Want to see the future of health care in the United States? A good place to start might be Spokane’s Inland Northwest Health Services.
“We’re a unique venture owned by competing hospitals where we actually take certain assets that were part each individual hospital and create one non-competitive asset for the entire community,” said Tom Fritz, CEO of Inland Northwest Health Services.
In other words, INHS, with its 1,100 employees, provides services for an extended network of hospitals in a much more efficient way than if each individual hospital attempted to perform these functions themselves. INHS services include electronic medical records, telemedicine and ambulances. It also operates the Children’s Miracle Network, a non-profit organization dedicated to helping children by raising funds for hospitals and programs across the inland northwest and in Alaska.
Deaconess Medical Center, Holy Family Hospital, Sacred Heart Medical Center, and Valley Hospital and Medical Center established INHS in 1994 as a non-profit organization to provide shared services supporting the hospitals in and around Spokane. Initially, INHS focused on medical air transport and inpatient rehabilitation services, and included St. Luke’s Rehabilitation Institute, a 102-bed center for patients recovering from injuries, strokes or surgeries. Then, in 1996, the INHS mission expanded to implementing a common hospital information system in the six facilities it served. The end result was six hospitals utilizing common data and technology standards, incorporating a single master patient index and supported by a centralized information technology staff.
Between 1998 and 2006, 28 more hospitals joined the INHS network. The common hospital information system is now in facilities ranging from 25-bed critical access hospitals in rural communities to a 623-bed Level 2 trauma hospital in Spokane. While the majority of hospitals are in eastern Washington and northern Idaho, hospitals in western Washington, southern Idaho, southern California, Alaska, and North Carolina also adopted the INHS model. Currently, there are 38 hospitals and health facilities on the network.
“It’s been a very efficient model,” said Fritz. “It’s one of the largest data-exchange networks in the United States.”
No more paper
Each hospital in the INHS network is able to implement an integrated information system that links all parts of the hospital, including clinical, financial and administrative functions. This improves hospital operations and enables more efficient management of patient information.
At the heart of this model are electronic medical records for each patient — a system with many advantages over the traditional paper medical records that are still prevalent throughout much of the U.S. health care system. Unlike paper records, electronic records on a patient are accessible anywhere on the network. If a patient from Spokane falls ill in California, his records are immediately accessible to doctors if the hospital is connected to the network.
Electronic medical records have other advantages as well.
“A lot of medical errors are related [to the fact that] that you don’t have the information readily available or that somebody misreads a person’s handwriting,” Fritz said. “Electronic records take care of both of those problems.”
Additionally, INHS pioneered the use of barcodes on medication dispensed by its hospitals.
“We were among the very first hospitals in the U.S. to use barcode scanning of medication,” Fritz added. “We barcode every medication now because this prevents incorrect dosages. As a result, we’ve been able to demonstrate medication error rates that have gone down to virtually zero.”
Another benefit of the INHS electronic network is its usefulness as an early warning system for disease outbreaks.
“We just were awarded a contract with the Center for Disease Control for disease surveillance because we can look at what’s going on in emergency rooms throughout the region and look for things like West Nile virus and other contagious diseases in a very timely way,” said Fritz. “We also work closely with the state-level Department of Health and the regional health districts. Our network is a significant asset for the state and the region.”
INHS’ initial venture — Northwest MedStar, the air ambulance service that takes patients from remote locations to hospitals — is one of its most visible services. It’s not only a godsend for patients in need of immediate medical attention; it’s also a lifeline for rural hospitals whose onsite facilities are often quite limited in comparison to urban hospitals.
Town and country
Without a doubt, one of the greatest achievements of INHS is its linking of urban and rural hospitals. Finally, people in rural areas have a reasonable expectation of receiving the same level of care — especially in emergencies — as those who live in cities thanks to the INHS network’s telemedicine innovations.
“The air ambulance is extremely important,” Fritz said. “If there’s a patient up in Omak who’s having a heart attack, we can have the patient’s medical data there for the crew that’s flying the patient in to one of our major hospitals. We can start the care way in advance of coming in and having to figure out what is the patient’s blood type.”
In addition to its air ambulance service, INHS also uses an innovative telemedicine program to link with rural hospitals.
“We have a service called Tele-ER where we hook up our networks to small hospitals, critical access hospitals and ERs so when they run into trouble or have a patient who is really sick with something they can’t handle, our doctors here in Spokane can communicate with them and help them through emergency procedures,” Fritz said. “It’s a real help to the rural hospitals.”
In addition, INHS operates a telepharmacy program where doctors in Spokane write prescriptions and dispense medications through machines in the rural hospitals.
The bottom line is that all of these programs working in concert greatly increase the likelihood of a positive outcome for patients in rural areas.
“If we can get to someone having a heart attack within two hours, the likelihood of that person leaving the hospital without any permanent damage is very high,” said Fritz. “If we get to you after two hours, it’s likely you’ll sustain permanent damage, which sets you up for future heart attacks, and its likely you won’t survive the second or third.”
Currently, INHS is bringing in patients to Spokane from outlying areas in about 92 minutes.
“We’re preventing serious tissue damage and reducing the likelihood of increasing costs if we get there within that window of time,” Fritz added.
A sustainable model
In addition to improving patient outcomes, INHS operations provide good examples of how health care providers can cut skyrocketing costs.
“We’re in 38 hospitals,” said Fritz. “If we weren’t there, you’d have 38 data centers operating in each hospital, working independently. We cut out all that overhead with one data center, which really saves a lot of money.”
INHS’ hospitals — 11 of which are in the top 100 most-wired hospitals in the United States — spend less than the national average for information technology investment. In addition, the length of stay at INHS hospitals is shorter than the national average, the cost per case is less, and the incidence of medical error — a major driver of health care costs — is significantly lower.
The success of INHS in creating a unique and sustainable health services network has not gone unnoticed in other regions.
“There has been some struggle over the last few years to try to create data-exchange networks in the U.S.,” Fritz said. “We’ve seen a proliferation of these networks, and some of them have already failed because of an inability to create a sustainable business model. Our network — one of the six or seven most important ones in the U.S. — is considered to be, and [is] referred to in most of the literature, as an example of a successful health information exchange.”
INHS has grown exponentially since its 1994 inception by doing what it does well and using considerable innovation. Fritz believes the growth will continue, benefitting people throughout the region and beyond.
“Our goal is to ensure that our hospitals are the safest hospitals in the United States and that the standards of practice are as high as they can be,’ Fritz concluded. “People from around the world and in the U.S. want to work for us because of the nature of what we do. Our staff sees themselves as helping the community instead of a particular hospital. Our view is that we should be competing on the quality of our services, not on technology.”
