WHATCOM COUNTY, WA a Case Study WITH UNANSWERED QUESTIONS

1
WHATCOM COUNTY, WAaCase StudyWITH UNANSWERED
QUESTIONS

• Marc Pierson
• My community
• PeaceHealth / HInet / CHIC / Pursuing Perfection

2
PEOPLE PLACE

• Who is we?Where is home?

3
(No Transcript)
4
"Never doubt that a small group of thoughtful,
committed citizens can change the world indeed,
it's the only thing that ever has." - Margaret
Mead

5
It Takes a Community
6
(No Transcript)
7
(No Transcript)
8
HISTORY

• Sense making

9
Healthcare Collaboration in Whatcom County

• 1990 Vision of Seamless Care
• 1994 Whatcom Integrated Delivery System
  Community Health Improvement Consortium (CHIC)
• 1995 SJH/PH goes live with Community Health
  Record
• 1996 Whatcom Health Information Network (Hinet)
• 1998 HInet becomes LLC charges for first time
• 2001 Diabetes registries, IOM report, continued
  growth
• 2002 Pursuing Perfection Project
• 2003 Patient Health Record (Shared Care Plan)
• 2003 Community-based Care Coordination

10
WHY DO IT?

• Community Information Technology

11
Values and Beliefs

• Seamless care
• Best outcomes
• Community collaboration
• Systems thinking
• We are all in this together
• Individuality is over-rated, and misconceived
  all that is uniquely human is social
• Sociology is the missing medical science

12
WHO DID IT?
13
No One Individual or Organization

• The initial vision came from the IOM
• The Catholic tradition of service influenced the
  Sisters of St. Joseph of Peace
• Don Berwick influenced the CEO
• 84 doctors and a hosp. exec team created a vision
  of seamless care
• A hospital and a payer funded the creation of the
  WAN / CHIN--then all users paid
• Malcolm Gleser wrote EMR code hoping for users
• Everyone let holes be drilled in their walls and
  they all purchased computers and printers
• Patients found their voice and created their PHR

14
CONVERSING more than installing systems

• We all worried, thought, planned, stalled,
  fought, agreed (not all at once, never
  completely), and found our way forward toward our
  hopes.
• It was and is mostly talk, conversations--understa
  nding each other, technology, timing, capability
• Who is we? Who is talking? Why? How?

15
In my opinionThe most essential person in our
community is a PhD Sociologist

• Injured by our system of healthcare.
• Compassionate and deeply understanding of the
  people.
• Aware that an organization is its people.
• Fully engaged (and employed) by the system

16
WHAT HAS BEEN DONE?
17
Current State of IT

• Private self sustaining Health Information
  Intranet serving community
• 1 hospital
• 300 physicians (99)
• 8 of 9 Skilled nursing facilities
• 90 locations
• Over 1800 pcs
• 1800 network users
• 170,000 inhabitants

18
Current State of IT

• Hospital online with robust installation of IDX
  LastWord EMR, accessible to all physicians and
  their staff in their offices and homes
• Labs and images online
• Several specialty practices importing notes GI,
  vascular lab, nephrology, echo, surgery centers
• E-mail - internet access antivirus protection
• Helpdesk phone and onsite service
• LAN consulting and implementation

19
Current State of IT

• Medical reference resources on line
• Up To Date
• Micromedex
• MD Consult
• Medical Journals, databases, etc in electronic
  library
• 40 doc family practice on Logician EMR
• 60 doc multi-specialty group implementing Better
  Health Record EMR
• 575 Patient Health Records in use, rollout to
  broader community started
• Pilot e-prescribing project beginning
• Designing integrated display of Patient Data from
  disparate systems

20
WHATS NEXT
21
Depending on the Conversations

• Medication reconciliation between patients and
  clinics (in pilot)
• eRx community-wide
• eRx state-wide?
• Interfacing / connecting existing EMRs including
  the PHR
• State-wide PHR?
• HIPAA compliant community-wide clinical
  analytical database for health quality improvement

22
QUESTIONS

• LOOKING FOR
• YOUR ANSWERS

23
Who are the legitimate stakeholders for clinical
/ health information technology?Who is we?
24
How do we meaningfully engage our communities,
states, nation in something that resembles a
public utility model for health information
technology?

• vs. privately owned and competing toll roads?

25
What is the ultimate role for Patient Health
Records in an individuals health? In a
communitys public health?

• Who is we?
• Enforce the continued professionalization of
  health?

26

• How might community members involvement in
  health information technology initiatives impact
  the process and outcomes?
• Enthusiasm
• Design
• Governance
• Scope
• Funding,
• Implementation

27
Social Networks Multiple Identities

• If physician adoption follows the average 17 year
  delay (a dense social network) and if it is
  compounded by financial barriers, what can be
  done to overcome the social-structural delay and
  financial barriers?

28
THANK YOU