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: What’s the makeup of the Louisiana Rural Health Coalition?
JW: In our coalition, we have 44 members but the LRRX network only includes 24, the members in north Louisiana. That’s because the tertiary care facility connecting to the rural hospital providing service is in Shreveport and can only provide technical services to a certain distance.
DL: When was it founded?
JW: Last year, in the 2007 legislative session, we lobbied the state and got $13 million appropriated by state general funds to implement year one of this network. It was actually a line item in our state general budget that said $13 million to go to the rural hospital coalition to implement year one of this network. Year one includes the LSU Health Center in Shreveport and then seven of our member hospitals. And we’ll add an additional seven hospitals each year until we get it done.
The Rural Hospital Coalition (Welch is CIO) and LSU Health Sciences Center in Shreveport jointly formed the Louisiana Rural Health Information Exchange. And I’m the CIO of that, too.. That’s a joint venture between the two players in the network. It is not a fiber, T3 or anything; it is simply the name of the network.
DL: Is that the only funding that you received?
JW: Yes it is.
DL: What technology have you already implemented?
JW: There are a couple of different technologies running simultaneously. The first thing is the rural hospitals themselves, not all of them have an electronic information system inside of their four walls. So for those that do not, of the 13 million appropriated we took a million and bought a hospital system for those hospitals.
DL: Which system?
JW: We gave them a list and left it open. And they were not tied to that list we left that open to the hospitals.
DL: So it wasn’t one vendor? Did you see any type of trend?
JW: Out of seven hospitals we wound up with three vendors, and one of those was not even on the list that I put out. They were not held to that list. I decided to leave it open because I did have that group purchasing mindset but at the same time the hospitals that are included are critical access, some of them are public hospitals, some are private and I said ‘no one size fits all.’
DL: How did you come up with the list?
JW: I did extensive vendor reviews. Some of them took themselves out of the game. And when you’re talking about small hospitals—all these hospitals are 60 beds or less—you don’t have a really large field of who are the players in that market. Eclipsys is not coming.
DL: Were you doing anything with ambulatory EMR?
JW: Some of our hospitals had rural health clinics and if they had a clinic I advised them to find an HIS that had an ambulatory piece so they had one vendor that covered all their entities instead of piecemeal and that’s what they did.
DL: You’re brand new in this space. When so many RHIOs are stumbling, what do you think it’s going to be that keeps yours going?
JW: I think the key difference is we’re not a RHIO for the sake of being a RHIO and I think that’s what a lot of organizations have done without a real defined goal other than to view each other’s information. That is one of the goals but that is not the purpose. The entire scope of this project is more than health information exchange.
DL: So what’s your business plan?
JW: Well outside of the HIS systems for the hospital, and then the CareFx and Initiate integration piece, the major component of this is we outfitted each of the hospitals with an incredibly state of the art telemedicine system and part of that is that they have a direction connection back to the Health Sciences Center in Shreveport. The entire purpose of this is that the hospitals I represent, every single one of them are in underserved rural areas with little to no access to specialty care whatsoever. The way the world is today—and this is our immediate ROI, the benefit we see now and that the patients love—is that their world today is they would go their rural hospital today, and if that hospital didn’t have the equipment to run the test or the expertise to make the call, that patient would be referred to the health sciences center in Shreveport.
The best case scenario is that you’re at a close rural hospital but usually you’re several hours away, a couple of hundred miles, a day or two off of work. It’s a big deal.
DL: These sound like very underserved communities.
JW: Yes. They are poor. They are the poor people of our state. They go their rural hospital and the rural physician has to refer to the LSU hospital in Shreveport. Then that patient would have to make an appointment and go to Shreveport for let’s say neurology. Then say the neurologist would make his recommendation that you need a nuclear scan. Given the nature of healthcare, those scans don’t happen the same day. So that patient would get an additional appointment. Now he’s already in Shreveport and he’s going to drive back home, then come back, then have the test, then the follow up. So we’re looking at three maybe four appointments and each is costing you a day of work, your kid a day of school. It’s costing money time and effort. So our immediate return on investment is to use this telemedicine equipment and the patient would then present at the rural hospital and the rural physician would say we need a consulation. Instead of the patient having to drive to Shreveport, they’ll make an appointment for the next week for the patient to come back to the rural hospital and do a telemedicine visit with that neurologist. And the neurologist can order test, and if the rural hospital has the equipment to do that test they’ll do it there. And if not, the patient will still have to go to Shreveport, but now you’re looking at all the patient has to do is go directly to the imaging center, do what you have to do and go home. That’s it you’re done with Shreveport bcause everything else can be done through the telemedicine system. And both physicians, your home physician as well as LSU specialist can view all your test results and doctors notes through the information exchange.