitals INHS Regional Healthcare Network INHS Regional Healthcare Network

13. Organization and Oversight • Executive Director • Eight-Member Board of Directors • Representatives from the boards of the sponsoring hospitals • Medical professionals • Community members

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

15. INHS Accomplishments • Weestablished 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 • Weconnected 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

16. 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

17. Physician EMR Views per Month EMR Views per Month Office Staff = 36,000 Physicians = 49,000

18. Physicians Mercury MD “Mobile” PCI Text & Speech Systems Expert Systems CPOE – Rules and Alerts Imaging Systems – Rad, Card, Path/Other EMR Usage Mobile Chart CPOE Readiness Telehealth Rural Access Clinical Docu-mentation ED/ Medication History Regional Telehealth Network Physician Office Systems – Billing and EMR INHS/IRM Community Foundation Meditech HIS System 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

19. 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

20. 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

21. Telepharmacy Currently four rural hospitals are receiving pharmacy services from Sacred Heart in Spokane. Four more are being added this year.

22. 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.

23. 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

24. 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

25. 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

26. 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.

27. Thank You Nancy Vorhees vorheen@inhs.org (509)232-8104