UT Southwestern CV Service Line – Vital Engine Roll-Out & Program Notes

Service Line & Program Structure

• The discussion centers on UT Southwestern’s Cardiovascular service line and its four primary programs:

  • Structural Heart
  • Core procedures: TAVR (Trans-catheter Aortic Valve Replacement) and TEER (Trans-catheter Edge-to-Edge Repair for mitral or tricuspid valves).
  • Lead nurse coordinators: Marina and Melissa.
  • Referral & imaging support: Jessica Jenton.
  • Minimally Invasive CABG (“Mini”)
  • Run by Dr. Husam Doolub, a globally recognized surgeon who performs coronary bypasses through 2\text{–}3\,\text{inch} thoracic incisions, avoids leg harvest, and eliminates sternotomy.
  • Recovery time is dramatically shorter (≈ 6\text{–}8 weeks for traditional vs. substantially less for Mini).
  • Nurse coordinators: Steva, Nelly, Erin.
  • Referral & imaging support: Amanda Willick.
  • Adult Congenital Heart Disease (ACHD)
  • Transition program for pediatric congenital patients aging into adult care.
  • Lead transition nurse: Latasha Davis (focuses on high-risk or cognitively delayed patients, or those losing insurance, etc.).
  • Referral/records “librarian”: Diane (former librarian; exceptional but slower tech adopter).
  • Current physician coverage has doubled from 2 to 4 ACHD cardiologists.
  • Aortic / Vascular Surgery
  • Entirely “internal”—all surgical and peri-operative workflows managed within UT’s ecosystem.
  • Nurse leads report through the same coordination hierarchy.

• Organizational chart simplification:
  \text{Service Line Director} \rightarrow \text{4 Programs} \rightarrow \text{Program-specific Nurse Coordinators} \rightarrow \text{Support Staff}

Patient-Flow Principles

• Structural, Mini, and Aortic programs = definite surgery + finite graduation (patients “graduate” after post-op follow-up).
• ACHD = possible non-surgical, life-long follow-up (patients remain until death or relocation).
• Centralized scheduling feeds most programs; ACHD exceptions arise because Latasha cherry-picks high-risk transitions from Children’s/Parkland.
• Pediatric “age-out” caveats:
  • Some congenital patients remain at Children’s well beyond 18 y (examples up to 30 y) due to intellectual disability or emotional physician-patient bonds.
  • Pregnancy = automatic transfer to adult cardiology (high-risk OB-cardiology care).

Personnel Snapshot & Reporting Lines

All nurse coordinators ultimately report to the service-line manager (speaker “Kelly”).

Vital Engine Roll-Out

• Purpose: secure cloud platform for DICOM images, records, inter-site chat, and vendor access.
• Phase 1 = basic referral, image upload/download, link sharing, secure chat.
• Phase 2 (future wish-list) = direct Epic auto-ingest (no manual download), advanced analytics, tighter vendor workflow.
• “Go-live” target: end of the month for Structural & Mini (“pilot spokes”).
• Training philosophy
  • Two-tier plan:
  1. Comprehensive Session – nurse coordinators + technically savvy staff; full Vital Engine toolset.
  2. Essentials Session – support staff (Diane, Carmen, Amanda) who mainly chase records; focus on log-in, sending/receiving links, uploading.
  • Possible provider micro-training only for tech-curious MDs (e.g., Dr. Tan, Dr. Doolub). Most physicians prefer coordinator-managed workflow.
  • Approx. \text{5} total training events to cover scheduling conflicts.
• Latasha, Taniel, and their support staff will still attend early trainings for cross-pollination, despite later-phase deployment.

Current Obstacles & Action Items

1. External EMR Change Over – one major referring office is switching to a new EMR this month; unknown if they’ll abandon CDs or current image-transfer tools.
2. Vendor Distribution Bottleneck – Structural must send each CT to 3\text{–}4 device vendors; UT’s native system enforces \approx30\,\text{min} cool-down between pushes, slowing throughput for \sim10\text{–}12 new referrals / week.
   • Wishlist: Have vendors log into Vital Engine and self-pull studies.
3. IT Pushback (PowerShare vs. Vital Engine)
   • UT is simultaneously rolling out Nuance PowerShare (seamless Epic ingestion). IT questions duplicative effort.
   • Distinctions highlighted to IT:
     • Vital Engine offers multi-party chat, program dashboards, vendor portal, and non-imaging document exchange—capabilities that PowerShare lacks.
   • New IT director (onboard \approx1 month) to meet with Sarah (Vital Engine PM) and Kavya (tech lead) to clarify scope.
4. “Spoke” Creation – still missing contact confirmation for one external office; prevents spoke activation.
5. Internal Image Routing – unknown feasibility of automatically copying UT-acquired CTs into Vital Engine; will affect vendor workflow design.
6. Personality / Tech-Adoption Variance – Diane prefers CDs; Amanda loves digital pushes; training must honor varied comfort levels.

Workflow Scenarios & Examples

• ACHD Transition Use-Case
  1. Latasha identifies \text{17-y} congenital patient nearing adult transfer.
  2. Joint Children’s/UT clinic visit is scheduled; Latasha, new ACHD MD, and pediatric cardiologist all present.
  3. Records and cath images uploaded to Vital Engine; link sent to UT ACHD team.
  4. If patient loses insurance, Latasha navigates charity-care or alternate coverage.
• Mini Invasive Concierge Flow
  1. Out-of-state cardiologist uploads CTA via Vital Engine link.
  2. Steva reviews 5 triage questions → “Not a candidate” → auto-forwards complete packet to Structural.
  3. Structural team schedules TAVR eval.
• Structural Vendor Push (ideal future)
  1. CT imported into Vital Engine (either external upload or internal auto-copy).
  2. Nurse tags Vendor A, Vendor B, Vendor C simultaneously; each logs in, downloads DICOM, submits sizing report back via chat.

Ethical / Practical Implications Discussed

• Emotional strain of pediatric-to-adult handoff; providers and families resist change without a “warm hand-shake.”
• High-risk pregnancies in congenital patients demand swift adult-cardiology involvement (ethical duty of care vs. patient attachment to pediatric team).
• Burnout risk: coordinators threatened with “punch people in the face” humorously due to referral delays; underscores operational stress.

Numerical References (LaTeX-formatted)

• Pediatric age-out expectation: 18\,\text{y}; real-world observed: up to 30\,\text{y}.
• Intellectual discrepancy example: 34\,\text{y} body with 8\,\text{y} cognitive level.
• Minimally invasive incisions: 2\text{–}3\,\text{inch} thoracotomy vs. full sternotomy.
• Traditional CABG recovery: 6\text{–}8\,\text{weeks}.
• Referral volume for structural: 10\text{–}12 / week.
• Vendors per case: 3\text{–}4.
• Cool-down between pushes in current UT system: \sim30\,\text{min}.
• Increase in ACHD physicians: 2 \rightarrow 4.

Immediate Next Steps

1. Kelly to call remaining external office for spoke data.
2. Email IT director + Sarah + Kavya to schedule Vital Engine vs. PowerShare alignment meeting.
3. Finalize training curriculum & attendee segmentation; block calendar invites.
4. Coordinate with Structural team to prioritize go-live once spoke list & vendor logistics cleared.
5. Gather product-team notes (Jordan ↔ Sarah) from post-transcript meeting for feedback loop.
6. Evaluate transport path for UT internal images into Vital Engine (phase 1 vs. phase 2 feasibility).

Long-Term Considerations

• Measure efficiency gains (e.g., reduced coordinator phone time) after 3 months of Vital Engine.
• Plan “graduation” criteria for ACHD patients who reach stable adulthood without surgery.
• Explore Epic ↔ Vital Engine API for auto-population (Phase 2).
• Extend pilot learnings to Aortic / Vascular program once IT and vendor kinks resolved.