# Presentation: 066998

## Connecting Healthcare Stakeholders Through HIT and Health Information Exchange

**The Inland Northwest Health Services Story**
**Thomas Fritz, CEO**

**Notes:**
This presentation will highlight a unique organization that has successfully established a business model using shared services and integrated information systems to improve the delivery of health care across a large geographic region – eastern Washington, northern Idaho, northeastern Oregon and western Montana.

## Inland Northwest Health Services

- 	INHS is a not-for-profit 501(c)3 corporation created in 1994, 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 and serving as a neutral party for all hospital-based collaboration
- Leveraging collaborative assets to control costs and provide high levels of expertise using shared resources

**Notes:**
INHS is a non-profit corporation created 10 years ago by the 2 competing integrated healthcare delivery systems in Spokane, Empire Health Services and Providence Healthcare.  This joint venture was created to provide an efficient model for the delivery of collaborative services like information technology and lower the cost of healthcare in our region.

This has resulted in the improvement in clinical outcomes through clinical information access and systems that assist caregivers.

Acting as the trusted party for both data security and data integrity

Maintaining strict data structures and standards to insure the ability to share data and compare clinical results across entities

We leverage our assets to control costs and promote systems usage

## Scope of System

- 32 hospitals, with over 3,000 beds, participating in the integrated information system
- More than 400 Physician practices are able to view hospital, laboratory and imaging data via a private network.
- More than 700 physicians accessing patient records and 225 wirelessly in hospitals via personal digital assistants
- 67 hospitals, clinics and public health agencies connected to the region’s telemedicine network
- 180 member technical staff serving over 18,000 end users

**Notes:**
Today 32 hospitals share this systems with over 2500 beds

More than 400 physician practices have access to the communicy EMR

700 physicians are accessing electronic patient records on a regular bases with 225 accessing their patient records wirelessly in the hospitals via their PALM pilots

55 Hospitals, clinics and public health agencies are connected to the telemedicine network 

170 member IT staff supports 18,000+ users

## Community RHIO Governance

- Inland Northwest Community Health Information Project (INCHIP)
- Advisory and decision-making body on community-wide health information standards and processes
- Voluntary coalition, with members meeting regularly to discuss and make recommendations and decisions
- Governed by Board of Directors with physician, non-physician, and community representatives
- Obtain agreement on key issues, I.e. data exchange processes and standards

**500,000 Local Area Population**

**Largest Healthcare Service Availability**
** ****Between Seattle and Minneapolis**

**9,000,000 Regional Population**

**Notes:**
This is a map of the INHS network shows where our partner hospitals and clinics are located.  We had historically responded to our neighboring hospitals in Eastern Washington and Northern Idaho, however over the past 2 years we have established sites in Western Washington and Southern Idaho.  I am currently working with 4 hospitals in Western Washington and 2 in Southern Idaho that would like to join the network.

## INHS Regional Network 3 to 5 Years

**INHS Regional Network 3 to 5 Years**

## Physician EMR Views per Month

**EMR Views per Month**
**Office Staff =  36,000     **
**Physicians =  49,000**

## Accomplishments

- We have improved clinical outcomes through information access and integrated clinical systems for physicians, hospitals, clinics and other health providers
- We have become the “trusted party” and secure custodian for a regional clinical data repository.
- We have leveraged collaborative assets to control costs and provide high levels of expertise using shared resources

## Accomplishments

- 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 established standard data sets, allowing comparison of clinical data and enhancing the longitudinal patient record
- We created a regional integrated information system that connects hospitals, clinics and physician offices, providing a community Electronic Medical Record

## Accomplishments

- 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
- We increased patient safety by utilizing advanced systems

## Obstacles and Challenges

- Limited funds from rural hospitals slows their adoption of key clinical systems
- Each new hospital brings new challenges – wanting everything for nothing
- Minimal physician office automation has slowed the longitudinal electronic medical record
- Poor IT investment decisions – hospitals and physicians are buying IT without knowing enough

## What we have learned

- Creating a sustainable business model:
- Leverage assets
- Provide an efficient cost plus model
- Create standardization
- Assure value-added services
- Assure quality of services
- Get lowest cost from vendors
- If you do these things, customers will stay and the business will be sustainable

## What we have learned

- Drivers are what affect joint ventures
- Are the drivers financial? Probably should look at standardization of information systems
- Are the drivers clinical (data exchange)? Can focus on data standards for information sharing
- Identify the real business needs of the participants and their communities

## What we have learned

- How do you create sharing among competitors?
- Let competitors run on the same network
- Governance needs to be neutral, not favoring any competitor
- Neutral governance organization can promote agreements on common issues (MPI, network standards, etc)

## What we have learned

- Community governance organizations take work
- Members continuously jockey for position
- Members have to be willing to set aside self-interest
- Everyone has to keep working at it
- Organization must have structure. expectations for conduct, and ground rules for communication and problem-solving

## Thank You

- Tom Fritz
- _[fritzt@inhs.org](mailto:fritzt@inhs.org)_
- Fred Galusha
- _[galushf@inhs.org](mailto:galushf@inhs.org)_
- Jac Davies
- _[daviesjc@inhs.org](mailto:daviesjc@inhs.org)_
- www.inhs.org