James Spillane Uses Health IT to Improve Care Coordination in a Remote Region of Alaska
James Spillane is Clinical Applications Specialist and Improvement Advisor at Aleutian Pribilof Islands Association (APIA), a non-profit tribal organization of the Aleut people located off the coast of Alaska. APIA administers five regional health clinics and serves a patient population with a substantial chronic disease burden. At APIA, Mr. Spillane leverages Health IT and electronic health records (EHRs) to better coordinate care and help APIA’s patients overcome health care access barriers.
A Unique Environment
Few areas in the United States are quite as unique or extreme as that of the Aleutian and Pribilof Islands. “Our clinics are roughly 800 miles away from the nearest hospitals or specialists in Anchorage,” explained Mr. Spillane. Distance is not the only problem, however. Extreme weather often causes flight cancellations, so many of APIA’s patients find it difficult to travel to medical appointments with specialists on the mainland. Without easy access to specialty care, patients with complex chronic conditions often forgo medical treatment. “Access to specialty and hospital care is very limited, and care coordination is incredibly difficult,” recalled Mr. Spillane.
APIA implemented a number of Health IT tools to improve access to care for its patients. APIA is using telehealth, for example, which enables patients to consult with specialists electronically. “A patient with a heart condition can go to one of our local clinics and use our telehealth equipment to meet with a cardiologist virtually,” explained Mr. Spillane. “The cart, which is equipped with an EKG device, blood pressure cuff, and other data collection tools, securely transmits the patient’s health information to the cardiologist instantaneously.” The cardiologist then uses this information to determine whether or not the patient needs an in-person appointment for follow-up, helping APIA’s patients avoid unnecessary and costly travel.
Health IT Facilitates Care Coordination in a Challenging Environment
In addition to building APIA’s telehealth capabilities to improve access to care, Mr. Spillane is optimizing APIA’s EHR system to improve care coordination. APIA incorporated clinical reminders into the EHR system to alert the clinics’ providers when patients are due for preventive screenings, such as eye exams for patients with diabetes or colonoscopies. Recently, Mr. Spillane and APIA took this technology one step further; APIA added a population health management tool that can generate lists of patients in need of preventive screenings. “With clinical reminders we can improve care for patients coming through the door, but with this new population health management tool we can coordinate care for our patients proactively,” Mr. Spillane explained. “Now, we can target and conduct outreach to patients due for certain health services.” Staff members on APIA’s care teams personally call patients in need of screenings and other health services to schedule appointments.
With Mr. Spillane’s help implementing and optimizing Health IT, APIA improved its preventive screening rates on several measures, including colonoscopies and screening for fetal alcohol syndrome, from as low as 20% to more than 90%.
Improving Health Care Quality
In addition to improving access to care and preventive screening rates, APIA is leveraging Health IT to participate in a number of quality improvement initiatives. For the Improving Patient Care (IPC) initiative, which is funded by the Indian Health Service, APIA is implementing the medical home model to further improve care coordination. Since implementing IPC, APIA increased the percentage of its patients assigned to a care team from 0% to 98%. APIA is also involved with the Million Hearts initiative and is working to increase blood pressure control among its hypertensive patients. “We are always thinking about what we can do to improve health care quality.” Mr. Spillane said. “Health IT is fundamental to our health care quality improvement initiatives.”