Situation Analysis:
- Northwest Montana medical facilities serve a population of 150,000+, widely dispersed across more than 45,000 square miles of mountainous terrain that poses challenges to providing effective and efficient health care.
- The limited primary, emergency and acute medical resources throughout the rural locations had a mixture of automated and manual health care records which, combined with the geographic dispersion of the facilities, made it difficult for health care providers to have complete information to assess, plan and treat patients effectively.
- The six hospitals, 12+ clinics, 1 long term care facility, and 1 home health facility comprising the area”s health care system include: Glacier Community Health Center, HealthCenter Northwest, Kalispell Regional Medical Center, Lincoln County Community Health Center, North Valley Hospital, Northern Rockies Medical Center, St. John”s Lutheran Hospital, St. Luke Community Hospital, and other participating sites in the region. All have disparate legacy health care information technology on various platforms and in different locations, including the following:
| Amicas PACS | HealthPort document imaging | Midas+ quality alerts |
| ChartBuilder EMR | HealthWyse home health | MIE WebChart EMR |
| DR PACS | ImageNow document imaging | PenRad mammo |
| eClinicalWorks EMR | Keane long term care | Pyxis pharmacy orders |
| FileMaker EMR | MedHost ED | SoftMed transcription |
| Fletcher- Flora LabPak | Meditech Client Server abstracting, admission, lab, pharmacy | Tech-Time ADT |
| GE Centricity perinatal | Meditech MAGIC admission planning, pharmacy, order entry departmental ,lab | Xcelera cath images |
| GE QS OB fetal monitoring | Microsoft Word clinical documents |
Approach:
The HIEM settled on a three-pronged approach to resolve the problems identified above. First, they began building a fiber-optic infrastructure throughout the region to support the exchange of health care data across the geographically dispersed health care system. Next, they contracted with ICA to provide a secure, aggregated health care data repository to integrate vital clinical information from their legacy systems into a longitudinal patient health care record. And finally, they decided to expand ICA”s base aggregation platform with clinical communication, disease management, clinical workflow and forms and notes capabilities to improve the efficiency, effectiveness and quality of care delivered.
Solution ICA Developed for the Client:
ICA developed a phased implementation approach which first integrated existing health care technology into vaulted data with patient matching capabilities, allowing the segregation of source data by participant while also enabling a longitudinal health care record to be generated for a patient at any of the facilities. This was accomplished by selecting critical feeding systems, piloting the approach and then expanding the aggregation phase throughout the community. Once the aggregation phase is complete, strategic additions of workflow enhancements and disease management functionality will be piloted and rolled out to fill present gaps in data, enhance clinical communication, and remind and alert the clinical team to abnormalities, preventive treatment and contraindications associated with patients in view.
| Previous Environment | ICA Environment |
| Incomplete information was increasing admission rates and ED length of stay. | Comprehensive medical information at ED presentation will allow for expedited assessment and treatment of ED patients, reducing length of stay and, potentially, hospital admissions. |
| Lack of data was impacting hospital, ED and clinic efficiency, as well as limiting the ability to optimize resources across a broad geography. | All members of a geographically dispersed health care team will have simultaneous access to the information they need to assess, plan and treat patients. |
| Incomplete data at the point of care was causing duplicate test ordering. | Duplicate diagnostic testing will be reduced. |
| Incomplete data at point of care was impacting clinical outcomes. | Diagnostic results, disease dashboards, flow sheets, alerts, reminders and clinical history will drive quality outcomes. |
Accomplishments to Date:
- Pilot “go live” was achieved in December 2008, with rollout to the remainder of participants projected throughout 2009.
- Patient matching is in place, providing the provider with a single view of a patient”s continuum of care with 99.6% accuracy.
Rollout of other capabilities will include:
- Implementation of workflow enhancement tools to improve clinical workflow and fill gaps for non-automated participants (secure messaging, forms and notes, alerts and reminders)
- Community-specific disease management tools for improving the quality of community health care delivery (dashboards and flow sheets)
- Exchange with the State”s health exchange, HealthShare Montana.
