In 2012, Poudre Valley Health System and the University of Colorado Hospital entered a joint-operating agreement to form UCHealth, with Memorial Hospital Central and Memorial Hospital North in Colorado Springs joining later that year. By the end of 2013, the entire system was utilizing the same IT platform, including for the electronic health record (EHR), human resources, email, intranet and supply chain.
That timeline was faster than is typical, especially given the size of some of the entities. Holding face-to-face meetings, establishing governance structures, communicating changes made and allowing flexibility helped with the onboarding process.
Systemwide implementation of the IT platform “created a baseline that focused on standardization and sharing best practices, being able to look at common information across the system,” says Steve Hess, UCHealth’s chief information officer. “Having the same IT platform helped inspire clinical and operational collaboration.”
Following a merger or acquisition, UCHealth ensures the new location implements certain operational standards and procedures — but the system makes exceptions to accommodate location-specific needs. For instance, although all UCHealth facilities have adopted the same IT platform, the health system understands that IT staffing protocols may vary from hospitals in rural areas to those in urban centers.
The flexible approach has allowed the health system to be nimble when expanding. For instance, it can integrate new hospitals within four to six months and ambulatory clinics within 90 days. Yampa Valley Medical Center in Steamboat Springs, Colo., joined UCHealth in 2017, followed by Pikes Peak Regional Hospital in Woodland Park, Colo., in 2018. In June 2019, UCHealth Highlands Ranch Hospital (pictured below) opened and UCHealth Greeley Hospital was set to open.
Hundreds of physicians and dozens of independent clinics have also recently become part of the organization.
Using horizontal integration and cross-functional collaboration to promote best practices
Through a framework that includes a nursing governance structure, UCHealth has standardized clinical procedures and streamlined best practices to support the delivery of high-quality care.
“The UCHealth vision is dynamic and a big unifier,” says Katherine Howell, chief nursing executive for UCHealth and chief nursing officer for University of Colorado Hospital. “When you get down to the details of it, from a clinical perspective, patients deserve the same standard of care no matter which door they walk into.”
The goal of establishing a standard of care across locations using research and evidence-based practice has informed the nursing governance structure. Operating horizontally, this framework includes seven nursing practice councils that define practice, ranging from decisions on documentation to critical care protocols. The structure relies on nursing, allied health and physician partner expertise, with support from nursing leadership.
Cross-functional collaboration incorporating subject-matter expertise helps ensure systemwide compliance, such as with new processes. For instance, if an IT system update takes place, “We do our best to support all affected staff and facilities, involve the appropriate stakeholders and engage them early on across geographic and functional areas, making sure the communications plan is clear and crisp,” Hess says.
A communications plan entails:
- Identifying relevant stakeholders
- Identifying messaging and talking points
- Creating a list of items to communicate
- Confirming who will communicate these items, and when
UCHealth strengthens that communication by employing physicians and nurses as clinical informaticists working on the IT team. These team members provide guidance on adjustments to platforms such as the EHR and embedded supply chains.
“When we need to make practice changes, everything goes back to the EMR,” Howell says. “The clinical informaticists participate in the practice councils and thus understand the clinical problem, which helps prioritize what goes to the top of the line.”
Optimizing care while expanding reach
UCHealth implemented a virtual health center in 2017. Staffed by trained clinicians with access to the system’s centralized EHR, the virtual health center augments in-person care through surveillance and monitoring across all UCHealth hospitals. By identifying medical problems and intervening earlier, UCHealth can improve patient outcomes and potentially prevent escalations.
Current services include:
- Monitoring of patients with high risk of falls
- Monitoring of patients in the ICU
- Vital-sign surveillance for non-ICU patients
- Cardiac telemetry
Early data indicates that the virtual health center has helped prevent transfers to the ICU.
“We’re using our data to help refine our early-warning systems and learn from our patients so we can identify early deterioration and intervene sooner,” Howell says. “This is helping us become more proactive.”