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. Presentation Overview. History of INHS Organization and Oversight Current Scope Program Highlights Lessons Learned. In the Beginning. - PowerPoint PPT PresentationTRANSCRIPT
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.