Turning Warning Signs Already in the Chart Into Earlier Treatment

Electronic health records (EHRs) are built to document care, and they do it well. When a patient’s condition starts to slip, the early signs are often in the record, but no single entry tells the story. Sepsis criteria can surface hours apart, a creatinine value can creep up over several days, and a culture result can post after the patient has gone home. Catching risk as it develops takes rules shaped by how clinical teams actually work. Those rules watch labs, vitals, orders, and results together and bring the pattern to the right clinician as it forms.

When a warning sign is caught at the moment it appears, a patient gets treatment before a manageable problem becomes a serious one. When it isn’t, the data sits in the chart, accurate and complete, while the window to act closes.

Inovalon’s own research shows how many teams struggle to act on that data in time. In a 2026 survey of more than 230 clinical leaders across acute and post-acute care, rising patient acuity and staffing shortages were the pressures cited most often as affecting patient safety. More than half called timely access to patient information a significant challenge, and among those leaders, roughly four in 10 said they lacked surveillance workflows that run in near-real time.

Our recent blog on the signs a safety management solution is falling behind made the general case for moving from voluntary reporting to automated surveillance. In this follow-up post, I get specific about three rules and what catching each problem early changes for the patient, with perspective from two Inovalon colleagues, Sara Chumbley, Pharm.D., and Ginnie Becker, MPH, BN, RN.

Catching sepsis before the treatment window slips away

Clinical teams are always chasing sepsis. By the time traditional monitoring catches it, precious minutes, sometimes hours, have passed.

The Severe Sepsis Time Zero rule flags the exact moment severe sepsis criteria align, when a documented infection, at least two systemic inflammatory response syndrome criteria, and signs of organ dysfunction appear within six hours of each other. The rule also fires when physician documentation of severe sepsis or septic shock appears before all three criteria are met. That moment becomes time zero, the starting point for measuring compliance with SEP-1, the federal sepsis care bundle. Instead of piecing the timeline together later, the care team knows when the treatment window opened and can act while early treatment has the most room to help.

Goshen Health, an independent, community-owned health system in northern Indiana, put this rule to work with Inovalon’s VigiLanz Quality Management™ as part of a sepsis improvement project it launched in 2022. When an alert fires, a unit secretary brings it to the provider, who confirms whether sepsis is suspected before the nurse starts the bundle. In the first 15 months, SEP-1 bundle compliance improved by 11%. For patients in septic shock, length of stay dropped by nearly three days with no associated increase in mortality. As of November 2025, the organization’s bundle compliance sat near the 50th percentile for benchmark facilities and was still climbing.

Emily Grooms, Goshen Health’s Manager of Clinical Informatics, and I documented the project with Inovalon colleagues in a peer-reviewed study in the Journal for Healthcare Quality. As I wrote in Infection Control Today this summer, an alert that goes nowhere doesn’t improve patient outcomes, and Goshen Health’s results show what can happen when alerts have a clear path to the bedside.

Spotting kidney injury while vancomycin is still running

“Too often, kidney injuries are caught after the damage is done,” Chumbley says. “Patients suffer when monitoring systems can’t keep pace with real risk.”

Vancomycin treats serious infections, and it can also injure the kidneys. That risk builds gradually, and with many patients on vancomycin at once, no one can compare each patient’s creatinine against the days before by hand.

The rule watches every patient receiving IV vancomycin and flags a serum creatinine increase of more than 30% within any three-day window. Pharmacists and clinicians are alerted as soon as the pattern appears, so they can step in while the injury is developing.

That timing matters well beyond the hospital stay. Citing a growing body of evidence that links acute kidney injury to a higher risk of chronic kidney disease, end-stage renal disease, and mortality, Cincinnati Children’s set out to reduce kidney injury among its pediatric inpatients. Pharmacists and physicians there built a multistep quality improvement program focused on vancomycin, with Inovalon’s VigiLanz Pharmacy Surveillance™ automating key processes such as screening and monitoring patients. At baseline, an average of six children a week developed kidney injury during a vancomycin course or within a week of stopping it. The program brought that average down to four a week, a pace the team estimated could prevent about 100 cases a year if sustained.

Closing the loop on cultures that come back after an emergency room visit

“When patients go home and cultures come back positive hours later, care coordination becomes a manual nightmare. Critical results can easily slip between the cracks,” Becker says.

Tracking down a positive result means noticing it, connecting it to a patient who is no longer in the building, and finding a clinician who can arrange a callback. This rule removes manual chasing. It tracks results for patients who have left the emergency room and alerts on actionable organisms the moment they’re identified. With Inovalon’s VigiLanz Infection Prevention™, the result reaches clinicians automatically, so the callback can happen fast and treatment can start sooner.

Surveillance earns trust when it fits the workflow and supports clinical judgment

None of these rules replaces the EHR. They run on the data it holds and extend the value of the record the care team relies on every day. How much good they do depends on how well they match the people using them. At Goshen Health, the team refined how alerts are processed and who receives them and keeps using data analysis to sharpen the alerts themselves. As Grooms put it, “these alerts are there to be an assistant, not necessarily dictate care.” Our research found the same, that patient safety technologies are most effective when they support clinical expertise rather than replace it.

For leaders reviewing their own surveillance programs, a few questions are worth asking. Were your rules built around your own clinicians’ workflows? When an alert fires, does it reach someone who can act on it right away? Do your clinicians trust the alerts they receive, and do you have the data to keep tuning them?

When the answers are yes, the warning signs in the chart stop waiting for someone to find them. They get to a clinician in time to change what happens next for the patient.

Bring configurable rules into your existing workflow with Inovalon’s care management solutions. To find out which rules would make the biggest difference for your patients first, request a demo.

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