1. 1 WHATCOM COUNTY, WA a Case Study WITH UNANSWERED QUESTIONS Marc Pierson My community PeaceHealth / HInet / CHIC / Pursuing Perfection

2. 2 PEOPLE & PLACE Who is “we”? Where is “home”?

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4. 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. 5 It Takes a Community

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8. 8 HISTORY Sense making

9. 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. 10 WHY DO IT? Community Information Technology

11. 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. 12 WHO DID IT?

13. 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. 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-- understanding each other, technology, timing, capability… Who is “we”? Who is talking? Why? How?

15. 15 In my opinion The 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. 16 WHAT HAS BEEN DONE?

17. 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. 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. 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. 20 WHAT’S NEXT

21. 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. 22 QUESTIONS LOOKING FOR YOUR ANSWERS

23. 23 Who are the legitimate stakeholders for clinical / health information technology? Who is “we”?

24. 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. 25 What is the ultimate role for Patient Health Records in an individual’s health? In a community’s public health? Who is “we”? Enforce the continued professionalization of health?

26. 26 How might community members’ involvement in health information technology initiatives impact the process and outcomes? –Enthusiasm –Design –Governance –Scope –Funding, –Implementation

27. 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. 28 THANK YOU