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
In its early days, INHS included Northwest Medstar (air ambulance)
and St. Lukes 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;
Childrens 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
systems purchasing, management, and on-going support services
to all sponsoring entities, all INHS entities, and 26 rural affiliate
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. Lukes Rehabilitation Institute
had been highly competitive for the areas 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 MEDITECHs MAGIC Health Care Information
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
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 MEDITECHs
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 patients 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, were 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. Its an economy
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
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
To address this issue, patient information was made available on a need-to-know
basis. Physicians and care providers assigned to a patients 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
Plans for Future Growth
Plans call for Inland Northwest to continue growing. INHS recently implemented
the MEDITECH HCIS at Kootenai Medical Center in Coeur dAlene, 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 were going to implement hand-held
access to patient data. Our strategy for all access to patient data is