Cardiac Care | No Boundaries

Cardiac care is beginning to transcend geography and physical walls under Centura Health's new coordinated system of care.

Cardiac care that is coordinated across facilities and physicians is a new goal at Centura Health, and the implementation is changing the landscape for patients and medical professionals across the Rocky Mountain region. Boundaries between hospitals, clinics, specialists and general practitioners are becoming transparent, expertise is available within minutes in outlying areas, and methods of administration are evolving into a more streamlined process.

The changes are part of a larger strategic plan for Centura. Given the national climate for health care change and the forces of a competitive market, in recent years Centura has taken bold steps to commit to long term strategies that affect the very core of patient care. One facet of this overall strategic plan is to move from the traditional method of separate care at each hospital, clinic, doctor's office and home into a system that allows cooperative care and expertise. The initial focus is in areas with the highest impact on families and patients: cardiovascular services, neurosciences and trauma care.

"It makes sense to attack the costliest and most serious problems first," says Dr. Karyl VanBenthuysen of South Denver Cardiology Associates. He explains that cardiac disease is common in our population, affecting 30 percent of the population, is responsible for 30--40 percent of inpatient work, and is the number one cause of death in the country, with more than 750,000 deaths annually. And, he says, "It's expensive, with estimated annual direct and indirect costs of hundreds of billions in the U.S."

Given these facts, and with Centura's broader strategic plan as the catalyst, in the fall of 2011, Centura Health’s cardiovascular medical directors held a ground-breaking meeting. The discussion focused on the premise that health care providers and facilities must collaborate more than has been seen in the past if they are to both survive in today's market and continue to deliver exceptional care. The outcome was a new "cardiovascular system of care" that will change the way cardiac care is expected and delivered within every facet of Centura Health.

The use of collaboration as the main agent of change makes sense given today's technologies and systems. It also makes good business sense. Says Dr. VanBenthuysen, "As models of payment change, it will be increasingly important to find efficiencies in the health care delivery. The alignment of providers and facilities/hospitals will facilitate that process." Centura Health currently has Colorado's largest health care network with 13 hospitals, 55 medical clinics, nine imaging centers and seven surgery centers, among others. This puts it in the unique position to share and access the bulk of the state's expertise and information. By utilizing the best practices, newest technologies and most innovative tools, the cardiovascular system of care is primed to improve overall efficiency and communication system-wide. Ideally, it will even lead to a healthier population through more accessible and cohesive prevention and long term care.

The Plan in Action

Although in beginning stages, there are concrete changes underway. "One of the most exciting aspects of the new cardiovascular system of care is the adoption of a CV Information System (CVIS)," says Dr. VanBenthuysen. "This will enable the immediate availability of multiple diagnostic tests--ECGs, echocardiograms, nuclear stress tests, cardiac catheterization--in much the same way that hospitals currently use 'PACS' systems for all X-ray services. We expect that the new CVIS will significantly improve the quality and efficiency of care."

Some of these new systems have been implemented. Dr. VanBenthuysen says his practice currently has "...the ability of interpret diagnostic studies such as echocardiograms and from multiple sites, speeding the time of interpretation. We can solicit for interpretation from our partners."

Future plans at South Denver Cardiology Associates involve the integration of their current office-based information system with that in the hospital. Dr. VanBenthuysen says this will allow office visit notes and lab testing to be immediately available. In addition, all hospital documentation will be immediately available.

Fast and easy access to information are attributes also envisioned by Dr. Sam Mehta, director of cardiovascular research and interventional cardiologist at Colorado Heart and Vascular, PC. "Moving to a coordinated system of care will allow easier transfer of information between cardiologists and primary care physicians. As such, duplications in testing can be avoided, as we all will have ready access to the same patient data." He says he expects this will allow cardiologists to focus more on the cardiovascular issue at hand. "Long term patient care may then be discharged back to the primary care physician if the patient's cardiovascular issues become stabilized, with long term recommendations for care," he says. "Thus, time and resources will be saved."

Avoiding duplication of services is a crucial advantage of a more coordinated system. Says Dr. VanBenthuysen, "Key cardiac services may be more strategically placed, avoiding duplication of expensive services such as open heart programs and sophisticated electrophysiological procedures." Dr. VanBenthuysen points out another possible advantage of a more collaborative system. "Providers of cardiac services (MDs, nurse practitioners, physician assistants, etc.) and facilities (hospitals, clinics, etc.) will become more aligned, decreasing competition and facilitating care," he says. "Centura prioritizes physician alignment as a key strategic goal." This change also appears to offer the financial benefit of lower costs. Says Dr. VanBenthuysen, "We anticipate... a net reduction in office personnel made possible by the improved efficiencies."

Rural Outreach

A major component of this new system is the level of support and outreach it potentially offers to rural communities. Jeff Woods, director of cardiovascular services for Centura Health, says that cardiologists now have a stronger presence in outlying areas. Since 47 of Colorado's 67 counties are rural, this is no small matter.

For instance, Woods reports that clinics in Summit County, Alamosa and Goodland, Kansas are opening and/or improving cardiac care clinics in existing facilities. Woods says specialized expertise also will be more readily available to outlying areas with tools such as Centura Health's Connected Care. Already active, this program guarantees that general practitioners in outlying areas can get a cardiac specialist on the phone within five minutes--so if timely questions arise, timely responses can be provided.

The philosophical move from cardiac care based on geography to care based on collaborative information has further ramifications. Says Dr. VanBenthuysen, "Cardiac services will increasingly be performed in the outpatient sector. This will emphasize the importance of coordination of care and communication of findings--processes that are optimally handled in an integrated system of care."

The integration of information is perhaps most important with the newest information and treatments. Says Dr. Mehta, "Cardiac intervention has been an exciting field that has been evolving... there has been an exceptional amount of newer treatments that are evolving for entities such as atrial fibrillation, valve disease and peripheral vascular disease that all fit in the realm of the cardiac interventionalist, and as such, growth will likely occur in different disease subsets." Having access to this information and treatments will be key.

With Centura Health's new cardiovascular system of care, access is what it's all about.