Shared Services: A Unique Model for Addressing Health Care’s Challenges

1. Shared Services: A Unique Model for Addressing Health Care’s Challenges Jac Davies, MS, MPH and Douglas L. Weeks, PhD May 14, 2007

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

3. 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. Luke’s Rehabilitation Institute, a stand-alone rehabilitation hospital • 1996 – Created a joint information systems group within INHS and implemented a common hospital information system

4. Inland Northwest Health Services Northwest MedVan Northwest TeleHealth Northwest MedStar Spokane MedDirect Children’s Miracle Network Information Resource Management St. Luke’s Rehabilitation Institute Information Resource Management Community Health Education And Resources Regional Outreach and Hospital Management Providence Health Care Empire Health Services Regional Hospitals

5. 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

7. Patient Safety Initiatives CPOE Evidence Based Medicine Rules and Alerts Structured Data/Paperless Chart Clinical Documentation Clinical Imaging Electronic Data Exchange Integrated Foundation System Administrative Data Clinical Data Financial Data Stable IT infrastructure Desktop LAN/WAN Internet Disaster Recovery Technology Planning Model HIT Building Blocks

8. 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 > 2.6 million records in the system

9. Advanced Clinical Displays

10. Management Systems

11. 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

12. 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

13. Leveraging the System • Computerized Physician Order Entry • Implemented in ER’s 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

14. 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

16. 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

17. 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

18. Training for EMS Personnel • EMS Live @ Nite • Monthly TeleHealth-based program offered to sites in 5 states • Continuing education targeted at rural EMS providers • In past 2 years EMS Live @ 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

20. Center for Occupational Health and Education • L&I 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

21. Spokane COHE • Developed patient tracking system (OMITS) • Tracking work time loss and patient status • Documenting patient’s treatment plan • Notifying employer • Communicating with key parties • Developed strong relationships with key stakeholder groups • Through L&I offered financial incentives to providers for adopting best practices

22. 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

23. 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

24. 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

25. St. Luke’s 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

26. 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)

27. Focus on INHS Research Resources • All department/divisions of INHS available to participate in research • 3 ‘most promising’ resources/venues: • St. Luke’s 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

28. 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

29. Interested in exploring collaboration? Please contact us: Jac Davies daviesjc@inhs.org (509)232-8120 Doug Weeks weeksdl@inhs.org (509)232-8148