Inland Northwest Health Services

Inland Northwest Health Services, a nor-for-profit corporation based in Spokane, Wash., provides the backbone for current and future innovative technologies in health information exchange. INHS connects 38 hospitals that allows physicians and healthcare providers to securely access patient information utilizing wired and wireless technologies.

Other INHS lines of business include St. Luke's Rehabilitation Institute, Community Health Education & Resources, Children's Miracle Network, Northwest MedStar, and Northwest TeleHealth.

INHS has more than 15 years of experience with videoconferencing networks and equipment in Washington state and the Pacific Northwest. Our clients use video monitors, high-resolution cameras, microphones and other technology to allow participants at different sites to have secure, two-way, real-time communication. All new INHS deployments in the U.S. and Pacific have been based on the H.323 Standard.

INHS migrated to a pure Internet Protocol network, which is facilitated by a state-of-the-art Metropolitan Area Network, and a Wide Area Network. The INHS Northwest TeleHealth network includes 38 cities in Washington and Idaho. Within those cities, NWTH is in 65 institutions and programs and operates more than 150 videoconferencing units. NWTH is contracted to run the operations center for the Northwest Regional Telehealth Resource Center (NRTRC), created in 2005 to advance telehealth in the Western United States, Alaska and U.S.-Affiliated Pacific Islands.

Fiber is the INHS preferred transmission medium because bandwidth is easily expanded as a site's needs grow. Incumbent providers or other companies that can supply T-1 or fiber capacity must have facilities sufficient to deliver and support the carrier-grade services necessary for 24/7 reliability. Not all fiber service providers in Washington are able to meet the INHS reliability requirements. If a community does not have available fiber, its choices are limited to the services from incumbent local exchange carriers. T-1 connections may be the best service that some communities can obtain.

The WAN is provided through private T-1s, based entirely on the availability of reliable quality transmission services in the community. INHS specifically determines the best service prior to WAN installation because rural locations are still underserved by more advanced telecommunications companies.

It has been in service and providing standard-definition access to distance learning and telemedicine services since 2001. We sought a “carrier class” solution for our end-users that provide the best suite of services that can be delivered. In the spring of 2010 NWTH will be replacing this bridge with a larger high-definition bridge to improve the quality of standard-definition calls and provide the options for high-definition calls for videoconferencing across the system. A portion of this bridge was funded by a grant from the U.S. Department of Agriculture Distance Learning and Telemedicine program. The cost of the bridge is approximately $500,000. Additional network infrastructure and endpoint upgrades have been made in 2009 and will be made in 2010.

The cost for a remote site, commonly referred to as a spoke site, to install videoconferencing equipment is approximately $15,000 for a well-equipped conference room or portable system. There are additional costs for network connectivity.

Our current staff of conferencing professionals includes five full-time employees, two analysts who rotate schedules to accommodate early morning and late evening offerings and provide direct support of the users and events on the daily schedule.

While it's true everywhere that trained emergency medical services, or EMS, providers can mean the difference between life and death, it is especially true in remote and rural regions.

Yet more than 80% of rural EMS providers are volunteers. With little to no funding, just maintaining this lifesaving certification can become a burden. Taking time off work to travel and attend classes is not only expensive, but also it pulls providers away from the communities that need them should an emergency occur.

That's where EMS Live@Nite comes in. To lessen the training burden for rural communities throughout the Northwest, in 2003 INHS partnered with Spokane County EMS to use technology so rural providers can access EMS education right in their own communities.

In 2004, INHS received a grant from the Office of Rural Health Policy's rural EMS program. But when that grant ended a year early in 2005, rather than shutter the program, INHS decided the need was too great and has been sponsoring it ever since, still in partnership with Spokane County EMS.

On the second Tuesday of each month, an instructor who specializes in a relevant topic delivers continuing medical education via live, interactive videoconferencing from Spokane. The program is now offered to 108 rural locations in Alaska, Idaho, Montana, Oregon, Washington and Wyoming with an average of 250 EMS professionals attending who receive continuing medical education credit to maintain their state and/or federal certification.

Evaluation information from EMS Live programs has continued to be collected. Year two evaluation data were collected from approximately 3,000 participants.

Most significant lessons: Knowledge was significantly increased as a result of the courses; the vast majority of students (more than 80%) was satisfied or very satisfied with the courses, and feels better prepared to respond as a result of the courses. Barriers and challenges have been minimal, and mostly revolved around working with course instructors to write appropriate knowledge test questions.

INHS has partnered with or been the applicant of several funding opportunities available from the American Recovery and Reinvestment Act. These include, broadband initiatives, funding from the Office of the National Coordinator for Health Information Technology for community initiatives such as the Beacon Community and research funding through the National Institute of Health and the Agency for Healthcare Research and Quality.

Not every rural community has a hospital, clinic, fire station or school with the technology to access the classes. Of course, with additional funding, those involved with the program say they could do so much more. “People should know the quality of the emergency care they receive when on vacation or traveling is dependant on the education of volunteers there to help them. We need to figure out how to fund the education for these people. It is a serious hole in the system.”