Montana RHIO seeks to improve patient safety and efficiency

Organization will help link some distant facilities in rural region

Members of the Health Information Exchange of Montana (HIEM), a Regional Health Information Organization in the northwestern part of the state, have begun using a computerized system that will help them integrate patient data across hospitals and clinics in the region. So far, Northwest Healthcare and Family Health Care has been using the technology, but by the end of this summer most members will be online.

"We are made up of hospitals and clinics from five communities in northwestern Montana. That includes the integrated network here in Kalispell of Northwest Healthcare, which is two hospitals, a nursing home, and a number of private practice clinics," explains Kip Smith, executive director of HIEM. "The outlying communities have four critical access hospitals and their medical providers in different kinds of clinical arrangements, plus two federally funded community health centers in rural communities."

HIEM's service area is 45,000 square miles, Smith continues. "While two communities are only 15 miles apart, the furthest facility in the membership network is 135 miles away and on the other side of the mountains," he notes. "They are very remote, rural, and mountainous, and present some unique challenges in terms of just the geography."

The organization was formed a few years ago, with the closest hospitals (Northwest's Whitefish and Kalispell Regional Medical Center) leading the way. "Kalispell had a lot of patients being referred, and providers generated these questions: 'Is there a way we can share patient records in any kind of expedient manner, have more complete information, and not repeat tests that do not need repeating?'" Smith shares. "What came out of these initial discussions was that those two facilities agreed to pursue the same platform for hospital records."

However, he notes, the clinics' records continued to be on different platforms — some electronic and some paper. "Over time, the other facilities began saying the same thing — that it would be really nice if when they got the patients' records back from the hospitals, the home provider there would have a more complete record," says Smith.

Choosing a vendor

Ultimately, HIEM selected the Informatics Corporation of America (ICA) of Nashville, TN, to provide the necessary technology. "Probably the biggest challenge that our group was trying to address was the fact that we have a variety of electronic records already in place in these facilities and doctors' offices — and they're not all the same," Smith explains. "So HIEM started exploring the options of an overlay model. This involves buying and installing a software system that allows the matching and extracting of patient information from disparate systems so the provider could pull those records forward and see all the information — labs, X-rays, clinic data, and so forth — without ever having to convert to the same platform." The ICA software, Smith adds, was developed at Vanderbilt to answer internal questions they had about disparate medical records and having different systems "talk" to each other.

As with all conversions, says Smith, HIEM is using a phased approach. "We did a pilot here in Kalispell, tying together the records of the two Northwest hospitals; they're up and running," he reports. "Starting next week and through the end of the summer we will be bringing on three of the remote hospital sites and several of the physician clinics, then the two community centers. By the end of this summer, we hope to have most of the facilities online and able to share records."

Laying the foundation

As the system was being installed and training was under way, Jere Schaub, RN, clinical informatics supervisor at Kalispell Regional, who is leading the quality metrics initiative, began laying the foundation for measuring performance. "We wanted to try to be reasonable about expectations, but we did want to show improvement," she shares. For instance, she notes, she wants to see improved access to information for providers in Kalispell Regional, in the ED, and for smaller rural communities getting patients back from Kalispell. "The other things we are looking at are medication reconciliation, being able to track the ongoing meds a patient is on regardless of where they are being seen, and vaccination information," Schaub says.

As HIEM was established, and later as ICA was brought on board, "we worked with them for help in looking at some metrics for success," Schaub recalls. "We formed a clinical working group made up of members from each organization, and we meet on a regular basis to discuss not only metrics but other things that may come up as we are reviewing the data."

The group has been meeting at least a couple of times a month for the past half year or so, she reports. "We started the pilot project in November and are still refining the data, and we're working with some target physicians to learn about the improvements they see."

How were these "target" physicians selected? "We started with our IT medical director and also chose inpatient hospitalists and ED physicians, as a few had expressed interest," Schaub says. "We also have a physician IT advisory group, and we involved them as well."

As for the data being reviewed, "we tried to pick data that were already being collected for other reasons — like hospital quality measures," Schaub notes. "In our smaller organizations they just do not have enough resources, so we wanted to choose metrics that made sense for them."

Schaub adds that individual facilities will be able to develop their own quality metrics. "Some may look at visits across the board — at issues like drug-seeking patients," she notes. "Others just want to be able to check if a patient claims they already had a certain procedure somewhere else."

Another significant metric Schaub plans to follow is physician satisfaction.

"We have surveyed our doctors around their satisfaction with the current means of data collection to establish a baseline," she notes. "We also want to see if they are utilizing online resources, and we want to make sure they're available through ICA."

Access is secure

Providers who use the system access it through a secure web site by entering a user name and password, explains Candy Deruchia, director of health care IT at Northwest Healthcare, who adds that a firewall has been created and other security measures have been taken as well.

The type of information the user can access varies with his or her role, she notes. "A physician can have a patient list and the patient's history," Deruchia explains. "Since more than one hospital is participating, they will get the whole picture — labs, radiology, history, EKGs, meds, problem lists, allergies, and so forth."

Not much staff training was required, she says. "You sit down with a doctor, and within a couple of hours, they're on the system," she claims. "It's very user friendly."

The real benefit of the system, she continues, "is that you can see what you want without needing to see multiple screens and getting lost; you can see the big picture in an easy format."

The key to optimal use, she emphasizes, is realizing the system is what she calls "patient-centric." "You concentrate on the patient, not the event," she explains.

The network will become even more robust in Phase II, says Deruchia, which will unfold over the next 12-18 months. "We will eventually have clinical messaging, a clinical dashboard, forms and notes in the system will become bi-directional, and we will be able to send data to statewide exchanges," she says.

A boon to rural facilities

Having a network like this is especially beneficial in a rural area such as northwestern Montana, notes Smith. "Given our geographic and distance barriers, this is huge," he says. "If we can share records back and forth, in some cases we may even avoid a patient being transferred."

What's more, he adds, continuity of care should be vastly improved. "I've seen so many times in the past where patients were referred from a rural to an urban facility, and the urban facility just has basic information and they turn around and repeat a test that may have been done a week ago," he notes.

The proof of success, he concludes, "will be providers telling us that this gives them much better information on which to make patient decisions."

[For more information, contact:

Candy Deruchia, Director of Healthcare IT, Northwest Healthcare. Phone: (406) 253-2739. E-mail:

Jere Schaub, RN, BSN, Clinical Informatics Supervisor, Kalispell Regional Medical Center. Phone: (406) 751-6661. E-mail:

Kip Smith, Executive Director, Health Information Exchange of Montana. Phone: (406) 751-6687. E-mail:]