Transcript Document

Shared Services:
A Unique Model for Addressing
Health Care’s Challenges
Jac Davies, MS, MPH and Douglas L. Weeks, PhD
May 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
Inland Northwest Health Services
Northwest
MedVan
Northwest
TeleHealth
Northwest
MedStar
Spokane
MedDirect
Information
St. Luke’s
Community
Information
Resource
Health Education
Resource Rehabilitation
Institute
And Resources Management
Management
Providence Health Care Empire Health Services
Children’s
Miracle
Network
Regional
Outreach and
Hospital
Management
Regional Hospitals
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
Technology Planning Model
Patient Safety Initiatives
HIT Building Blocks
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
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
Advanced Clinical Displays
Management Systems
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
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 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
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 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
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
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
Diabetes Education Program Facts
& Figures
Over 1,400 new patients seen and over 1,000 followup 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 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)
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
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?
Please contact us:
Jac Davies
[email protected]
(509)232-8120
Doug Weeks
[email protected]
(509)232-8148