MEDITECH Winning Profiles

Establishing a Model for Multi-Entity Collaboration

Inland Northwest Health Services
Spokane, WA


About Inland Northwest Health Services

INHS was born from a desire to provide for greater community health while lowering the cost of health care through the reduction of duplicative services. INHS represents the collaborative efforts and financial backing of the two health care organizations operating in Spokane, WA – Empire Health Services and Providence Services of Eastern Washington – and employs a staff of more than 800.

In its early days, INHS included Northwest Medstar (air ambulance) and St. Luke’s Rehabilitation Institute. After the initial establishment of INHS, funded by the two sponsoring organizations, additional opportunities for consolidating and sharing of services were identified. These included a third-party administrator for health system workers and some self-insured employer groups in Spokane; Children’s Miracle Network, a fundraising entity; regional hospital management services and support; a telemedicine program; a physician outreach; referral and recruitment services program; and community health resources.

Another important consolidation was the creation of the Information Resource Management department, which provides all the information system’s purchasing, management, and on-going support services to all sponsoring entities, all INHS entities, and 26 rural affiliate facilities.

East of the Cascade Mountain Range, Washington State is a predominantly rural region dotted by small towns with populations between 2,000 and 15,000. Spokane, WA (county population 450,000), is the lone major city in eastern Washington and is the last metropolitan center of its size along the northern tier of the United States until Minneapolis. Although this landscape is in stark contrast to the dense and urban populations along the east and west coasts, the citizens of eastern Washington and parts of Idaho and Montana receive the same kind of high quality health care found in any other location, large or small. This is due to the collaboration among several health care organizations across the region that have joined forces to establish Inland Northwest Health Services (INHS). This organization includes 26 affiliates and more than 2,500 beds linked electronically by the Health Care Information System (HCIS) solution provided by MEDITECH.

The roots of the INHS network were set in 1988, when three of the major health care facilities in Spokane merged to form Empire Health Services. The members of Empire – Deaconess Medical Center, Valley Hospital and Medical Center, and St. Luke’s Rehabilitation Institute – had been highly competitive for the area’s resources. They competed for patients, research dollars, public funding, and even for medical staff. Each facility was also using a different information system consisting of disparate, “best-of-breed” software applications. Administrators at Empire Health Services made the decision to bring the three facilities together under a single information system that would lower the net operating costs of information technology services for the overall group, as well as enable patient data to be integrated across the system. After a comprehensive vendor search, Empire selected MEDITECH’s MAGIC Health Care Information System.

In September 1996, Empire Health Services expanded its system by collaborating with two additional organizations – Providence Services of Eastern Washington and Dominican Health Services – to build an integrated information network with each facility running on the MEDITECH HCIS. Empire, Providence, and Dominican now operate under the Inland Northwest Health Services name, providing shared services for information systems, a patient flight transport system, and a rehabilitation center.

“Sacred Heart and Deaconess are only five blocks apart and were fierce competitors before the creation of Inland Northwest,” says Craig Nielsen, chief applications architect at INHS. “Their doctors did not work together; their IS (information systems) people did not even know each other. Now allied under the Inland Northwest banner, the hospitals share information, much to the benefit of our patients.”

From the start, the purpose of the alliance was to cut costs and improve patient care by sharing information without jeopardizing the individual autonomies of the institutions or patient confidentiality. Under this design, authorized personnel, who would be required to adhere to strict guidelines regarding file security and patient confidentiality, would be able to access information from any of the three organization units.

“When the original three facilities merged, they brought in many different systems, and most of them were not originally purchased to support multiple entities,” Nielsen says. “We realized early on that we could not combine services unless all of the organizations were working from the same system; so we went out with the idea of finding a complete system that would support multiple facilities while allowing them to remain as separate entities. MEDITECH fit and it definitely worked."

Integration in Moderation

Even an advanced IDS like Inland Northwest is limited in the operational resources it can combine. Most of the hospitals want to retain some semblance of their own identity, particularly with regard to financial autonomy. Because the organizations are part of an IDS, financial reporting is done on a monthly basis, but receivables and payrolls are done separately from the main HCIS. In addition, antitrust regulations prevent Inland Northwest from merging certain financial functions across the network. Accounts receivable, billing, and managed care functions are carried out by each facility separately.

Other information functions are also performed at each site individually. For example, each Inland Northwest facility has its own Laboratory Information System, but the data entered into a non-integrated application is automatically fed into the integrated electronic patient record – MEDITECH’s Patient Care Inquiry (PCI) application.

Developing New Efficiencies

There were a number of support functions that were combined to help reduce redundancies across the network, in such areas as purchasing, payroll, and accounts payable, Nielsen says. “Yet the hospitals are still independent organizations, so areas such as billing and accounts receivable remain separate,” he adds.

Also, in an effort to ensure patient confidentiality, the sharing of patient records is done under the strictest scrutiny and only authorized personnel responsible for an individual patient’s care can gain access. Since the HCIS applications are integrated, however, clinicians are able to pull data from each facility and bring it together in one application, creating a more complete patient record.

“As Medicare and Medicaid reimbursements decline, facilities have to find ways to reduce costs,” says Fred Galusha, INHS chief information officer. “Currently more than 10,000 employees from 26 care facilities receive their paychecks from one system operated by one IS department. In addition, we’re able to receive better discounts on purchase services by combining purchase orders from multiple facilities. This creates larger orders, which reduces the per-unit cost of goods. It’s an economy of scale.”

Secure Access to Records

The decision to employ a single, integrated information system across three organizations did more than just reduce costs for each member of the alliance, it also gave authorized care providers access to better, more complete patient information. In addition, physicians at Inland Northwest gained the ability to share patient information, a top priority for care providers.

“Inland Northwest held a physicians retreat, and the one consistent message that came back loud and clear was physicians want a standardized patient information system,” Nielsen says. “They want all patient records to be presented with the same technology and terminology.” Inland Northwest met this desire by implementing a single-vendor information system, accessible throughout the IDS. However, the increased scope of access brought about concern for the confidentiality of patients’ clinical data.

To address this issue, patient information was made available on a “need-to-know” basis. Physicians and care providers assigned to a patient’s care are able to access individual electronic records. To grant access to consulting physicians or tertiary care providers, a request for a consult must be placed in the computer system.

“With paper records, physicians have easier access by simply going to the nursing station or to the medical records department and requesting the record,” Nielsen says. “Electronic records require physicians to be assigned to the patient whose records they wish to view. If there is no request entered to consult on a patient, then that physician cannot view the record.”

Beyond access-level security, Inland Northwest also employs a number of checks and balances available within its HCIS to ensure that only authorized personnel have access to patient records. Periodic audits of the records can also be performed as an internal review of who has been accessing records.

Plans for Future Growth

Plans call for Inland Northwest to continue growing. INHS recently implemented the MEDITECH HCIS at Kootenai Medical Center in Coeur d’Alene, Idaho, a 166-bed tertiary care facility. In addition, the hospitals in Spokane routinely treat patients from western Montana, which increases the need for an integrated information system extending to regional facilities in that area.

Other areas of growth include plans to increase physicians’ use of voice recognition software, provide patients with access to their own medical records from the bedside, enable clinical images to be viewed on wireless devices, and increase overall wireless functionality for physicians. As CIO Galusha says: “Thirty percent of physicians use hand-held PDAs (personal digital assistants), so we’re going to implement hand-held access to patient data. Our strategy for all access to patient data is through PCI.”

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