Title: WHATCOM COUNTY, WA a Case Study WITH UNANSWERED QUESTIONS
1WHATCOM COUNTY, WAaCase StudyWITH UNANSWERED
QUESTIONS
- Marc Pierson
- My community
- PeaceHealth / HInet / CHIC / Pursuing Perfection
2PEOPLE PLACE
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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
5It Takes a Community
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8HISTORY
9Healthcare 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
10WHY DO IT?
- Community Information Technology
11Values 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
12WHO DID IT?
13No 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
14CONVERSING 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?
15In 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
16WHAT HAS BEEN DONE?
17Current 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
18Current 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
19Current 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
20WHATS NEXT
21Depending 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
22QUESTIONS
23Who are the legitimate stakeholders for clinical
/ health information technology?Who is we?
24How 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?
25What 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
27Social 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?
28THANK YOU