Improving Care in Progressive Care Units Through Telehealth
Improving Care in Progressive Care Units Through Telehealth
As COVID-19 cases have surged this winter, hospitals across the nation have struggled to meet the needs of severely ill patients. Many facilities are facing a shortage of beds and staff members to provide adequate care. By early December, a record number of 100,000 patients were hospitalized with COVID-19, putting a fearsome strain on hospitals and staff.
Against this dire backdrop, the value of telemedicine has never been so clear. For example, the “tele-ICU” uses real-time audio, video, and electronic monitoring to connect critically ill patients to a dedicated team of intensivists and critical care nurses who are based in a remote telehealth center. The benefits of tele-ICU have been well-documented: in addition to preserving the health and safety of healthcare workers, hospitals using tele-ICU have reduced mortality rates, safely decreased the average length of stay for patients, and improved adherence to clinical best practices.
The value of telehealth isn’t confined to the ICU. Researchers have now shown that using telemedicine within hospital progressive care units (PCUs) also has a positive impact — for patients and hospitals alike.
What is a Progressive Care Unit?
Progressive Care Units (PCUs) were introduced as a way to manage hospital patients who need an intermediate level of care: more care than is provided on a general medical floor but less than in ICUs, where many patients require ventilator support and continuous invasive monitoring. Also known as “step down” or “high dependency” floors, progressive care units are often the next step for patients leaving the ICU — patients who need monitoring because they are at high risk for complications. Patients in PCUs still need a high level of skilled nursing care and surveillance but they are more stable than patients in ICUs.
The Impact of Telemedicine in the PCU
Can telemedicine be effectively used to manage the treatment of patients in progressive care units?
That’s the question a team of researchers addressed in a large-scale study of a health system in Florida. Published in Critical Care Medicine, the study was the first of its kind. “Although there are many studies about the effects of telemedicine in ICU, currently there are no studies on the effects of telemedicine in PCU settings,” the research team noted.
Using a retrospective, observational approach, the team examined primary data from patients admitted to PCUs between December 2011 and August 2016 across five hospitals in the South Florida region. Since not all PCU beds at these hospitals were equipped to use telemedicine, patients who did not receive telemedicine served as the control group. In total, the researchers examined the experience of 16,091 patients, including 8,091 admitted into telemedicine PCUs and 8,000 admitted into non-telemedicine PCUs.
What did they find? First, patients in the telemedicine PCU group were 44% more likely to survive compared with patients in the non-telemedicine PCU — even accounting for the fact that patients in the telemedicine PCU were older and had higher disease severity and risk of mortality. Second, patients in the telemedicine PCU group saw a decrease in their hospital length of stay, when compared to the control group. And finally, decreases in mortality and length of stay among patients in the telemedicine PCU group were achieved “without substantial cost incurrences” to hospitals, the study found.
Transforming PCU Care Through Telemedicine
Progressive care units are gaining traction in hospitals across the nation as a strategy for freeing up beds in ICUs for the most acutely ill patients — a chronic challenge that has only become more critical during COVID-19. The American Association of Critical-Care Nurses first recognized progressive care as a nursing specialty in 2004 and today it is one of the fastest growing nursing specialties.
The growth of PCUs will only continue, researchers predict, as a result of the country’s aging population, increasing costs of care, and shortage of intensivists. Simply put, hospitals cannot afford to admit low-risk patients to costly ICUs just for monitoring purposes.
Just as telemedicine has proved to be an effective strategy for improving — and expanding — care for patients in the ICU, it has the potential to improve care delivery in PCUs by allowing for additional remote monitoring of critically ill patients.
Whether a patient in the progressive care unit is recovering from a stroke, has started a potent drug regimen that requires monitoring, or has recently suffered a heart attack, telemedicine allows an on-site caregiver to connect with a remote expert intensivist. With access to the patient’s vitals and electronic medical record, the off-site providers can write orders, provide continuous monitoring, and answer important questions.
In the months to come, equipping more progressive care units with telemedicine capabilities could improve patient outcomes and bring sorely needed expertise to hospitals without intensivists on site 24/7, especially for rural hospitals, which are particularly vulnerable to the shortage of critical care specialists.
Learn how Caregility can provide the technological support you need to equip your step-down unit with around-the-clock monitoring of critical care patients.Learn More
Infographic: The Value of Inpatient Virtual Care
COVID-19 has exposed the value of inpatient virtual care in a way previously appreciated by only a small fraction of the healthcare industry. From providing safety to care teams, to bridging healthcare disparities and enabling access to family members, the challenges we continue to face are steep. Check out our infographic below for an overview of how far we’ve come and where virtual inpatient care stands now.Learn More
UK HealthCare and Caregility Bring Patient’s Family Together Virtually During Covid-19
COVID-19 has presented care givers and patients with a variety of new challenges. For many patients diagnosed with COVID-19, visiting with loved ones while they are in the hospital has been impossible. Caregility and UK HealthCare have been fortunate, and proud, to be able to provide that connection for Jerome Johnson and his family. The only form of communication that allowed Jerome and his family to see and hear each other was UK HealthCare’s eICU system–an in-room video monitor and camera.
Originally designed to allow clinicians to monitor patients remotely, UK HealthCare’s COVID team used Caregilty’s UHE telehealth platform to patch families into the eICU system, allowing them to see their loved ones while they were in isolation. Jeanine and their two children, Jorden and Jeanieca, spent hours talking to Jerome and lifting his spirits during the most harrowing days of his stay.
Read Jerome and his family’s heartwarming story here: “This coronavirus has no name, no age and no color.”Learn More
Caregility and WMCHealth Thought Leaders Discuss Telehealth’s Role in the COVID-19 Response with HIMSS TV
Caregility VP of Clinical Solutions Wendy Deibert and Dr. Corey Scurlock, Medical Director of WMCHealth’s eHealth Program, recently sat down with HIMSS TV reporter Susan Morse to discuss telehealth trends during the coronavirus pandemic and beyond.
Although WMCHealth, a Caregility client, was fairly far down the road with telehealth adoption when COVID hit, the public health crisis accelerated key implementation plans for the health system. Scurlock and his team immediately set about using telehealth to add physician coverage redundancy, increase access to specialists and create COVID-specific workflows that would help clinicians.
Scurlock details how WMC used virtual care resources “to help reduce [clinician] burnout, help increase patient safety and also to help facilitate family communication which was really important during the pandemic.” He goes on to share how his team worked with Caregility to stand up new tele-hospitalist and virtual sitter programs.
Deibert details the steps Caregility has taken to help clients like Westchester Medical Center quickly respond to new challenges. Purpose-built solutions developed by the company include slimline carts that easily bring virtual care to the patient bedside and a mobile app that quickly turns existing smart devices into telehealth endpoints, enabling providers to immediately leverage what’s on hand.
“We saw the need and quickly respond and tried to find ways people could quickly bring up telehealth and keep patients and physicians connected while reducing the risk of being exposed or the amount of PPE everybody needs,” Deibert elaborates.
Morse also asked the telehealth veterans about the patient response to virtual care and about their thoughts regarding the trajectory of telehealth in a post-pandemic world. “The pandemic brought to light the value that telehealth can bring,” said Scurlock. “It brought to light the ability to implement telehealth quickly. And once places got used to that – they will never go back. And patients don’t want to go back.
“When you look at telehealth, if it’s implemented correctly and the right metrics are followed and you have the right partners, the return on investment or return on value for patients is immense. For the US healthcare system, it’s really the way to solve our provider shortages, our aging population and to actually reduce global spending in the long run.
“Having a good flexible platform like Univago is really great. Working with companies like Caregility and the Caregility platform really allows the telehealth provider to outsource most of the monitoring, and most of the day-to-day work on it is almost seamless when you use it. I think we will continue to march forward in telehealth. We will continue to use it in COVID but also expand it into our non-COVID areas and areas we didn’t think that we would before.”
Watch to the full interview on HIMSS TV: Patients, Providers ‘Don’t Want to Go Back’ to a Pre-Telehealth WorldLearn More
Creative Solutions to Virtual Care Delivery During This Time of Crisis
Jonathan Witenko, system director of virtual health and telemedicine at Lee Health, recently sat down with Healthcare IT News editor Bill Siwicki to offer a glimpse into his health system’s use of telehealth in the COVID-19 response. In the article Cloud-based telehealth, linked with Epic EHR, helps one hospital scale up virtual care, Witenko shares how Lee Health worked with Caregility to “ramp up to tens of thousands of telemedicine visits per month as it dealt with the constraints of the coronavirus pandemic.”
The southwest Florida-based non-profit health system encompasses five hospitals, 12,000 employees and over 1,400 physicians managing over one million patient contacts per year. As COVID cases climbed, Lee sought to quickly expand its telehealth infrastructure to support virtual health screenings for employees, virtual visits for patients sheltering in place at home, and virtual engagement mechanisms for inpatients amid visitation restrictions.
Within roughly one week, Lee integrated the Caregility UHE telehealth technology platform with the health system’s Epic EHR and began rolling out new telehealth programs. Virtual visits quickly soared to 1,200 sessions per day.
Read the full interview here, where Witenko details Lee Health’s experience and offers recommendations to healthcare peers seeking to similarly expand their telehealth footprint. “Look for technology that is versatile not only for current state, but can be incorporated into multiple permutations,” Witenko advises. “Otherwise you’ll have dozens of disparate programs.”
In June, Witenko joined Caregility vice president of clinical solutions, Wendy Deibert, and senior vice president of global sales, Scott Andrus, on a webinar delving further into Lee Health’s efforts to keep patients connected and healthcare workers safe using telehealth during the pandemic. Watch the on-demand webinar Innovation and Collaboration in Virtual Care for guidance on how to:
- fast-track telehealth deployment
- establish a command center to approach telehealth build-out from a system level
- make sure virtual care delivery is secure and compliant
“We needed a scalable system that could traverse all patient needs in the home and the hospital, be rapidly deployed, and one that was infinitely scalable for the new normal of the future,” said Witenko. “Caregility was able to disperse across all patient locations and has the bandwidth to support our growing needs. We now have a collaborative partner that will work with us to further expand our virtual care offerings. I feel optimistic about the future.”
View a case study on Lee Health’s telehealth initiatives during COVID-19 here.Learn More
How COVID-19 is Changing Everything in Healthcare
The following op-ed column by Mike Brandofino, President and COO of Caregility, was originally published in the Sunday, May 3, 2020, print edition of the Asbury Park Press.
We were sure that telehealth and virtual care eventually would become permanent fixtures in U.S. health care. We never envisioned a global pandemic would bring us here in less than a month.
Right now, health care organizations across the country are using telehealth to engage and assess patients while stemming the spread of the coronavirus. Hospitals are turning to remote patient monitoring to limit direct exposure, reduce the need for scarce personal protective equipment supplies and keep health care workers safe. Virtual care is one of the few levers available to practices and clinicians trying to maintain some semblance of care delivery during the COVID-19 response.
Early in the crisis, our clinical team explained to me what would transpire over the coming weeks. It was hard to believe. But they were right. Nurses and doctors would work round-the-clock shifts. Dwindling supplies and high risks of exposure would threaten the effectiveness and safety of the system.
Hospitals no longer can wait weeks or months to have telehealth solutions installed. They need cameras and virtual access in whatever form they can get them—on rolling carts, mounted to walls or through web-equipped devices—as quickly as possible.
Already, telehealth call volumes have skyrocketed as clinicians try to keep up. We’ve seen hospitals go live on a Monday and perform more than 7,500 remote patient video visits daily in their first week of using telehealth. We’ve also seen scenarios play out that have struck a deep emotional chord. In some heartbreaking cases, telehealth has been the only link between dying patients and their loved ones. Other scenarios offer a silver lining, such as connecting parents with their babies in neonatal intensive care units and allowing isolated patients to comfort hospitalized family members amid visitation restrictions.
Ultimately, this crisis has made virtual care a fixture of health care forever. Just like after 9/11 when New Yorkers turned to virtual collaboration to carry on, U.S. and global health systems will come to rely on telehealth. This crisis has accelerated legislative efforts to broaden uses and reimbursements for telehealth services, as seen with the CARES Act. We have seen validation of telehealth under the most extreme tests. It’s fair to say that health care never will be the same.
Already, consumers are getting used to digital doctor visits as the new normal. Hospitals and clinics are planning expanded use as they brace for the threat of a potential COVID-19 resurgence. For the months ahead, social distancing measures will hold, only waning with time. With that will come a need for broader behavioral telehealth solutions as we face the emotional and psychological impact on citizens as well as exhausted health care workers.
As we lay out tentative plans to rekindle our economy, telehealth will play a vital role in back-to-work and back-to-school health screenings. Demand for remote guidance from clinicians will rise as at-home diagnostic and antibody testing for COVID-19 enters the consumer market. Telehealth may well be the proverbial bridge back to the “home visit,” as technology platforms and an array of connected devices become permanent fixtures in our homes as well as health care offices.
What happens next? Almost certainly, it will be a domino effect changing standards and regulations for reimbursement, patient data, privacy, security and more. More important than ever will be the effective application of technology to make better use of suddenly limited resources. Our health system will be in economic recovery. As a result, an even greater onus is on those of us within the health care technology community to support patient care with innovations that help care givers do more with less.
What lessons have we learned? What can we do to be better prepared for the next epidemic? What immediate needs do we need to focus on next? Let’s start by offering our gratitude to our health care providers—and listening to their guidance about how to reshape the system. We owe these caregivers, and their patients, support and attention as we look for new ways to improve care delivery during COVID-19 and beyond.
View the original piece authored by Brandofino and published by the Asbury Park Press here:Learn More
Telehealth Flexibilities and Funding During COVID-19 – What You Need to Know
Virtual care resources have proven to be invaluable assets for clinicians to safely manage COVID-19 patients and continue traditional care delivery remotely during the current public health crisis. In support of these efforts, regulatory agencies have temporarily waived some limitations and expanded reimbursable services related to telemedicine in accordance with the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
Designed to equip the US health system with maximum flexibility to respond to the pandemic, policy updates include:
- over 80 additional billable telehealth services for Medicare patients
- telehealth service payment parity
- extension of the use of telehealth services to new patients and provider types
Caregility created a guide that highlights new telehealth flexibilities during COVID-19 to help you understand these opportunities.
To reduce some of financial strain on US healthcare institutions, new funding opportunities for virtual care infrastructure have also emerged. The CARES Act provisioned $200 million for the Federal Communications Commission (FCC) to establish a COVID-19 Telehealth Program to support healthcare providers in the fight against the ongoing pandemic.
The program seeks to extend “connected care services to patients at their homes or mobile locations” by extending funding to eligible healthcare providers for telecommunications services, information services, and devices necessary to enable the delivery of telehealth services. Funding can be used for treatment of coronavirus as well as other health conditions during the coronavirus pandemic. The FCC opened its COVID-19 Telehealth Program Application Portal on April 10th.
The COVID-19 Telehealth Program is limited tononprofit and public eligible healthcare providersthat fall within the following categories:
- post-secondary educational institutions offering healthcare instruction, teaching hospitals, and medical schools
- community health centers or health centers providing healthcare to migrants
- local health departments or agencies
- community mental health centers
- not-for-profit hospitals
- rural health clinics
- skilled nursing facilities
- consortia of healthcare providers consisting of one or more entities falling into the first seven categories
Both rural and non-rural health clinics are eligible to receive funding.
(Source: FCC COVID-19 Telehealth Program FAQs)
Funding decisions will be made on a rolling basis and the FCC will continue to accept and review applications until the funding is exhausted or the current COVID-19 pandemic has ended.
To receive disbursements, eligible healthcare providers that are approved for funding will be required to submit an invoicing form and supporting documentation.Applicants who receive funding will be required to comply with program rules and requirements, including applicable reporting, and may be subject to compliance audits.
A link to the submission portal as well as additional details on the application requirements and process, awardees to date, and related news can be found here.
Although it is still unclear how long relaxed telehealth policies and expanded reimbursement coverage will be in place, what is clear is telehealth has secured its place as a permanent fixture in US healthcare delivery. As CMS Administrator Seema Verma recently put it, “The genie is out of the bottle on this one. I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”Learn More
Lee Health and Caregility Speak with WINK TV on Telemedicine’s Impact During the Coronavirus Pandemic
Lee Health Chief Informatics Officer Dr. Michael Carricino and Caregility President and COO Mike Brandofino recently sat down with WINK News investigative reporter Lauren Sweeny to discuss telemedicine’s impact during the coronavirus pandemic.
Caregility is working with Lee Health to scale up telehealth offerings across the southwest Florida-based health network to enhance patient care during the health crisis. “We’re performing neurology visits, primary care, urgent, pediatric, psychiatric and cardiothoracic surgery follow up, so we’re doing quite a bit,” Dr. Carricino reported. “I’ve heard more stores in the last few weeks about success with telehealth engagement than I had in the last several years.” The health system is currently seeing around 1,000 patients a day using telehealth.
From allowing patients to visit with doctors from their homes, to allowing parents to visit their babies in the neonatal intensive care unit, telehealth is exploding in popularity. Caregility presently supports roughly 35 hospital systems around the US, facilitating approximately 200,000 patient telehealth visits per week.
“I have to believe that it has had an impact on the number of COVID-19 cases and flattening the curve because all of those folks are not traveling to a doctor’s office,” said Brandofino.
Watch the full news clip here:Telemedicine exploding in popularity during coronavirus pandemic »Learn More
Telehealth and COVID-19: Virtual Care Resources and Stories from Healthcare’s Front Line
Healthcare IT News recently highlighted the debut of Caregility’s iConsult Mobile telehealth application, noting that the company will give the technology free to clients to help combat COVID-19. (Read the full article Caregility unveils mobile telehealth app, gives it away to fight pandemic.)
The new mobile application includes far-end camera and audio controls and the ability to add other clinicians and family members on demand to any virtual consult with a patient at any location over any mobile device.
Caregility’s full COVID-19 Virtual Disaster Response Program includes capacity expansion of its UHE Telehealth platform for 90 days at no cost for current customers. That includes use of the iConsult Mobile application and iObserver virtual patient observation sitting application, which minimizes staff exposure to COVID-19.The iConsult Mobile application has an iOS and Android client that can quickly be leveraged on existing tablets and mobile devices so hospitals can rapidly scale up virtual care operations. Additionally, Caregility has created new streamlined mobile carts that are ready for rapid deployment in emergency departments and containment units for assessments, observation, screening and communication.
Hospital clients on the front line of the COVID-19 epidemic have been quick to put the telehealth solutions to use.
Houston Methodist has doubled its number of virtual visits, reporting over 1,000 patients seen via telehealth on March 19th in a recent interview with Becker’s Health IT editors. Executive Vice President and Chief Innovation Officer Roberta Schwartz PhD shared that “[Houston Methodist’s] virtual ICU, developed by Caregility and MIC Sick Bay, was quickly turned on for our COVID-19 patients so that many of our providers can see the patients via virtual visits and not risk exposure in our ICU rooms. I couldn’t be more proud of the technology infrastructure that is truly helping us serve the city.”
Washington-based Confluence Health revealed to News Radio 560KPQ that “along with many other healthcare providers, [Confluence] has halted elective surgeries and in person routine care visits, but has not halted services to patients.” The healthcare provider recently partnered with Caregility to provide two-way audio and video enabled virtual visits for non-emergent healthcare services. Virtual visits can be accessed using the existing Epic electronic medical record (EMR) patient portal, MyChart.
The recent Wall Street Journal article ICUs Leverage Remote Doctors and Telemedicine to Manage Coronavirus Deluge sheds light on Caregility client Northwell Health’s tele-ICU efforts during the pandemic. Northwell includes 23 hospitals and 72,000 employees across New York, one of the hardest hit states in the outbreak. The healthcare organization has increased tele-ICU beds from 170 to 420 with plans to accommodate even greater patient volumes. “Northwell has a telehealth command center in Syosset, NY, from which teams of critical-care physicians and nurses are already monitoring more than 130 beds, of which 116 are occupied by COVID-19 patients,” said Director of Clinical Operations of Telehealth Services Kara Benneche at the time the article was published.
To learn how Caregility can support your team’s virtual care needs during COVID-19, please reach out to us at (732) 440-8040 or at CaregilityCares@Caregility.com.Learn More
Telehealth’s Role in the COVID-19 Response
Caregility President and COO Mike Brandofino recently sat down with Journal of AHIMA editor Mary Butler to discuss telehealth’s role in easing provider burden during the COVID-19 response, as well as future outbreaks and pandemics.
The interview touches on the use of telehealth to support provider efforts, from remote clinical assessments to at-home monitoring of at-risk patients. Brandofino addresses the uptick in provider demand fueled by the current outbreak, the logistics of telehealth implementation, and the additional telehealth funding recently approved by Congress.
JAHIMA: Last week Congress approved extra funding for telehealth. Were you happy to see that and will that help providers use a solution like yours?
MB: We’re so glad that they had the foresight. We’re starting to see some movement in coverage of telehealth sessions. They approved coverage of things like Teladoc, which is a patient with a doctor for a 20-minute session, but they hadn’t yet really done coverage for this e-sitting or for the monitoring in the ICU. That’s still underway. But the fact that they recognize telehealth as having a potential large impact in fighting COVID-19, we’re happy with that. And I think it’ll enable some hospitals that haven’t had funding to get telehealth programs underway.
Read the full interview in the Journal of AHIMA: Could Telehealth Ease Provider Burden During COVID-19 Response?
To support customers during the current pandemic, Caregility has created a COVID-19 Virtual Disaster Response Program to help health systems plan, prepare for, and manage patients. This includes offering existing health system customers expanded capacity and use of iObserver and iConsult Mobile solutions during the crisis.Learn More