Texas Health Resources’ CNIO Details the Organization’s Journey towards High Reliability | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

Texas Health Resources’ CNIO Details the Organization’s Journey towards High Reliability

November 1, 2017
by Heather Landi
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As more healthcare delivery organizations undergo clinical transformation processes, the demand for senior nursing informatics leaders continues to gain momentum—and along with new needs, the role of the chief nursing informatics officer (CNIO) is evolving forward, maturing and becoming more complex. A 2017 Nursing Informatics Workforce Survey conducted by the Healthcare Information and Management Systems Society (HIMSS) indicates that nurse informaticists are widely seen as playing a crucial role in the development, implementation, and optimization of clinical applications, including nursing clinical documentation, computerized practitioner order entry (CPOE) and electronic health records (EHRs).

Mary Beth Mitchell, R.N., CNIO at Texas Health Resources (THR), based in Arlington, Texas, has led nursing informatics initiatives at the health system for the past seven years. THR is an integrated health system with more than 350 points of access, including 29 hospital locations that are owned, operated or joint-ventured with THR, 100 outpatient facilities and 250 other community access points, including the Texas Health Physicians Group clinics. The health system serves more than 7 million residents across 16 counties throughout North Texas.

Mitchell will be speaking about the role of informatics in improving healthcare delivery at the Dallas Health IT Summit taking place December 14 and 15 at the Hilton Anatole. Mitchell recently spoke with Healthcare Informatics Associate Editor Heather Landi about the informatics-driven initiatives at the health system and the challenges facing CNIOs. Below are excerpts from that interview.

What are some of the major initiatives that you’re involved with at Texas Health Resources right now?

We have two big initiatives; one is around high reliability. We’re becoming a high reliability organization and that threads through everything we do; it’s not an initiative in and of itself, it’s more of a shift in culture to that high reliability way of thinking. And then, several of our strategic initiatives support that high reliability movement. The strategic initiative that I’m most involved in is the reliable care blueprinting, we call it RCB, and that is really aimed at clinical care, reducing variation and standardization of care practice. So, whether you are in our larger flagship hospital, or are in a small, rural community hospital, you should expect the same experience and the same level of care and the same outcomes, given what those hospitals are able to provide. And that also creates a lot more efficiency; we can do things in a standardized manner and we gain efficiencies through that. And, we’ve had several good outcomes, mostly related to catheter-associated urinary tract infections (CAUTI) and we’re starting to see outcomes around sepsis. We’re really looking at the clinical outcomes from that reliable care blueprinting, and really trying to get the adoption of that model up. It’s been kind of tough; when you start changing care practices and clinical practices. That’s our biggest initiative across all our care settings.

We’re also starting to do more with predictive analytics as a strategic initiative. We’ve had early warning systems and we’ve had really good luck with our readmission predictive tool, and now we’re putting in a sepsis predictive tool and we’re looking at other predictive tools. Personally, I believe that the more information we can push out to our clinicians so they don’t have to go in and find that information then that really improves clinical care. If the clinicians are presented with the information they need earlier, then they can make decisions and act. That’s really been a focus of ours.

The other area I want to mention is around our interoperability and integration. We’ve integrated all our physiologic monitors, as many organizations have. We’ve also integrated our IV pumps, so we have integration between the physician orders and the IV pump and the pump automatically sets itself and the nurse validates it. We’re starting to see some reduction in medication errors. It strengthens our high reliability culture and it strengthens the ability to have more automation, thus decreasing errors. We’re also doing that in the NICU, which is our most vulnerable population, and we’ve had really good successes as we put in the IV pump interoperability in our NICUs. We’re still doing that work and we won’t be finished until the end of the year. Now we’ve started our project for low acuity units to have integration. Our first hospital will probably go live in December. I personally believe that more of that integration and interoperability is really needed because that decreases the documentation burden and improves reliability, as well as the timeliness of that data.

You mentioned the challenge of changing clinical practices and getting adoption. How have you and other executive leaders addressed these challenges?

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