— by Susan McBain, Orcas Issues reporter —
The Orcas Island Health Care District (OIHCD) had a chance to focus more broadly than usual on island health issues at its regular meeting on Feb. 5. Staff from Orcas Island Fire & Rescue (OIFR) joined the commissioners to describe OIFR’s new Mobile Integrated Healthcare pilot project and to discuss OIFR’s part in after-hours care, one of OIHCD’s major concerns.
Chief Scott Williams and EMT Pat Ayers introduced the Mobile Integrated Healthcare (MIH) pilot program, which is expected to launch in May or June. MIH is defined as “provision of healthcare using patient-centered mobile resources in the out-of-hospital environment that are integrated with the entire spectrum of healthcare and social resources available in the community.” The current plan for the program staff includes a full-time community paramedic who will work with patients in their homes and in the community to fill gaps between acute and routine care. For example, the paramedic might help those just released from the hospital to settle in at home, help them establish routines for medication, connect them with services from other organizations, and do routine checks during recuperation.
MIH is not intended to replace EMS, home health care, or hospice services but to help patients connect with these and others services as needed. The OIFR program will coordinate with medical and public health providers, hospitals and clinics, community and social support organizations (such as the Senior Center and Orcas Community Resource Center), education systems, and other organizations to identify patients and help meet their needs. Because of our older population, particular risks on Orcas are falls, chronic diseases, need for patient education on proper care, and medication reviews. The program will also offer services to patients with substance abuse problems, mental illness, and inability to travel to medical appointments.
Chief Williams and Jim McCorison then presented data on the volume of public visits to OIFR for medical reasons in 2018. Total visits were 219, about 25% of all medical events. Visits during weekend days were substantially more than during weekdays. The commissioners requested that, when possible, OIFR also gather data on how many people visited because they couldn’t get into a clinic and how many people were flown off island.
Chief Williams reported improvements in handling of after-hours EMS medical calls with both Orcas Family Health Center (OFHC) and the UW Neighborhood Clinic (UWNC).
OIHCD Superintendent Anne Presson has been working with Kaiser on the issue of denial of transport coverage. She has asked Kaiser representatives for talks in person. She noted that Kaiser’s plan has become more expensive while offering fewer benefits recently, and that the situation makes treatment of people on island even more important.
The District’s after-hours work group reported that the individual providers at UWNC have committed to providing the after-hours care necessary to meet island needs. However, whether Orcas providers will see patients in person if the on-call provider is located on Lopez is still unclear. UWNC has agreed that its triage nurse will offer all services—including in-person visits with a provider—to all callers, not just preregistered UWNC patients. But that service may not be offered yet. UWNC senior managers have agreed a deadline is needed for completing negotiations on after-hours care. As he has before, Commissioner Art Lange observed how many issues would disappear if the two practices could be consolidated.
Lange, Presson, and Commissioner Patty Miller talked with senior UWNC managers about the 2019 contract with OIHCD. Major issues are the services OIHCD will offer, after-hours care, consultation on choice of a medical director, and performance metrics. The discussions clarified UWNC’s “dashboard” document, showing the performance data it already collects, but the commissioners would like more information before deciding if the data will meet the District’s needs. They would like also more clarity on services UWNC will provide, possibly could provide, and cannot provide. Miller hopes much of this information will be available by the Feb. 19 OIHCD meeting. Recognizing the importance of metrics in measuring quality of services, the commissioners established a quality committee that will work with both clinics to ensure that they are collecting appropriate data.
Finally, the commissioners agreed to ask both clinics to track equipment expenses in 2019. The District owns UWNC equipment, but the commissioners also need to understand OFHC’s equipment needs in order to plan for funding.
The next regular OIHCD meeting is Tuesday, Feb. 19, at 4 p.m. at the Fire Hall.
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This is music to my ears.. How fortunate that we have someone of Mrs Ayers countenance to facilitate this program. I won’t report on her experance level other than what I’ve witnessed as exceptional. All those in the perfossinal work force that have had the pleasure of working with this individual have something in common. The expectation of compatance and completion.
Looking forward to yet more excellence in our community. To all involved, great work and onward.
Clyde Duke.
We are so fortunate to have Susan McBain faithfully attend these meetings and then do such an amazingly thorough job of reporting back to us. Thank you, Susan!
Interesting.
I did not see Susan at this meeting on the 5th.
There is a preponderance of unsupported assertions in this report. I do not believe an audio record would supply the missing quotations. The visual presentation also lacked many of the assertions made above.
So, one more time, with feeling: healthcare is about professional advocacy and collaboration: Trust. This cannot be gained by gaming the social/political environment, bullying those that differ, denying the experience of those we serve, or self-serving turf battles.
In ten months, the UW clinic we have had so much hope and investment in, has failed to negotiate core issues. This is a matter of record.
This extends not only to the matter of after-hours care, but to financial accountability, and scope of practice. It is not a matter of disagreement, it is a consistent pattern of *failure *to *address explicit requirements. Period.
Failing to share with us a vision of Primary Care for this community that extends beyond office hours not only betrays our particular need in this corner of the world, but betrays a lack of understanding of Orcas as a microcosm of ALL healthcare, where failure to integrate care causes proven, well-researched systemic failure of all types. This is not open to debate.
The matter of after-hours care is a requirement like having a Fire Dept. would be even if no building ever burned. We have a Public Health need analogous to the Public Safety presence we already enjoy, exerting a unified monitoring, evaluating, and educational presence in our lives.
If OIFR already has a program that addresses this, more power to ya.’ But if you are just figuring it out, the reality is that it is the core failing of our US healthcare system. But rural communities have a crazy advantage despite lack of resources, because they have the ability to more easily integrate care at all levels than a larger Metro area. If we can get along…