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Today on This Week Health.

looking to do centralized bed placement.

Almost like an air traffic control, really trying to expand and maximize all of our capabilities, staffed beds, open beds, EBS is a patient more appropriate in a one of our critical access facilities versus, our main facility just to get the right level of care at the right time. 

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Welcome to the This Week Health Talent Hall Conversation. I'm Reed Stephan, VP and CIO at St. Luke's Health System in Boise, Idaho, and I'm joined today by my friend, Terry Kautz, who's the Senior Vice President and Chief Digital Officer at the Guthrie Clinic. Terry, welcome and thanks for making the time.

Thank you for having me. I'm excited.

Take a minute and introduce the Guthrie Clinic to listeners who may not be familiar with who you are.

Sure. The Guthrie Clinic is rural health system, an integrated health system. We serve both the states of New York and PA on the southern and northern tier of those two states.

It's about 9, 000 square miles. We have five hospitals and about 32 multi specialty clinics peppered throughout that region. we're kind of in a sweet spot where we don't have a whole lot of other competition in the region. So we are the, health system of choice primarily because we, you know, any other You have to drive an hour or more to get to a facility.

Okay, great. Part of the purpose of these town hall conversations is to also introduce people to each other virtually. So if you wouldn't mind, just take a minute and share your background, your education path, your career journey that's led to the role you have today at the Guthrie Clinic.

Yeah, I probably have a pretty untraditional background as it relates to a CIO, CDO kind of title.

Those are the best ones that I find. Yeah, so I actually started my professional career as a teacher, has taught for two years and decided pretty quickly that's not the field that I wanted to be in. I went back to school and got my nursing degree and, and, Was serving in originally from Ohio and worked for a clinic in Akron Children's Hospital in primarily like NICU and open heart kind of settings, which meant that I was on call a lot.

and some of those calls can be pretty long and tasking and so was starting to look for my next journey and somebody who was managing our OR system said, you know, you should look into this EPIC thing. It's going to be kind of big. Had no idea what that meant, but our at Akron Children's, they were looking to implement EPIC.

And they were looking for clinicians to help, primarily because at that time EPIC was not very pediatric focused, so a lot of that content needed to be self developed and interviewed for an analyst role and had no idea even after the interview what that meant, but had the job offer and decided to take the leap.

And really Started my journey into IT that way, so implemented many of the ER systems in the area, and then went into the inpatient. About that time, Meaningful Use kicked off and went into consulting. Had the pleasure of working for small systems in large systems, the largest being Health and Hospitals in New York City and got a lot of experience and just kind of grew within that world.

And Guthrie recruited me to manage their Epic platform about seven years ago when I got off the road and then had the opportunity to replace my previous CIO. And before I did that I hadn't heard the term recovering CIO before, but I've heard it lots of times since, and now I know what that means, because it's definitely a different world.

Yeah, for sure. Well, for those that are listening behind Terry, I can see it looks like at least four EPIC 10 Gold Star trophies. So clearly you have embraced and you know how to implement EPIC to maximize that investment. So congratulations on that.

Thank you. Thank you. We're really excited about that.

Yeah, you and I were at an event recently, and we talked just a little bit, but it left me wanting to know more. But you were sharing a bit about this Guthrie Pulse Center that you'd stood up, which as I understand it is essentially a command center, just, you know, universally. Will you share a bit about this Pulse Center and the virtual care models that it currently houses, and how you kind of manage the centralized operations?

Yeah, so, about a year and a half ago close to two years ago, we started down this journey of understanding how could we serve our patients where they needed to be served in our region, which again is 9, 000 square miles. So, depending on what facility you're closest to will depend on what access you have to different types of services.

And then we were also having workforce challenges. A lot of our nurses left the ICU setting in particular because of COVID and the burnout related to that. And we were just really struggling with staffed beds. And we did a couple visits to a couple locations that were, was doing virtual nursing.

Some of them were doing like I said, centralized transfer center or bed placement center, but we really wanted to combine the two together to kind of, feed off the synergies between those two work groups. And so we set out on that journey. We are an EPIC shop and we do try to use EPIC first, but EPIC has, some EICU setting.

And being able to kind of connect virtually. And so, we have engaged with Artisite. We've engaged with another platform called SickBay by Medical Informatics to kind of give us that sweet spot of being able to have the biometric data streamed centrally, but then also the visual data. And Now, currently, we have a command center that houses our transfer center that transfers all of our patients within the system and then also in and out of our system.

We have central telemetry location, tele sitting, virtual nursing for both med surg and ICU, and then we also have our EICU component with tele intensivist, and we plan to continue to grow that. What we found is there was a ton of change management. And a lot of resistance, particularly around the nursing, oversight, there was some feeling that there might be some big brother but we continue to do a lot of communication, a lot of rounding, really advertise those quick wins, you know, when something good happened and our retention rate went from near 30 percent to 13. 9 percent in our nursing fields.

We have no travelers in our ICUs which is about a seven million dollar savings for us and now our team feels supported, right? So they're happier, they're more engaged. The Press Ganey scores, and I don't have those in front of me, but they were also very impressive. A struggling group. Now that coupled with a couple other things, right?

So we adjusted our nursing pay. We looked at team based care models, making sure that they had the right support and right number of hands and then added this layer of virtual nursing and it's really had some great success. When we expand it, we're looking into the home though.

So we're looking at how can home health, hospice fold into this? Where can we support those nurses that get calls all hours of the night? Where can we support patients who don't have a primary care provider and provide those like transitions of care visits looking to do centralized bed placement.

We actually just talked about that today. That's also going to be a large change management, but really looking at. Almost like an air traffic control, really trying to expand and maximize all of our capabilities, staffed beds, open beds, EBS is a patient more appropriate in a one of our critical access facilities versus, our main facility just to get the right level of care at the right time.

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So from the time that you first had this idea of, hey, we should probably look at creating this, let's call it the Pulse Center, to when you first opened up and actually were delivering virtual care models with the centralized operations, how long was that?

So we got budget approved in September of last year.

Okay. So that's been about a year ago since we got the PERFORMA approved for this first year. We went live with the virtual nursing in February March of this year.

Wow. So did you just co opt some space in the hospital? Did you have to get a new building? Where did you locate the Pulse Center?

Yes, we have an MOB office that's centralized and kind of in between all of our facilities that had a second floor available that we commandeered and we've already outgrown the space. We're actually looking to expand into a different area. We're Acquiring another facility as well that's supposed to close at the end of this year.

And so we know that we're going to need more hands in the center, especially if we expand the care models. But it was ready to move in. We had to hang some, screens for visualization. And we also it had sit to stand desks and some of those other things, but it was very little investment in the actual hardware that needed to go into the center because it was pretty much ready.

So that's a pretty impressive time to value of like, late fall to early spring to actually open up and deliver, start delivering on the first kind of value proposition. You talked about a couple of technologies what was the process you used as you kind of decided where we're going to build or buy or partner, like how did you think about that?

So we first evaluated EPIC. Epic is epic, right? That's where everything is kind of housed as far as the patient's concerned. But we have tried to use their Epic Monitor and, it just, it wasn't as robust as we wanted it to be.

So we did look to see other technologies that wasn't a niche thing. So like Avasure is very much for tele sitting, and then you have Care Agility. You have all these platforms that have their niches. We were really looking for something that could, no matter what our use case, we could use it. was one of the things that sold us on Artisite.

And their ability to be flexible with us. actually a partner with them in co developing and that's been really fruitful for us, especially at the speed that we want to move. The other thing is that we knew we needed To be centralized, we needed to have biometric data, so the ventilator data, the cardiac monitoring data, and we came across the platform that was able to, no matter what vendor we use at each facility, because as we acquire, you inherit the debt of that facility, they were able to streamline that to a central location, so it gave us speed to be able to stand it up quickly, and then Use it for other things like our critical cardi or pulmonary doc can log in from home and assess on whether or not a ventilator patient needs to be moved or something of that nature without actually coming into the facility.

So, I mean, we try to look at things that are not very specific and very niche, but also has the ability to kind of scale quickly with us Healthcare is unique. Rural healthcare is unique, as you probably know, and urban healthcare is unique, and healthcare in the West is unique, and healthcare in the East is unique, and so there's not going to be a solution that's meant to fill all of those needs, in my opinion, and we wanted to be able to flex with that.

Yeah, that makes a lot of sense. I love the concept of a platform and you think about your pull center and not having people having to look at different screens and a bunch of different systems, but to pull that together into one view and then really that ability to aggregate all of that data because to your point, that's not uncommon to have different kind of modalities across your system, but to make, to simplify that then for that centralized group is really important.

As you look to the future and kind of what's next in the future of the Pulse Center, what are you most excited about?

So I'm most excited about the ability to use AI in this space. I think we're really just at the verge of the capabilities that now that healthcare is really embracing data the power that it can have and you know, just doing some development with Artisite right now see how we can do like telecase management.

And being able to really maximize the throughput in the patient experience to know that if a person's MRI gets read in the next four hours, they can go home, or this person might need an ICU bed soon, to be able to kind of predict and plan for that, not only from our staffing and resources, but also from that patient experience, or maybe even the time If there's a, opportunity to do that, I think it's going to really change how we provide care.

Yeah, that's great.

Terry, first, I think, congrats on what you've created there at the Pulse Center. I think it's incredible. Thanks for sharing the story and I hope that listeners might reach out with maybe more in depth questions they have as we all try and, I think, solve the same problem. help each other and create that rising tide that we all benefit.

So, really appreciate your time and just thank you for being a part of the community.

Yeah, thanks Reed.

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