Quality-Based Purchasing and Quality-Based Purchasing and Health Information TechnologyHealth Information Technology

Inland Northwest Health ServicesThomas Fritz, CEO

Decade of Health Information TechnologyDecade of Health Information Technology

"America needs to move much faster to adopt information technology in our health care system. Electronic health information will provide a quantum leap in patient power,

doctor power, and effective health care. We can't wait any longer."

Tommy Thompson, Secretary, DHHSJuly 21, 2004

National Strategic FrameworkNational Strategic Framework

• Goal 1. Inform Clinical Practice

• Goal 2 – Interconnect Clinicians

• Goal 3 – Personalize Care

• Goal 4 – Improve population health

Rationale for HIT & QBPRationale for HIT & QBP

• Improving quality of care – Providing more complete and timely access to

patient data, when and where care is delivered

• Increasing operational efficiency– Reducing time needed to access and manage

information

– Using information to better manage resources

• Reducing costs– Eliminating duplicative procedures– Reducing delays in facility processes and patient

procedures

Rationale for HIT & QBPRationale for HIT & QBP

• Utility of HIT and QBP is limited without electronic health information exchange

– Cannot readily import data from other health care providers, so patient record is incomplete

– Cost savings are reduced because staff must still manage paper-based records that come into the practice from other sources

– Increased potential for unnecessary, redundant testing because record is incomplete

– More complete information allows for more accurate management of resources

Realities Realities • Consumers already expect and believe that

practitioners are appropriately sharing clinically appropriate information to take care of them

• Consumers believe that practitioners keep all clinical records in a computer-based system

• Consumers have a high level of trust with doctors and hospitals managing their data

Electronic Medical RecordElectronic Medical Record

• A common Electronic Medical Record system operates in all participating hospitals, physician offices and clinics, providing one standardized clinical data structure and presentation

• Visit Histories

• Cumulative Laboratory results

• Radiology exam profile/reports

• Transcription reports including e-Sign

• Patient Demographics

• Computerized Physician Order Entry

• Clinical Notes

QBP - Remove WasteQBP - Remove Waste

• Under use, overuse, misuse

• Process waste – work flow

• Administrative waste

• Medical Errors

• Right diagnosis, right treatment

Inland Northwest Health ServicesInland Northwest Health ServicesSince 1998:

• We leveraged collaborative assets to control costs and provide high levels of expertise using shared resources

• Our intent was simply to create a system whereby physicians would use the assets to improve patient care

• We wanted to minimize duplication of clinical tests and cost

• We wanted to move in a direction of clinical computing rather than billing and claims management

• Our original intent was only to provide support to hospitals

Inland Northwest Health ServicesInland Northwest Health Services Strategic Focus Areas

1. Community electronic medical record – single client identifier (MPI)

2. Physician system adoption and usage

3. Patient safety, public health

4. Operational efficiency

5. Computerized physician order entry

6. Evidence based medicine adoption and acceptance

7. Decision support systems

Building the Foundation Building the Foundation

-- Created a system of complete accountability

– Provide “value-based” physician convenience systems to readily obtain and deliver real-time clinical results ie digital image store

– Create “community asset” and provide extensive community education and marketing for all partners

Lessons LearnedLessons Learned

• We learned that physician champions were essential for acceptance and adoption

• We learned that we had to demonstrate trust in data management, integrity and security.

• We had to become a “neutral trusted party”

Obstacles and ChallengesObstacles and Challenges

• Gaps in the technology standards create serious interoperability issues

• Education and studies have not adequately helped in understanding Return-on-Investment

• Minimal physician office automation has slowed the longitudinal electronic medical record – Puget Sound Health Alliance, First Choice & Health Care Authority

• Poor IT investment decisions – hospitals and physicians are buying IT without knowing enough – Quality Improvement Organization (QIO) effort

OutcomesOutcomes

• One hospital realized cost savings of $1.3 million over four years by implementing a new hospital IS within the INHS shared services model

• Participating hospitals spend 1.9% - 2.0% on HIT versus national average of 3.1%+

• Pre-INHS, one hospital needed 98 FTEs for IS. INHS uses 57 FTEs to support that account, which now includes HIS, approximately 200 other IT systems, and around 2500 desktop devices

• We increased physician adoption to 40% - still inadequate

Spokane Internal MedicineSpokane Internal Medicine• 10 physicians; implemented EMR in

mid-90’s• Results

– Significant improvements in workflow and operational efficiency

– All patient information and current medical literature available electronically in each exam room

– Reduced 4 FTEs due to ability to receive laboratory, hospital and imaging information electronically

Spokane Ear, Nose and ThroatSpokane Ear, Nose and Throat

• 12 physicians; implemented EMR in 1998• Results

– Prior to implementation, spending $144,000 per year on transcription services, and $120,000 per year maintaining paper records

– In the first year after implementation, reduced transcription costs by 83%

– Have eliminated costs for managing paper records

– Added three physicians at minimal cost to practice

Physicians Clinic of SpokanePhysicians Clinic of Spokane

• 18 physicians; implemented EMR in 1999

• Results

– Costs for transcription services reduced by more than 80% within two years (from $330,058 per year to $56,465)

– Reduced number of FTEs in laboratory from 13.52 to 9.12, with a 25% increase in lab orders

– Communication between providers and support staff improved dramatically

Success of the SystemSuccess of the System

We started with our own hospitals and today have 38 hospitals, with over 4,400 beds, participating in the integrated information system

• More than 50 clinics, 400 Physician practices (1000+ physicians) are able to view hospital, laboratory and imaging data via a private network in Spokane

• More than 1000 physicians accessing patient records wirelessly in hospitals via electronic devices in Spokane

• Connect Fairchild AFB and the Spokane VA Hospital

• 76 hospitals, clinics and public health agencies connected to the region’s telemedicine network

• 225 member technical staff serving over 20,000 end users

PHS Southern California

Valley Hospital Palmer Alaska

Benefits of Regional ApproachBenefits of Regional Approach

• Patient care is improved through better availability of more complete medical records at all points of care

• Medical errors are decreased through use of innovative technology including bar-coded medication verification and electronic nursing documentation

• Rural health care is enhanced and health personnel shortages addressed through video and data connectivity to regional experts

• Hospital operation is more efficient through integrated billing and clinical information systems

• Overall health system savings are achieved through creative use of shared services and resources

• Our system providers are technically ready for QBP

Thank YouTom Fritz

fritzt@inhs.org

www.inhs.org