Innovation Through Collaboration: Innovation Through Collaboration: Local, Regional, and State Local, Regional, and State

HIT Initiatives HIT Initiatives

Nancy L. VorheesChief Operating Officer

Inland Northwest Health Services

Inland Northwest Health ServicesInland 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

• Leveraging collaborative assets to control costs and provide high levels of expertise using shared resources

• Utilizing advanced systems to increase patient safety

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

INHS ProgramsINHS ProgramsINHS ProgramsINHS Programs

Scope of SystemScope of System

• 35 primarily independent hospitals (over 3500 beds) participating in the integrated information system with a single client identifier

• More than 20 clinics receiving data electronically via HL7 messaging

• More than 50 clinics and 400 physician offices able to view hospital, laboratory and imaging data

• 68 hospitals, clinics and public health agencies connected to the INHS telehealth network

Foundation SystemsFoundation Systems

• Integrated hospital information system

• Integrated physician office EMR

• Northwest TeleHealth

Local Initiatives

• 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 EMRPhysician Office EMR

Source: INHS/IRM – Server Farm, Spokane Datacenter

Handheld Chart

Mercury MDClinical Usage

Physicians Users = 300

Time Savings = 10 - 20 min.

Complete ChartLab results

Pharmacy OrdersRadiology Reports

Nursing NotesVitals & I/O

Expert System AlertsPhysician notes

Mobile Chart with Decision SupportMobile Chart with Decision Support

Provides real time automated checking Provides real time automated checking starting with the “Five Rights”…starting with the “Five Rights”…

Right patientRight patient

Right drugRight drug

Right doseRight dose

Right timeRight time

Right Route of Right Route of AdministrationAdministration

Clinical - BMV – Patient SafetyClinical - BMV – Patient Safety Clinical - BMV – Patient SafetyClinical - BMV – Patient Safety

2.9

2.52.22.8

33.4

3

4

3.8

4.6

4.54.9

6.15.6

5.3

6.2

4.4

5.1

4.9

5.6

0

1

2

3

4

5

6

7

Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3

2001 2002 2003 2004 2005

Adult & Psych

Reported Medication Error RateReported Medication Error Rate

Peds &NICU

Regional Initiatives

Electronic Medical RecordElectronic Medical Record

• A common Electronic Medical Record system operates in all participating hospitals and associated clinics, providing one standardized clinical data structure and presentation

• Visit histories and transcription reports including e-Sign

• Cumulative laboratory results and radiology exam profile/reports

• Patient Demographics

• Computerized Physician Order Entry

• Each patient has a unique Master Patient Index (MPI) – one number, one regional record – currently over 2.6 million records in the system

Physician Access to EMRPhysician Access to EMR

• A common hospital electronic medical record allows better physician access to necessary inpatient information

• Physicians don’t have to learn different systems or use different access points when their patients are in different hospitals (anywhere in the region)

• Physicians can access hospital records from their home or office – anywhere they have a secure web browser

• Physicians can also access records wirelessly in hospitals using PDAs

INHS Telehealth SystemINHS Telehealth 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

• Clinicians provide remote Clinical Consults and Education in Neurology, Wound Care, Psychiatric services, Diabetes and many other areas

• Prison Based Health Services receive specialist care

TelepharmacyTelepharmacy

• Currently ten rural hospitals are receiving pharmacy services from Sacred Heart in Spokane. More are being added this year.

• Evaluation Measures:– Number of medication errors

– Number of interventions

– Type of interventions

– Turn around time for orders

– Hospital satisfaction

TeleERTeleER

• TeleER links the Deaconess Emergency Room in Spokane with twelve rural hospitals.

• Evaluation Measures:– Number of consults

– Number of transfers

– Health status

– Impact of consult on status

– Provider satisfaction

State Initiatives

State InitiativesState Initiatives

• Washington Telehealth Consortium– Effort to link multiple telehealth networks– Also addressing barriers to telehealth

utilization

• Health Information Infrastructure Advisory Board– Identifying alternatives for state-wide

health information exchange

Lessons LearnedLessons Learned

• Develop a common mission of lowering regional health care costs

• Recognize that clinical data and information technology should not be used as competitive tools

• Where possible, adopt technical standardization

• Be creative about sharing resources

Thank You

Nancy Vorheesvorheen@inhs.org

(509)232-8104