Bert Caldwell: INHS patient information system a model for nation

The doctor overseeing the certification of health information systems marvels at what has been achieved at Inland Northwest Health Systems.

In 2008, says Mark Leavitt, the Certification Commission for Healthcare Information Technology plans to begin implementing standards for networks linking hospitals, clinics and doctors. Just the kind of system INHS has managed for a decade.Leavitt was in Spokane a week ago to get a better understanding of INHS operations, and where the organization might go next. He was not the first to be impressed. Former House Speaker Newt Gingrich, founder of the Center for Health Transformation, said the INHS network might be the best in the country after seeing a demonstration at Sacred Heart Medical Center last year.

Providence Health & Services, Sacred Heart’s parent, and Empire Health Services formed INHS in 1994. The organization now employs more than 1,000, with 250 employed in its medical information department.

The INHS system allows 38 hospitals and 3,200 doctors to access the records of 2.6 million patients. All the information is entered electronically, which Leavitt says reduces potential errors in patient treatment, and saves money.

That was the rationale for creating CCHIT, and providing $7.5 million in federal funding. The organization is now a non-profit entity, a step taken to assure its independence.

Leavitt has headed the commission from its inception. He says he set up a computerized patient record system before he opened his Portland internal medicine practice in 1982. In 1985, he formed one of the first companies that sold records software. He subsequently sold the firm to GE Healthcare.

His visit with INHS will be the first of several he expects to take as the commission points toward implementation of network standards, which will be the third and last phase of the three funded by the U.S. Department of Health and Human Services.

Standards for physician systems were implemented last year. Hospitals are up this year.

Certification, with its 250 criteria, is done over the Internet. Leavitt compares it to a driving test, but one that takes all day.

Although 35 systems for doctors have already been certified, with many more pending, Leavitt says only 15 percent of all doctors use electronic record-keeping. Adoption by hospitals is one-third that rate.

“It’s actually kind of frightening — and I’m a doctor — that it’s done manually,” Leavitt says.

He says implementation has been difficult because this generation of health care providers was raised on prescription pads and hand-written charts. When accidents occur, some fatal, the tendency is to add another human to the chain of people reviewing the paperwork. Good software would have flagged the potential problem.

Leavitt sums his response up in an imaginary bumper sticker: “Paper training is for puppies, not for doctors.”

He says adoption of electronic systems has been hampered by a severe shortage of competent trainers.

If he could, Leavitt says, he would yank the INHS management team out of Spokane and put them on the road as consultants. INHS Chief Executive Officer Tom Fritz is on the commission.

Fritz says medical information systems continue to be a priority for the Bush Administration. Thursday, he participated in a conference call with HHS Secretary Mike Leavitt, no relation to Mark, That focused on several ways to improve consumer awareness of health care issues.

But hesitant care providers are not the only problem. Business, political and privacy issues remain, as well.

For many doctors and small clinics, investing in new diagnostic equipment or other hardware offers a better return than an information system. Subsidies or some other type of incentive may be necessary, Leavitt says.

Potential compromise or misuse of information also puts many off, particularly if the development of regional systems like INHS leads to a centralized data-bank. Leavitt says centralization is not necessary, but he notes that consumers uncomfortable with financial information systems a decade ago have come to accept them.

Fritz says all INHS information is encrypted, the network is closed, and users can access only the information they need to know to do their jobs.

He hopes INHS will be among the first networks certified when standards are released next year.

Leavitt gives the organization a preliminary A.

“You’re solving a lot of the problems we were set up to overcome,” he says.