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Shared Services: Shared Services: A Unique Model for Addressing A Unique Model for Addressing
Health Care’s ChallengesHealth Care’s Challenges
Jac Davies, MS, MPH and Douglas L. Weeks, PhDJac Davies, MS, MPH and Douglas L. Weeks, PhDMay 14, 2007May 14, 2007
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.
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
NorthwestMedVan
NorthwestTeleHealth
NorthwestMedStar
SpokaneMedDirect
Children’sMiracleNetwork
CommunityHealth EducationAnd Resources
InformationResource
Management
Providence Health Care Empire Health Services Regional Hospitals
InformationResource
Management
St. Luke’sRehabilitation
Institute
RegionalOutreach and
HospitalManagement
Inland Northwest Health ServicesInland Northwest Health Services
Scope of System Today34 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
Stable IT infrastructureDesktop LAN/WAN Internet Disaster Recovery
Integrated Foundation SystemAdministrative Data Clinical Data Financial Data
Structured Data/Paperless ChartClinical Documentation Clinical Imaging Electronic Data Exchange
Patient Safety InitiativesCPOE Evidence Based Medicine Rules and Alerts
HIT
Bu
ild
ing
Blo
cks
HIT
Bu
ild
ing
Blo
cks
Technology Planning Model
Hospital EMRA 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
Advanced Clinical Displays Advanced Clinical Displays
Management Systems
• 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
Physician Office EMR
INHS/IRM – Server Farm, Spokane Datacenter
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
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
INHS Telehealth SystemNursing 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
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
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
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
Center for Occupational Health and Education
L&I pilot projectSites in Renton and SpokaneGoals– 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
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
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
Diabetes Education, Parenting Education, Smoking Cessation, and other types of Community Health Education
Served 11,342 clients in 2006
Community Health Education and Resources (CHER)
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
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
Research Efforts at INHSCharacteristics 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)
Focus on INHS Research ResourcesAll department/divisions of INHS available to participate in research3 ‘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 recordsAccessible for prospective research following patient consentAccessible for retrospective research following IRB approvalPotential for studying impacts of HIT/HIE
Other possible topics: critical air ambulance services, rural health care systems, telehealth
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
Interested in exploring collaboration?
(509)232-8120
Doug [email protected]
(509)232-8148
Please contact us:
