• Case Study: Informing Bedside Decision Making

    Apr 28, 2011

    Catholic Health Initiatives is investing $1.5 billion in clinical IT to improve bedside decision making.

    When Denver-based Catholic Health Initiatives (CHI) developed its strategic vision for 2020, its top priorities included developing pioneering models and systems of care to improve healthcare delivery. CHI, with 73 hospitals in 19 states, is using a major health IT initiative to make that vision a reality.

    This case study appears in the Leadership special report, Creating Value for Patients for Business Success.

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    Many elements of its IT program are targeted directly to improving decision making at the bedside. Among them: introducing a virtual nursing program to extend the expertise of highly trained nurses and strengthening CHI's business intelligence program to support decision making about patient care.

    "These are things that will really allow us to change the way that we care for folks," says Stephen Moore, MD, CHI's chief medical officer.

    Positioning for the Future

    Over the next five to seven years, CHI intends to invest $1.5 billion to improve clinical IT across the organization. Plans call for a systemwide EHR used by both inpatient and outpatient physicians, a health information exchange, and physician and patient portals.

    Moore considers that investment to be "foundational" to support a transformation in clinical care.

    "This is the investment we have to make in information systems across our home health facilities, across outpatient physician practices, and within our hospital setting to be successful in other ventures, especially telehealth," he says.

    CHI, which operates in many rural areas across the country, already has more than 80 telehealth programs in place, including teleradiology throughout the CHI system, a telepharmacy program in North Dakota, and a telepsychiatry program in Nebraska and Kansas.

    Going forward, however, telehealth programs will not be limited to CHI's rural operations and outpatient programs.

    Beginning this year, CHI will pilot two telenursing programs, in which clinical nurse leaders will use health information exchange technology to provide oversight and support to nurses on multiple medical-surgical units simultaneously.

    "We believe this oversight by critical-thinking, highly-educated nurses will improve quality and also improve the discharge planning and coordination of care as we move patients outside of the hospital into their homes," says Kathleen Sanford, RN, senior vice president and CNO.

    One of the pilots is in CHI's North Dakota and Minnesota market, where a chronic shortage of clinicians drives the need for an innovative model for nursing care. The other pilot is in Kentucky where, to start with, "virtual nurse coaches" will support young nurses working on a night shift.

    "The plan is for that to lead into more roles for telenursing-similar to eICUs, but these will be e-medical/surgical units," she says.

    Using Data for Decision Making

    CHI currently maintains a patient data repository that collects information from more than 13,000 separate patient records on a daily basis. The EHR systems and other IT upgrades under way will supplement that significantly.

    "This is going to allow us to capture many, many more data fields-from laboratory tests to radiology tests to key documentation pieces about our patients," says Moore. "This will give us the opportunity to enhance our decision making significantly in two ways."

    This body of information, gathered in real time, will allow clinicians to immediately identify infectious patients and isolate them quickly. Further, the data can be analyzed retrospectively to understand trends in complications and readmissions.

    "This will allow us to track what's happening and inform the organization about our workflows and the way we're caring for certain patients," says Moore. In addition, it will really enable us to begin caring for those patients in a different way," he says.