Jamie Welch is CIO of the Louisiana Rural Hospital Coalition, linking 24 northern Louisiana community providers with Louisiana State University Health Sciences Center in Shreveport. Its goal is to make member hospitals the "medical home" for all members of the community. Grant-funded, it's already changing the way care is delivered in the poorest counties in the state. Recently, HCI editor Daphne Lawrence had the opportunity to talk with Welch about how the RHIO was set up and how it will sustain itself.
DL: How quickly did the hospitals adapt and how receptive were they?
JW: They’re actually incredibly receptive. I knew the hospitals themselves would be receptive because it’s a time and money saver but I wasn’t sure of the patient population because high tech stuff for people who are not used to high tech is a big unknown. We get probably at least ten requests a day from patients who are like ‘wait, I can do this?’ And they’re excited because they don’t have to leave home.
DL: What system are you using for the telemedicine system?
JW: We did put it out to an open bid and we contracted with WireOne, but all the equipment is PolyCom.
DL: And this was completely funded by the RHIO?
JW: That $13 million covered all of it. We were very tight with our money.
DL: Did you have to do any training?
The staff were really good about it. Telemedicine systems are not complicated, you know it takes half an hour max to be training on it. They’re very intuitive and obvious and the remote control that comes with it leaves no guessing. It says what every button does. Outside of that, as the physicians use it more and more they get used to things like how to put the earscope in, if it’s the first time. It’s practice.
DL: Are you tracking data that see savings, ROI?
JW: The hospitals are tracking that. And the only one of them has really gotten to a place where they can give us those numbers is BunkieGenerall. One of the things we covered for them was a PACS system so they could do electronic imaging, and they immediately calculated some of their costs. And they calculated the cost of the film printed out, the stickers, the envelopes, and just all these things and they estimated their immediate ROI with the PACS. That’s not even taking into account that that PACS is integrated into everything else and so patients don’t have to get printouts and walk around with them, and overnights are not happening. Just the PACS system saves them $12,000 a month.
DL: Whos’s paying the upkeep on that?
JW: Remember their start-up costs are paid for this and we covered 18 months of maintenance for the whole system. And they know that once those 18 months are up they know the maintenance is their cost. But that $12,000 a month they’re saving on the PACS more than covers the cost on the electronic system and actually winds up saving them $4000 a month. Which in the world of a 60-bed critical access hospital, $4000 a month is huge.
DL: So this will be able to sustain itself as a business model when the grant money runs out?
JW: Yes. However much maintenance we could cover for them, we would pre-buy. Once that’s up that’s on their back to take that cost.
DL: Can you speak to the technology you’ve invested in?
JW: Sure. Carefx sits on top of all these other things as an integration engine. We did a contract with CareFx, CA (Computer Associates) and Initiate and they’re doing the integration. Initiate is doing the master patient index, and all it is, is they have a direct secure connection into the actual hospital system at all the facilities, and so they keep those patient records and keep that index for where to go find the information for each patient.
Then CA is doing security infrastructure, they provide the authentication, the user provisioning, the secure proxy servers, the entire security platform. Then CareFx comes in and they partner with IBM, using the IBM infrastructure and they take that and they build portlets, a web portal that’s made up of smaller windows. These portlets are the views in the PACS system and pharmacy system and doctors notes and all the things that are available inside the hospital system.
DL: When you put this all together were you following any type of model, anyone else’s model or did you develop this on your own?
JW: I did not pattern this after anything and it’s simply because there’s a really lot of really good effort happening and anywhere I look it seems to take years to do anything. And I refuse to get into any game that’s going to take a long time. That’s just not how I operate. I talked to some of the other RHIOS but it’s high level conversations. There’s no talk of joining together or anything like that. One day in the future, sure. We’re not trying to be a silo, closed off to the world, it’s just I don’t think it’s time for anybody to start connecting.