One of these 35 hospitals is located in southern California. Three more hospitals in the same area are currently being implemented, and will be operational by this fall.
This picture gives you some sense of the size of the region we serve.
There are three key technology systems that have become the foundation for a wide variety of health information technology initiatives at the local, state and regional level.
Local means the primary benefit is at one facility – a physician office or a hospital.
One local initiative is the development of a centralized physician office Electronic Medical Record system. Instead of trying to implement a separate EMR in their own office, physicians subscribe to an EMR service. They get all of the functionality of an EMR without a large up-front capital investment. Also, physicians using this service don’t have to worry about back-end operations – backing up data, off-site storage, etc.
This graph shows the value of bar-coded medication verification systems at improving patient safety. This hospital had a 50% reduction in reported medication errors following implementation of BMVS.
Initiatives that impact multiple organizations across a community or a region. Regional initiatives often build on local initiatives, such as linking up multiple EMRs into a regional network.
A key factor in INHS’ success has been the creation of a common electronic medical record system in the hospitals we serve and their outpatient care clinics. This system provides a standardized data structure and presentation format, so that data is readily exchangeable between facilities and that physicians who move between facilities don’t have to learn new systems. The standard EMR includes all relevant patient data, and provides the basis for computerized physician order entry. Every patient in our system has a unique master patient index which is the same regardless of the hospital where the patient is seen. This unified MPI supports a single, longitudinal medical record for all patients in the region, and supports electronic data exchange between organizations.
This integrated system gives physicians unprecedented access to patient information. This significantly improves their ability to effectively and efficiently deliver patient care. The ability of physicians to access patient information in this region is unequaled any where in the country.
Now I’m going to spend a few minutes discussing our telehealth system, which has created strong linkages between urban and rural health care providers and organizations. The Northwest TeleHealth system provides ready access to professional education programs for nurses, physicians, hospital administrators and other health care personnel in rural communities. Telehealth is also used to deliver clinical services in rural communities, including clinical consults, diabetes education, and prison health services. The Telehealth program also allows urban health care facilities to provide assistance to rural health care practitioners, through our Telepharmacy and TeleER programs.
The telepharmacy program uses our videoconferencing network and the integrated hospital information system to enable pharmacists located at Sacred Heart Medical Center in Spokane to oversee dispensing of medications in rural hospitals. This program is critical because many rural hospitals do not have access to pharmacists in their own communities. The need for this service is so strong, hospitals are waiting in line to be signed up. The evaluation measures for this program show the areas that the telepharmacy program is particularly trying to address – reducing medication errors, intervening in potential medication errors, keeping the service fast and responsive, and making sure the hospitals are satisfied.
A similar program, TeleER, links rural emergency rooms with the emergency room of Deaconess Medical Center in Spokane. Rural ERs are often staffed by physician extenders (physician assistants and nurse practitioners). The live visual link to the ER experts in Spokane gives the rural health care providers needed support to help them make the right decisions for the patients. The evaluation measures for this program are focused on how TeleER affects patient outcomes, how much it gets used, and whether providers like the program.
Currently our major initiatives are not limited to a state level, but cross state boundaries. There are some initiatives in the works that are state focused and driven by collaborations between multiple organizations.
Highlighting two state-level initiatives in WA – The Washington Telehealth Consortium is a group of hospitals and telehealth networks that is working on a project to link up multiple individual telehealth networks around the state. This group is self-formed, created because of a common understanding that there needs to be a more comprehensive, holistic approach toward delivering teleheatlh programs across the state. INHS is helping to lead this initiative. The second initiative – the Health Information Infrastructure Advisory Board or HIIAB – was created as the result of state legislation. The HIIAB worked over a year to identify alternatives for establishing state-wide exchange of health information. They’ve come up with a recommended solution, health data banks, and will shortly be funding some pilot projects to test it out. INHS is considering whether to pursue one of these pilot projects.
Innovation Through Collaboration:Innovation Through Collaboration:
Local, Regional, and StateLocal, Regional, and State
HIT InitiativesHIT Initiatives
Nancy L. Vorhees
Chief 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
• 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
Providence Health Care Empire Health Services Regional Hospitals
INHS 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
• Electronic Medical Record
Server Farm: 38 clinics, 250
providers, 1250 users
• Interfaced with hospital
information systems, PACS,
• Interfaced to practice
(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
Physicians Users = 300
Time Savings = 10 - 20
Vitals & I/O
Expert System Alerts
Mobile Chart with Decision SupportMobile Chart with Decision Support
Provides real time automated checkingProvides 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 ofRight Route of
Clinical - BMV – Patient SafetyClinical - BMV – Patient Safety
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
• 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
• 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
• 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
• TeleER links the Deaconess Emergency
Room in Spokane with twelve rural
• Evaluation Measures:
– Number of consults
– Number of transfers
– Health status
– Impact of consult on status
– Provider satisfaction
State InitiativesState Initiatives
• Washington Telehealth Consortium
– Effort to link multiple telehealth networks
– Also addressing barriers to telehealth
• Health Information Infrastructure
– 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
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