Lincoln Hospital District No. 3, based in Davenport, is holding firmly to its roots while adapting to changes in the health care environment.

The district’s flagship facility, Lincoln Hospital, has been upgrading technologies on site, increasing outpatient services, developing a home-monitoring system, and pioneering telemedicine technologies for emergent and specialty services, says Tyson Lacy, the hospital’s 34-year-old CEO.

The 25-bed, acute-care hospital is located a few blocks north of U.S. 2, at 10 Nichols St., 35 miles west of Spokane.

The hospital district serves a population of about 8,500 residents and covers most of Lincoln County and portions of south Stevens and west Spokane counties.

Lincoln Hospital has 10 providers on staff, including a general surgeon and five other physicians. It has 50 nurses and a total staff of 240.

The district also operates an ambulance service and North Basin Medical Clinics in Davenport, Wilbur, and Reardan.

The hospital has a five-bed emergency room, a full-service lab, and a full imaging department with a recently acquired 40-slice CT scanner and a digital mammography machine. The hospital recently opened a pain clinic.

“We’re working with a Post Falls pain clinic,” Lacy says. “There’s a big need in the community to help eliminate dependence on opioids.”

The hospital recently remodeled its transitional care and rehab facilities where it provides physical, occupational, and speech therapy.

The hospital also has a small café that’s open to employees and the public.

About a year ago, the hospital started Health at Home, a patient-support program that provides individual assistance and monitoring to patients according to a plan of care established with their primary-care providers.

“We’re the first hospital using the Health at Home program that we know of in the state,” Lacy says.

Jennifer Larmer, chief clinical officer, says the district recommends Hearth at Home to patients who’ve been recently diagnosed with—or are trying to manage—chronic diseases, including diabetes and lung, heart, and blood-vessel disorders.

Depending on their individual conditions, patients are issued scales, glucometers, blood-pressure equipment, and pulse and oxygen-saturation meters. They also receive a device that collects data from the equipment via Wi-Fi.

Patients take daily readings, which are transmitted wirelessly to a portal and then monitored by nurses based in North Carolina. The nurses can forward the information to a patient’s care providers and contact the patient by phone if something is amiss or if the patient skips a reporting period.

The program is funded through a two-year grant from Spokane-based nonprofit Empire Health Foundation, and is being implemented by the Lincoln Hospital District, InScope Health, and the Critical Access Hospital Network.

Larmer says the initial 10 Health at Home patients, all of whom were diabetic, saw reductions in their A1c levels after six months. A1c readings help determine average blood sugar levels in the preceding two or three months.

More than 40 patients have participated in the Health at Home program, and 22 are still active in it, Larmer says.

Due to the broad geographic range of the district, Health at Home is ideal for many patients who aren’t able to come to the hospital or clinics for frequent monitoring.

In some cases, however, it has been a challenge for rural residents to access Wi-Fi. In one case, InScope even provided an inverter to enable a patient to use an automobile electrical system as a power source, because the patient had access to cellphone service, but no electrical power.

The hospital district closed a hospital-based nursing home and an assisted-living facility in Wilbur in 2012 due to the growth in uncompensated care. Since then, the district has been focusing on ways to extend the ability of rural residents to remain in their homes as they age. Larmer says she’s confident programs like Health at Home will help do just that.

“I see a potential for providing a lot of services to help people stay in their homes,” she says.

The Health at Home system also has the potential to expand with added video applications.

For some more critical situations, Lincoln Hospital helped pioneer FAST Stroke and Cardiac Level One protocols, which promote quick intervention at rural hospitals for patients experiencing heart attack and stroke symptoms. The programs have protocols for coordinating with specialists and medical teams at larger hospitals.

Lincoln Hospital, for example, begins initial patient stabilization and treatment and coordinates with teams from Northwest MedStar air ambulance and Providence Sacred Heart Medical Center for transport and further intervention.

In the case of a heart attack due to a blockage of blood supply to the heart, it takes less than 90 minutes from the time the patient enters the hospital door until an angioplasty procedure is performed to attempt to clear the blockage.

“We looked at every detail to pinpoint how we could speed it up,” Larmer says.

Lincoln Hospital was one of the first hospitals to use Hawkeye, a robot through which physicians from remote locations can observe, diagnose, and treat patients at Lincoln Hospital.

Hawkeye has multiple lenses for observing the patient, and an onboard screen for the patient to view the physician.

It also plugs into electronic medical equipment, allowing the physician to read the data remotely.

Larmer says Hawkeye is an invaluable tool in stroke intervention.

“It’s great to have a connection with a neurologist,” she says. “For a stroke patient, time is brain. We’ve been able to manage some patients here.”

Tim O’Connell, the district’s chief financial officer, says Lincoln Hospital District had $22 million in revenue and $21.5 million in expenses in 2015. Nearly two-thirds of the hospital’s revenue is derived through federal and state funding programs, he says. The district collects about $600,000 annually through its taxing authority, O’Connell says.

The hospital logged more than 4,500 patient days in 2015 for an average daily census of 12.5 patients.

The patient census has been declining in recent years, O’Connell says, adding that only a quarter of the hospital’s revenue comes from inpatient care.

“The federal and state focus is on keeping patients out of the hospital,” he says.

Like all hospitals, rural hospitals must adapt with a larger emphasis on outpatient care.

Larmer says Lincoln Hospital District is implementing a care model called patient-centered medical home, in which a team approach develops a customized plan for each patient and connects patients with appropriate resources.

“Care coordination is part of what’s changing,” she says. “Payers are starting to recognize the impact of the team approach in reducing readmissions.”