HIE Profile: Inland Northwest Health Services: Building a Strong Sustainability Model
A sustainable health information exchange (HIE) model doesn't come overnight. Just ask Mike Smyly, chief business development officer for the information resources management division of Inland Northwest Health Services (INHS), a nonprofit based in Spokane, Wash. Founded in 1994, INHS connects 38 hospitals and 450 ambulatory organizations, including 4,000 physicians and 750 provider-based EMR systems.
Inland Northwest Health Services (INHS) serves eastern and western Washington State, as well as northeast Oregon, western Montana and northern Idaho. "Our sustainability for HIE service is a by-product of the previous work we've done," says Smyly. "When we talk about HIE, it's a very important concept but currently customers are driven by the need to have meaningful use, clinical documentation and computerized physician order entry (CPOE) to support patient safety and satisfaction, and provide the best possible outcomes. If you want to get people excited about information exchange, start discussing the possibilities for care coordination, disease management and clinical quality measurement, as well as cost reduction."
INHS has been a proponent of integrated systems and bringing clinical documentation to the patient's bedside for the past seven years. Having spent these years working with its facilities and providers to implement advanced clinical systems such as CPOE, barcode medication verification, clinical decision support, evidence-based structured templates for physician documentation and standardized system nomenclature, INHS and its facilities found they were well positioned for meaningful use and HIE. They also support three HIMSS Stage 6 hospitals (including two critical access hospitals).
"When continuity of care documents are referenced, most people are talking about the lowest common denominator because many providers have disparate systems with no standardized language, making it hard for providers to exchange information. Having built the regional system as an integrated system, we have an advantage since we already have a normalized system," says Smyly. "With our team providing the IT system implementations for the 38 hospitals, we are able to leverage that experience for every new hospital with whom we work. It's like standing on the shoulders of giants."
Approximately 20 of the hospitals and two large reference labs provide data to the HIE, according to Smyly. An electronic master patient index (MPI) is employed to integrate patient data among inpatient and ambulatory clinical data. With about 47,000 end users accessing the community-wide EHR, consumers can obtain records on 3.5 million patients.
Othello Community Hospital, a 25-bed critical access hospital in the 7,000-resident town of Othello, Wash., already has achieved Stage 6 meaningful use.
Harry Geller, Othello Community's administrator, says linking into INHS makes access to clinical software more affordable. Seeing 1,400 admissions per year with 60 percent being obstetrical visits, and Medicaid is the primary revenue source, he reports.
Pushed out from a central database in Spokane, Wash., Meditech software is available on computers across the town of Othello to cover applications including financials, emergency room and operating room operations. "We could never have this technology on our own without other hospitals being hooked into INHS," says Geller.
Othello Community was one of the first providers to connect with INHS 14 years ago. About 2003, Othello Community and INHS mapped out a strategic plan to install clinical applications to "wire the place to the max," says Geller. Because INHS maintains the software, Geller says he has been able to reap "well over six figures a year" by not having an IT department at Othello Community. This is a great benefit for a hospital that spends $4,000 to link to the INHS system. "Getting experienced clinical IT personnel in a rural community can get expensive," he says.
The next step for Othello is looking forward to Epic software being made available to small rural hospitals through INHS' services, says Geller. INHS is in the throes of installing an Epic EMR at Providence Health System in Seattle, which is slated to go live by 2013. "While there are more healthcare demands, there's also more data to access," he says. The hospital can track the course of a patient's care throughout the continuum of care. "Through better communication, we achieved better hand-offs from nurse to nurse and doctor to doctor," he notes.
Providers that are connected to INHS are driven to meet government regulations, such as meaningful use. INHS has 12 hospitals attesting to meaningful use Stage 1 in 2011. "Ten INHS-affiliated hospitals are expected to be right behind those initial 12 by mid-2012," Smyly says.
Looking forward, INHS is negotiating with two Caribbean hospitals in St. Croix, U.S. Virgin Islands, which are looking to meet meaningful use Stage 1 requirements.
INHS was recently highlighted in a July report from the Washington, D.C.-based National eHealth Collaborative (NeHC), titled "Secrets of HIE Success Revealed," which featured 12 operational HIEs that "demonstrate through their strategies and business models that HIEs can benefit multiple stakeholder groups, and can, in the process, become growing, self-sustaining business enterprises."
INHS' success factors, according to the report, include shared EHR and stakeholder collaboration. Smyly says the majority of its work is focused on strategy integration and getting to where stakeholders want to be with their IT systems. "Our strategy is very directed. We marry objectives with planning," he says.
The number of users and patients will likely broaden as INHS has become a hosting partner with EMR vendor, Greenway Medical Technologies. Smyly expects this partnership will expand its offerings. "Some of our customers have adopted Greenway technologies, so the decision was driven by our customers' needs," he says.
"When you bring in more information to an exchange, there's a good opportunity to reduce duplication," says Smyly. At INHS, there are designated employees who manage the MPI on an ongoing basis to undo duplicate alerts and merge records if applicable keeping the MPI as clean as possible. "From an integrity view, it's about trust," he adds.
Financially, INHS' information resources management division acts as a health IT vendor delivering services to integrated delivery networks through a contract. INHS participants pay monthly fees where Smyly reported that hosted EMR services can cost a 650-bed hospital 25 to 30 percent less than what the hospital would have paid to deploy an EMR itself. The fees are based on a cost-plus model.
And yet, INHS is not without its share of barriers. According to the NeHC report, INHS' challenges to growth and sustainability are similar to what other hospitals and HIT solution providers are experiencing: how to address and prepare for industry-wide gaps in standards and lack of data consistency at the providers' point of care. INHS continuously invests resources to improve standardization through training and continued improvement in the way data are entered and presented.
INHS is looking to connect an additional 100 EMR systems by the end of 2012. "HIE itself and being able to exchange data is interesting but customers are looking for technologies and that's worked for us in the hospital and physician information system space," says Smyly.
Inland Northwest Health Services (INHS) serves eastern and western Washington State, as well as northeast Oregon, western Montana and northern Idaho. "Our sustainability for HIE service is a by-product of the previous work we've done," says Smyly. "When we talk about HIE, it's a very important concept but currently customers are driven by the need to have meaningful use, clinical documentation and computerized physician order entry (CPOE) to support patient safety and satisfaction, and provide the best possible outcomes. If you want to get people excited about information exchange, start discussing the possibilities for care coordination, disease management and clinical quality measurement, as well as cost reduction."
INHS has been a proponent of integrated systems and bringing clinical documentation to the patient's bedside for the past seven years. Having spent these years working with its facilities and providers to implement advanced clinical systems such as CPOE, barcode medication verification, clinical decision support, evidence-based structured templates for physician documentation and standardized system nomenclature, INHS and its facilities found they were well positioned for meaningful use and HIE. They also support three HIMSS Stage 6 hospitals (including two critical access hospitals).
"When continuity of care documents are referenced, most people are talking about the lowest common denominator because many providers have disparate systems with no standardized language, making it hard for providers to exchange information. Having built the regional system as an integrated system, we have an advantage since we already have a normalized system," says Smyly. "With our team providing the IT system implementations for the 38 hospitals, we are able to leverage that experience for every new hospital with whom we work. It's like standing on the shoulders of giants."
Approximately 20 of the hospitals and two large reference labs provide data to the HIE, according to Smyly. An electronic master patient index (MPI) is employed to integrate patient data among inpatient and ambulatory clinical data. With about 47,000 end users accessing the community-wide EHR, consumers can obtain records on 3.5 million patients.
Othello Community Hospital, a 25-bed critical access hospital in the 7,000-resident town of Othello, Wash., already has achieved Stage 6 meaningful use.
Harry Geller, Othello Community's administrator, says linking into INHS makes access to clinical software more affordable. Seeing 1,400 admissions per year with 60 percent being obstetrical visits, and Medicaid is the primary revenue source, he reports.
Pushed out from a central database in Spokane, Wash., Meditech software is available on computers across the town of Othello to cover applications including financials, emergency room and operating room operations. "We could never have this technology on our own without other hospitals being hooked into INHS," says Geller.
Othello Community was one of the first providers to connect with INHS 14 years ago. About 2003, Othello Community and INHS mapped out a strategic plan to install clinical applications to "wire the place to the max," says Geller. Because INHS maintains the software, Geller says he has been able to reap "well over six figures a year" by not having an IT department at Othello Community. This is a great benefit for a hospital that spends $4,000 to link to the INHS system. "Getting experienced clinical IT personnel in a rural community can get expensive," he says.
The next step for Othello is looking forward to Epic software being made available to small rural hospitals through INHS' services, says Geller. INHS is in the throes of installing an Epic EMR at Providence Health System in Seattle, which is slated to go live by 2013. "While there are more healthcare demands, there's also more data to access," he says. The hospital can track the course of a patient's care throughout the continuum of care. "Through better communication, we achieved better hand-offs from nurse to nurse and doctor to doctor," he notes.
Providers that are connected to INHS are driven to meet government regulations, such as meaningful use. INHS has 12 hospitals attesting to meaningful use Stage 1 in 2011. "Ten INHS-affiliated hospitals are expected to be right behind those initial 12 by mid-2012," Smyly says.
Looking forward, INHS is negotiating with two Caribbean hospitals in St. Croix, U.S. Virgin Islands, which are looking to meet meaningful use Stage 1 requirements.
INHS was recently highlighted in a July report from the Washington, D.C.-based National eHealth Collaborative (NeHC), titled "Secrets of HIE Success Revealed," which featured 12 operational HIEs that "demonstrate through their strategies and business models that HIEs can benefit multiple stakeholder groups, and can, in the process, become growing, self-sustaining business enterprises."
INHS' success factors, according to the report, include shared EHR and stakeholder collaboration. Smyly says the majority of its work is focused on strategy integration and getting to where stakeholders want to be with their IT systems. "Our strategy is very directed. We marry objectives with planning," he says.
The number of users and patients will likely broaden as INHS has become a hosting partner with EMR vendor, Greenway Medical Technologies. Smyly expects this partnership will expand its offerings. "Some of our customers have adopted Greenway technologies, so the decision was driven by our customers' needs," he says.
"When you bring in more information to an exchange, there's a good opportunity to reduce duplication," says Smyly. At INHS, there are designated employees who manage the MPI on an ongoing basis to undo duplicate alerts and merge records if applicable keeping the MPI as clean as possible. "From an integrity view, it's about trust," he adds.
Financially, INHS' information resources management division acts as a health IT vendor delivering services to integrated delivery networks through a contract. INHS participants pay monthly fees where Smyly reported that hosted EMR services can cost a 650-bed hospital 25 to 30 percent less than what the hospital would have paid to deploy an EMR itself. The fees are based on a cost-plus model.
And yet, INHS is not without its share of barriers. According to the NeHC report, INHS' challenges to growth and sustainability are similar to what other hospitals and HIT solution providers are experiencing: how to address and prepare for industry-wide gaps in standards and lack of data consistency at the providers' point of care. INHS continuously invests resources to improve standardization through training and continued improvement in the way data are entered and presented.
INHS is looking to connect an additional 100 EMR systems by the end of 2012. "HIE itself and being able to exchange data is interesting but customers are looking for technologies and that's worked for us in the hospital and physician information system space," says Smyly.