Digital innovation is a cornerstone of UMass Memorial Health’s strategy, garnering the health system impressive accolades including HIMSS Stage 7 certification for EMR adoption, CHIME’s Most Wired Level 8 certification, and Epic Gold Stars Level 10 status.
Dave Smith, Senior Director of Digital Innovation for UMass Memorial Health, attributes his organization’s competitive edge to a physician-led leadership team that truly embraces digital transformation. UMass Memorial has been delivering hybrid care for the better part of 20 years through its flagship eICU and tele-stroke programs. The throes of the pandemic and ensuing challenges related to patient safety, capacity management, patient flow, and staffing shortages reignited interest in hybrid care innovation, leading the health system to pursue additional programs like hospital at home, remote observation, and remote patient monitoring (RPM) in recent years.
In the enlightening session “Hybrid Care Innovation: The ROI of Bedside Virtual Care at Scale,” part of Becker’s Healthcare’s 2024 Digital Health and Telehealth Virtual Event, Smith sat down with Caregility President and COO Mike Brandofino to share compelling insights into the transformative hybrid care initiatives his organization is pursuing, how his team approaches ROI, and what it takes to scale new hybrid care models.
Hybrid Care’s Return on Value
UMass Memorial’s Hospital-at-Home program is a great example of how health systems are bringing resources to bear to improve outcomes, efficiency, and the experience for patients and clinicians. Patients receive twice-daily visits at home, supported by EMS partners working in collaboration with UMass doctors and nurses. They also have immediate access to virtual nursing support. The health system employs a four-to-one ratio for field nurses and a 30-to-one ratio for virtual nurses.
By bringing acute care to the patient’s home, the team has been able to expand capacity. “In our first year of operation, we saved over 3,000 bed days at our busiest hospitals,” shared Smith.
“With our eICU program, we monitor 150 critical care beds around the clock with intensivists on any given shift and the aid of a pharmacist at night,” Smith said. Since its inception in 2006, UMass’s eICU program has seen a 27% reduction in patient mortality and fewer patient complications, reducing care costs.
“For programs like tele-stroke and tele-psych, the ROI is really about improving access,” Smith continued. “But also, community hospitals see the ROI because they don’t have to hire and retain a full-time specialist. Instead, they buy professional services from a tertiary health system like UMass Memorial.”
The health system’s remote video monitoring (RVM) program has shown the strongest direct labor-cost ROI by enabling a single care team member to support six patients instead of conventional one-on-one observation ratios. “To take advantage of the full 12-patient panel, we assign each observation tech six primary patients and six backup patients for a total of 12,” Smith shared. “For every remote observation tech, we save $300,000 a year in direct labor costs.”
The health system is also leveraging AI solutions for radiology, ophthalmology, and ambient dictation to save providers valuable time. “I don’t think AI is going to replace doctors anytime soon, but I do think the ones who embrace it will probably surpass the ones who don’t,” noted Smith.
Scaling Hybrid Care Innovation
Smith sees digital health innovation as “the cost of doing business for healthcare systems that want to innovate and remain competitive.”
“We're in the process of building a new 72-bed inpatient facility that will open about a year from now and every bed will be wired with Caregility technology. We'll use the technology for a variety of use cases like virtual rounding, remote observation, specialty consults, patient/family communication, and even tele-ICU level care. And the funny thing is, it was an easy sell to hospital leadership because they understand the importance of hybrid care and balancing staffing demands. I just think hybrid care is the new standard.”
Dave Smith
Senior Director of Digital Innovation, UMass Memorial Health
Smith champions platforms that can be leveraged across the enterprise over point solutions. “To do anything at scale, it cannot exist in silos and pockets that are scattered throughout the organization,” he shared. “A good example is our commitment to building a digital medicine hub. We’re taking most of our virtual services and putting them under one roof. By doing so, not only will it be a showcase for our health system of the future, but we’re expecting to find operational synergies by having these virtual care teams collaborate in the same physical space. So, teams like eICU, transfer center, RVM, RPM, interpreter services, and virtual nursing will all be working alongside each other.”
“We’re also investing in a new digital innovation team to support rapid scalability. Digital health and especially AI is evolving so quickly that we need to operate at a faster pace to keep up. I’ll be leading a new multidisciplinary team to focus on emerging technologies that support our system initiatives and foster collaboration with our care teams. The whole idea is to identify opportunities, experiment with proofs of concept, fail fast, if necessary, iterate, and then deliver a solution or look at alternatives.”
“People are embracing technology in ways never thought possible and it’s making hybrid care models not only plausible but also practical.”
ViVE 2024 Recap: Embracing Practical Applications for Healthcare’s Future
Author: Kedar Ganta, Chief Product and Engineering Officer, Caregility
The third edition of ViVE demonstrated that healthcare technology has come of age. The 2024 conference wasn’t just about futuristic ideas; it showcased practical applications of health IT advancements that are augmenting care and revolutionizing healthcare delivery. Discussions centered on the significant shift from traditional models to hybrid care, promising improved outcomes across the healthcare ecosystem.
Beyond this overarching theme of progress, there was equal emphasis on both opportunities and challenges. Here are a few of the themes that dominated conversations at the event.
Expansion of Virtual Care
The growing significance of virtual care in supporting new care models is undeniable. There were numerous announcements of new virtual care platforms and partnerships that showcased their potential to enhance patient monitoring and care delivery. Despite its potential, virtual care still confronts significant hurdles such as bridging the digital divide, building patient trust, addressing privacy concerns, and navigating complex regulatory issues.
An offshoot of virtual care expansion that continues to get attention is virtual nursing. This year ViVE introduced a new track for nurse leaders at the conference, aimed at cultivating nurse-led innovation to address challenges and improve care delivery. Sessions on nursing’s role in the home, tackling staffing challenges, and training for future work point to the growing role technology will play in this field.
Responsible AI
AI continues to bask in the limelight, showcasing its potential for streamlining administrative tasks and optimizing workflows, impacting the entire patient care journey from admission to discharge. There are still many questions about the ethical considerations of applying this technology at scale, yet, despite these concerns, many organizations are eager to embrace AI-augmented solutions.
Natural Language Processing (NLP) saw a significant surge in momentum, offering a greater promise of reducing administrative burden. In addition to industry incumbents like Nuance and M*Modal, emerging players such as Abridge, Sunoh.ai, and DeepScribe are vying for prominence. Abridge’s recent funding garnered attention, accelerating their efforts to lead in this space. Notable is DeepScribe’s collaboration with Amazon Web Services (AWS) to scale their healthcare-focused large language models and seamlessly integrate with AWS HealthScribe, signaling a shift towards purpose-built healthcare language models.
As AI becomes increasingly pervasive, we can expect more discussions around the need for regulations and guidelines governing AI’s ethical and acceptable use in healthcare. Responsible use of AI is imperative to uphold patient data privacy and mitigate the risks of misuse.
Data, Security, and Trust
The emphasis on interoperability at the event underscored the significance of data in decision-making, leading to better patient outcomes and driving innovation to revolutionize healthcare delivery.
Cybersecurity took center stage, prompted by the recent high-profile attack on Change Healthcare. As my colleague Jeff Ryan put it, “The focus certainly shifted from AI to cybersecurity as news spread of the incident.” The cyberattack serves as a cautionary reminder of the risks of pursuing innovation without sufficient governance measures in place. It underlines the importance of implementing robust cybersecurity measures to safeguard patient privacy and maintain trust within the healthcare ecosystem.
A Glimpse into the Future
As the curtains closed on ViVE 2024, it dawned on me that we now possess the necessary technology to support the healthcare workforce and ecosystem. It offers a promise where staffing challenges are addressed, burnout is reduced, and the joy of healthcare is restored. From cybersecurity and interoperability to responsible AI, the digital health space offers ample opportunities for innovation. The onus lies on the industry and its leaders to be proactive, challenge the status quo, and forge a new path to reshape the future of healthcare as we know it.
About the Author Kedar Ganta brings 20 years of leadership experience in enterprise-scale and cloud-native applications to his role as Chief Product and Engineering Officer at Caregility. He previously served as Head of Product for Global Growth Verticals at Cisco Systems and shaped digital product strategy in technical leadership roles at athenahealth, GE Healthcare, and Microsoft.
VA Telehealth Services: Transforming Veteran Care
For solid evidence of the benefits of telehealth, look no further than the U.S. Department of Veterans Affairs (VA). Long considered a national leader in virtual care adoption, VA telehealth services reflect an all-in commitment to using technology to enhance healthcare access, capacity, quality, and experience for Veterans, their families, and caregivers.
Like their compatriots in the public healthcare sector, VA facilities saw a tremendous uptick in telehealth utilization during the COVID-19 pandemic. Although Veterans’ use of audio-only virtual visits has since leveled off, video-based telehealth use by Veterans has surged by 2,300% compared to pre-pandemic levels, according to recent research.
VA Telehealth Trends
VA telehealth services make care accessible in Veterans’ homes and communities in multiple ways, including:
Routine, scheduled primary care appointments and screenings
Non-urgent, ad-hoc ambulatory care for medical advice and medication support
Acute care programs such as tele-critical care and tele-stroke
Remote patient monitoring for complex chronic condition management at home
Mental health support for anxiety, depression, PTSD, and more
Preventing suicide, which disproportionately impacts Veterans, is one core objective the VA seeks to meet by improving Veteran access to care, in part through telehealth. In 2021, more than 98% of VA mental health providers conducted at least one video visit with a Veteran, demonstrating how integral virtual access is to providing much-needed care to those who have served our country.
The VA also recognizes telehealth as an essential element in improving healthcare accessibility for rural and unhoused Veterans. In 2021, the VA reported a 2,800% increase in virtual care provided to highly-rural Veterans. The national health system also distributed more than 57,000 tablets to Veterans without access to video-capable devices or the internet to support virtual visits in 2021.
In 2022, more than a third of all Veterans who received care from the VA used telehealth. Today, video visits account for roughly 12% of outpatient care for Veterans. As of April 2023, telehealth utilization accounted for 36.7% of all visits across primary, subspecialty, and mental health services provided by the VA.
Virtual Care Lessons from the VA
The VA’s commitment to telehealth ensures that Veterans can connect and receive care anytime and anywhere. Here are a few lessons that private sector healthcare organizations can draw from the VA’s experience.
It takes a village: A multi-faceted approach to care that offers in-person and remote engagement opportunities is table stakes in ensuring health equity. The VA’s inclusion of community partners and non-traditional care sites in promoting Veterans’ health contributes to the organization’s success and should be echoed throughout the industry.
Overcoming state licensure issues: The VA’s authority to conduct telehealth services across state lines, bypassing state-specific licensure requirements, helps increase Veteran access to care. Amplifying similar legislative efforts within the private sector could reap similar results for larger patient populations.
Patient enablement in the home: The VA’s track record with in-home remote patient monitoring programs and device distribution to support unhoused Veteran access to care offers other healthcare organizations a blueprint to draw from for emerging hospital-at-home care models.
Future Goals
The VA continues to make strides in telehealth services. As stakeholders with the VA’s Office of Connected Care put it, “Telehealth is being integrated into core operations throughout VA, with adoption growing remarkably over the past several years. As we now look to a post-pandemic future, we anticipate continued growth of telehealth utilization across VA, making quality VA healthcare more accessible, convenient, and efficient.”
The Veterans Health Administration endorsed a five-year strategic vision for connected care with goals to enhance Veteran digital engagement, deliver healthcare without walls, and solidify connected care’s foundations. “This vision includes deploying digital tools that allow Veterans to connect with VA and their healthcare services at any time, delivering even more care into the home through video telehealth and remote monitoring, expanding clinic capacity by using telehealth to match supply and demand across VA’s expansive geographic footprint, enhancing Veteran access to rare national expertise irrespective of the Veteran’s location in the country, and much more.”
Caregility is proud to work with the U.S. Department of Veterans Affairs in support of telehealth initiatives aimed at enhancing care for Veterans, their families, and caregivers.
Hospital of the Future & the Race for the Patient Footwall
Budgetary constraints and staffing challenges are compelling healthcare organizations to rethink their operational strategies to find new ways for burned-out care teams to work smarter, not harder.
One strategy that providers are employing to drive efficiency, standardize processes, and elevate the standard of care in inpatient settings is the adoption of hybrid care models. These care models introduce remote clinicians and digital health tools at the bedside. Leading health systems such as Houston Methodist, OhioHealth, and UMass Memorial Health are among those planting the first “smart hospital” and “hospital of the future” flags, introducing high-end technologies in every patient room.
As healthcare organizations bring telehealth, artificial intelligence (AI), interactive patient consoles (IPCs), and other health IT resources to the hospital bedside, the race for a space on the patient footwall is heating up. And hospitals looking to differentiate themselves and improve operations through the adoption of innovative technologies are rightfully being more discerning in their product evaluations.
Increasingly, providers are favoring a platform approach to underpinning infrastructure in an effort to keep solution sprawl and fragmentation at bay. Recent research from the Health Management Academy reveals that 62% of leading health systems want their tech capabilities (across categories) to be met by a single vendor.
Signify Research similarly observed a shift in provider preferences towards solutions that cater to broader use cases. “Historically, endpoint solutions have been departmental, siloed, point-focused products (hardware-centric), however, enterprise-scale solutions with a focus on platform-centric and configurable workflows have become increasingly prominent.” Continuous monitoring solutions are cited as a prime example of this shift from point solutions to comprehensive platforms that not only centralize but also simplify resource administration and management.
The ability of bedside technology to integrate seamlessly with existing hospital systems, especially the Electronic Health Record (EHR), is crucial for securing a coveted spot on the patient footwall. A platform’s ability to seamlessly integrate with a broad spectrum of peripheral systems further supports consolidated solutioning, allowing care teams to pilot adjacent technologies more easily.
Case in point: In the realm of virtual care, new telehealth edge devices like Caregility’s APS200 Duo enable healthcare organizations to introduce AI capabilities using the same device that supports audio and video feeds used for virtual patient engagement and observation. The device’s ability to integrate with IPCs and smart TVs in the patient room allows care teams to leverage existing technology investments during implementation.
As healthcare institutions continue to integrate advanced technologies into care delivery, the importance of unified, platform-based solutions becomes ever more apparent. This strategic approach not only simplifies infrastructure but also significantly boosts care teams’ ability to deliver personalized, efficient, and high-quality care at scale.
Interested in learning more about how hospitals are leveraging enterprise telehealth and IPC platform integrations to support forward-thinking care initiatives? Join clinical experts from OhioHealth, Vibe Health, and Caregility for the webinar “Clinical Workflow Optimization: The Role of Virtual Nursing” taking place on Thurs., Feb. 8, from 2-3 pm EST.
Future-Proofing Senior Care
The surging senior population in the U.S. stands in stark contrast to the declining number of medical doctors specializing in geriatric care. According to a recent JAMA Network viewpoint from UMass Memorial Health geriatrician Dr. Jerry Gurwitz, the number of geriatric specialists in the U.S. has fallen almost 40% over the last decade.
Meanwhile, skilled nursing facilities (SNFs) and nursing homes are grappling with the same nurse staffing shortages plaguing other healthcare organizations. The Department of Health and Human Services (HHS) recently announced a proposed rule that would establish minimum nurse staffing levels for nursing homes. CMS estimates that roughly three-quarters of nursing homes would have to strengthen staffing in their facilities in order to comply, amplifying workforce demand in a system already strained by staff deficits. As facilities struggle to maintain target staffing ratios, rural and disadvantaged nursing homes face the threat of additional closures, leaving senior care at risk.
These industry-wide staffing shortages mirror issues playing out in inpatient care. And the parallels don’t stop there. Long-term care facilities can expect to encounter similar outside disruption from retail health organizations as Aging-in-Place technologies introduce in-home alternatives to traditional care. With seniors expected to represent about 20% of the U.S. population by 2030, inpatient, post-acute, SNF and long-term care settings alike will see senior patient volumes rise.
The Domino Effect on Hospitals
The lack of open nursing home beds is already marooning some patients in hospitals. Growth in the senior population, coupled with evolving expectations set by Aging-in-Place technologies, will significantly influence how hospitals strategize and deliver care. As seniors grow accustomed to enhanced virtual care and in-home services, they’ll expect similar accessibility and convenience when transitioning from SNFs to hospitals or vice versa. We’ll likely see accelerated adoption of Hospital-at-Home and other advanced home care models as a result.
Healthcare organizations will grapple with not only an influx in senior patient volumes but also a higher degree of care complexity, as comorbidities become more prevalent in an aging population. Multidisciplinary care coordination will be vital to effective care delivery. One could even posit that in the not-so-distant future, the lines distinguishing SNFs, home care, and hospitals may blur, giving rise to a more fluid, patient-centered healthcare delivery model. Accountable Care Organizations, which emphasize value over volume and coordinated patient care across different providers, may serve as a precursor to the evolving landscape.
Telehealth’s Place in Senior Care
Just as hospitals are reimagining care delivery in response to staffing shortfalls, burnout, and evolving patient expectations, senior care must similarly innovate to get ahead of compounding trends. By embracing models that leverage virtual care, SNFs and other senior care providers can not only better compete but also enrich patient experiences and elevate care delivery standards.
1) Democratizing Access to Scarce Geriatric Specialists
By establishing remote access to the limited pool of geriatricians, SNFs can traverse geographic boundaries. Virtual care ensures seniors, especially those in regions most affected by staffing deficits, aren’t left in the lurch by bringing expert care to them on-screen, anytime, anywhere.
2) Enabling Bedside Teams and Emerging Care Models
Hybrid care models like Virtual Nursing help alleviate pressure on limited bedside staff and improve patient experience by introducing remote support resources to care models. These programs also help establish workflows that lay the groundwork for remote, in-home service expansion.
3) Seamless Care Coordination Connecting Clinical Teams, Patients, and Families
Virtual care fosters collaboration between disparate multidisciplinary care teams, patients, and their families. Recognizing that family members often shoulder caregiving responsibilities for relatives, virtual care facilitates intergenerational support. This is particularly helpful when managing chronic conditions.
As we stand at this crossroads, the increasing importance of tech-enabled care cannot be overlooked. Although virtual engagement won’t be a panacea in senior care, where technology adoption rates may be weaker, it does introduce new ways to better support aging patient cohorts and their care teams. This impending transformation underscores the need for healthcare organizations to be agile, forward-thinking, and willing to embrace change – not just as a response to shifting demographic trends, but as pioneers redefining what comprehensive care for seniors truly entails.
Hybrid Care in the Age of Retail Health
Amazon Clinics and other direct-to-consumer (DTC) healthcare market entrants are “disintermediating the traditional healthcare journey,” as Trilliant Health researcher Sanjula Jain, Ph.D., recently put it. As retail health options flood the field, patients are increasingly by-stepping PCPs in favor of DTC telehealth solutions to address their low-acuity healthcare needs.
For those who can take advantage of DTC telehealth services, there is a clear convenience win. However, some argue that this disruption to the status quo is introducing additional fragmentation that can negatively impact patient care and provider operations.
Implications for Patients: One major question arising from the surge in retail care relates to the handling of patient data exchange. If a patient receives treatment from a retail health provider, how will that care episode be integrated into their primary health record?
Implications for Providers: For traditional healthcare providers, the rise of DTC healthcare models can result in a loss of critical patient insight or potential patient drift to other care delivery sources, eroding health system market share and revenue.
As we watch the debate over whether patients should also be regarded as consumers play out in a literal sense, here’s the reality: We are all patients seeking effective care and consumers demanding modern convenience and responsiveness. The ideal health system is one that delivers on both.
How Providers Can Compete
Competing in a modern healthcare market disrupted by retail health will require some degree of assimilation on behalf of healthcare provider organizations (HPOs). By establishing hybrid models of care that include virtual service offerings, providers can give patients the same easy access to low-acuity care as DTC alternatives, keeping patients within the health system.
Beyond creating clear and convenient pathways to non-urgent care, strategically wielding virtual care across the enterprise poses additional competitive benefits for health systems. When used at the bedside, inpatient virtual engagement tools introduce remote clinical support resources to patients and floor teams, improving patient experience and outcomes in mid-to-high acuity care encounters, as well. Integrated virtual care empowers HPOs to offset staffing challenges while keeping pace with other industries in terms of delivering the convenience and digital access consumers have come to expect.
With an aging patient population and chronic conditions on the rise, these tools will become even more essential to health systems’ survival. Looking ahead, HPOs can anticipate similar outside competition from retail health as Aging-in-Place and Hospital-at-Home programs continue to move the point of care beyond traditional brick-and-mortar institutions. Establishing the virtual care infrastructure now will help providers meet emerging demand by enabling remote monitoring and management of chronic conditions. Here, provider organizations that have the historic relationship and longitudinal patient data to support a more personalized care plan may garner an edge.
A Catalyst for Care Model Transformation
By embracing hybrid care, healthcare organizations can provide more convenient, personalized, and efficient care, which is crucial for competing against retail health competitors and meeting the evolving needs of the patient population.
Perhaps one of the reasons healthcare has historically lagged other industries in terms of innovation has been due to the absence of significant external threats. Whether this is true or not, it’s clear that healthcare as an industry is at an inflection point.
In a world rapidly moving towards direct-to-consumer health models, healthcare organizations can’t remain passive observers. To compete effectively, we must pivot, innovate, and integrate. By embracing hybrid care models, healthcare organizations can honor both the patient and consumer aspects of individuals and secure their place in the future landscape. The era of retail healthcare isn’t a threat; it’s an opportunity to evolve and provide better, more connected care everywhere.
Programs like virtual nursing and continuous patient observation have rapidly risen to prominence as telehealth models mature on this side of the pandemic. The trend reflects an emerging hybrid care paradigm where remote and in-person engagement are blended to optimize patient care. Health systems can modernize care models and overcome many of the resource challenges hampering hospitals today by scaling virtual care to bring remote reinforcement into clinical workflows in acute settings and beyond.
To enable hybrid care across their enterprise, healthcare organizations are making virtual care and engagement accessible at every patient bedside. For many campuses, this means migrating away from siloed, pandemic-era telehealth implementations to a virtual care platform that’s better suited to support diverse clinical use cases.
As you’re scaling virtual care and refining your telehealth strategy, you want to establish infrastructure that is versatile enough to grow with you as needs change and your roadmap evolves. Here are five core tenets for ensuring long-term sustainability.
1) Reliable Infrastructure
Your virtual care platform is the heart of telehealth operations in your organization. Above all, you need a platform you can trust. Look for reliability across multiple areas, including HIPAA compliance and encryption security, ample capacity to support spikes in session concurrency, and uptime guarantees with retrospective analytics to back up claims. Conduct a network assessment with your solution partner early on to pinpoint and proactively address network weaknesses that may impede virtual care programs. Seek out partners who champion open communication and transparency in root cause analysis if and when issues arise.
2) User Experience
Ease of use can make or break adoption regardless of how much you invest in your virtual care platform. Solutions should avoid application download requirements for patient users and offer clinical users a consistent user experience across various workflows. Beyond the GUI, consider your experience with program builder, implementation, and IT support teams. Secure virtual care partners who are as easy to work with as the software and endpoint solutions they provide.
3) Centralized Administration
As operations expand, you’ll want a solution that allows you to easily manage your growing device fleet. Web-based administration portals help centralize managing multiple telehealth programs and allow remote governance and support of telehealth endpoints. Endpoint systems should be configured to proactively alert tech support remotely in case of malfunction and should be able to be restarted remotely. Reporting and analytics functionality should wield insight into program performance metrics and endpoint utilization.
4) Clinical Workflows
Clinically driven virtual care solutions that are purpose-built for specific workflows fare better than more generalized, one-size-fits-all solutions. Virtual care solution companies with extensive patient care experience on their bench bring clinical integrity to program development and can help bridge gaps between your internal IT and clinical teams. Both internal departments should be involved in strategy from the onset. Virtual clinical programs can and should be tailored to your health system’s specific needs. Start with one or two virtual workflows and expand from there.
5) Innovative Integrations
Virtual care platforms with API integration are ideal. They allow you to centralize core telehealth capacity while layering in integrations as you pilot emerging technologies. Each unit can tailor virtual care program workflows and resources for their unique needs. EHR integration allows clinicians to launch virtual sessions from a familiar work environment. Consider additional virtual care integrations such as clinical decision support (CDS), interpreter services, digital devices, and AI. Platforms that support HL7 and SMART on FHIR data standards help streamline interoperability and enable real-time access to patient data during virtual visits.
When scaling virtual care, it’s important to think multi-dimensionally about telehealth programs. What are your core workflow priorities? What additional resources can be brought into workflows to amplify efficiency and patient and clinician experience? Can programs be expanded to support multiple campus locations? By considering these variables early on you can develop a strategy that meets today’s challenges and sets the stage for continuous growth as hybrid care models continue to mature.
For a deeper dive into virtual care roadmapping and program implementation considerations, contact Caregility today to speak with one of our telehealth experts.
Virtual Care KPIs: What Should You Be Measuring?
This season, most of us find ourselves looking back on the year’s accomplishments and making plans for the year ahead.
For healthcare professionals, 2023 planning entails looking for new solutions to problems that contributed to one of the toughest financial years in recent history. Research from KaufmanHall pegged 2022 as the worst-performing year for hospitals since the beginning of the pandemic, with margins down 37 percent and 2022 expenses toppling 2021 levels by nearly $135 billion. This was largely attributed to inflated labor costs as hospitals compete for staff amid workforce shortages.
Overcoming these challenges in the new year comes down to an objective that lives on health system to-do lists in perpetuity: finding innovative ways to work smarter.
In the years during and since the pandemic, telehealth and virtual care have played a significant role in clinical transformation. Perhaps most notably, healthcare organizations are getting serious about hybrid care models that leverage telehealth at the bedside to support patient safety, workforce flexibility, and competitive differentiation.
Given the infancy of virtual and hybrid models, care teams looking to understand what quantifies program success may find themselves in uncharted territory. Whether you’re evaluating your performance over the past year or building a case to measure programs you may be planning for 2023, these key performance indicators spell success for virtual care.
Virtual CareKPIs to Assess the Value of Clinical Programs
As you get started, think about what data you can collect on your virtual care program to compare to traditional models. If possible, gather information on trends and averages prior to launching your virtual program to establish a baseline for comparison. There are several direct and indirect cost factors to consider.
Patient Outcomes
Look for improvements to these clinical measures to assess program value as it relates to patient safety and outcomes:
Average length of stay
Care escalation trends
Harm or adverse event incidence
Patient fall rate
Patient fall-with-injury rateVirtual observation serves as a second line of defense for at-risk patients. Here’s what to look for in a solution.
Patient throughput
Readmission rate
Improvements to these clinical quality metrics have direct cost and reimbursement implications. Clinical outcomes also influence patient experience as reflected in HCAHPS scores. Assess how scores for patient satisfaction and experience compare before and after implementation.
Clinician Experience
Another key consideration – particularly given the current staffing climate – is virtual care’s impact on clinician experience and turnover.
The 2021 NSI National Health Care Retention & RN Staffing Report placed the average cost of turnover for a bedside RN at $46,100, with each percent change in RN turnover costing or saving the average hospital an additional $262,300 per year. Clearly, a lot is on the line when it comes to finding new ways to better support and keep staff.
Bearing that in mind, factor these metrics into your ROI analysis:
Leave Rates: Did your virtual care program reduce leave rates by improving workflows to reduce burnout?
Talent Acquisition: Does your virtual program introduce remote work opportunities that attract new workers?
Staff Retention: Is the virtual program improving care team satisfaction to help retain talent?
Routinely conduct surveys to collect staff feedback on their experience with and perceptions of the virtual care program. Do clinicians find the technology to be helpful and easy to use? Do virtual support resources improve the experience for new hires? What do team members like and dislike about virtual workflows and how can problems be addressed?
Time Management
Conduct time studies prior to implementation to serve as a benchmark to evaluate efficiency gains. Compare pre- and post-implementation studies to determine time saved by transitioning processes to virtual workflows. Gather average hourly rates and staffing numbers in traditional care models to look at ROI associated with reduced labor costs in virtual care programs.
For admission workflows, for example, how long does it take to complete a full admission virtually? How does the average number of virtual admissions conducted per shift compare to your traditional care model?
Although harder to quantify, time savings generated for floor staff by transitioning common processes to virtual workflows can be reinvested in other patient-facing activities, extending program benefits to additional areas.
Effectively implemented virtual care programs can have a tremendous impact on each of the above metrics. Collectively, these improvements can create substantial value and ROI for health systems at a time when it’s greatly needed. Programs should demonstrate cost savings and/or improvement in clinical outcomes, satisfaction, and/or throughput. By measuring the direct and indirect benefits of your virtual and hybrid care initiatives, you can justify your program and inform process improvements as your strategy evolves.
Telehealth’s Role in Emergency Care
NEJM recently published a case study on Stanford Health Care’s use of telehealth in the emergency department. The widely circulated article adds to a growing body of research examining the efficacy of virtual care programs.
Here’s what the study revealed.
In December 2020, Stanford launched its ED Virtual Visit Track (VVT), with the goal of accelerating the health system’s process of evaluating lower-acuity ED patients using a remote physician. “Supported by virtual visit–enabling hardware, software, workflow development, and training, as well as by VVT-trained support staff,” the remote physician virtually assesses low-acuity patients presenting at Stanford’s adult and pediatric ED sites.
Stanford emergency medicine physicians and research scientists compared the outcomes of 2,232 VVT patients to traditional ED patients over an 11-month period. “In a matched cohort of patients, the median ED length of stay (EDLOS) for VVT patients was 1.9 hours compared with 4.2 hours for patients cared for in the typical main ED workflow.”
Researchers also cited lower return visits among VVT patients, though differences were not statistically significant (6.7% vs. 7.2% for 72-hour revisits and 10.4% vs. 12.4% for 7-day revisits). All VVT physicians rated their ability to provide care that’s comparable to in-person care as very good or excellent.
What the Research Tells Us About Telehealth in the ED
Stanford researchers found that virtual care encounters in the ED were on par with, if not better than, in-person encounters for lower-acuity ED patients. Additional research findings paint a similar picture.
Clinical ED teams often use virtual workflows to screen and stratify patients who are better suited for an alternate care site or do not require in-person engagement. Real-time, video-based telehealth was most frequently identified as the most feasible supporting technology. Researchers also note that proper technical infrastructure to support virtual care, although challenging, is essential to program success.
Benefits of virtual emergency care cited within the 18 studies include:
cost reduction
improved quality of care
decreased patient transfer rate from rural centers to major centers
reduced mortality rate
reduced patient treatment time
reduced ED overcrowding
Additional Use Cases for Virtual Emergent Care
Care teams find similar success with telehealth-enabled EMS. Phone or tablet-based virtual consultations between paramedics in the field and remote emergency physicians can improve the speed of patient triage, diagnosis, and intervention before a patient ever makes it to the ED. By using virtual care to engage physicians while on-site or in transit with the patient, EMS responders can redirect lower-acuity patients away from high-cost care sites like the ED when appropriate.
CMS’ Emergency Triage, Treat, and Transport (ET3) model seeks to extend the applicability of telehealth in EMS. The ET3 payment program, currently being piloted, pays EMS participants for use of telehealth to initiate and facilitate patient treatment in place with a qualified healthcare provider for Medicare patients. It also expands Medicare reimbursement to include patient transports to alternative, lower-acuity care destinations like primary care offices and urgent care centers when emergency care is found to not be required.
We saw telehealth being similarly employed to support patient triage in the field during the COVID-19 pandemic, validating the essential role virtual care plays during public health emergencies. Telehealth-enabled field hospitals and curbside EDs were erected to manage patient surges and reduce overcrowding and exposure.
More recently, telehealth was used to support natural disaster emergency response for patients and clinicians impacted and displaced by Hurricane Ian. Evacuees relied on telehealth to maintain ties to providers, while out-of-state physicians and advanced practice nurses were given temporary rights to fill care gaps in Florida when local resources were impacted.
From emergency medical response in the field to virtual visit tracks in EDs, virtual care’s role in emergency medicine continues to mature. As Stanford researchers put it, “Although typically applied when a patient is outside of the care environment, a [virtual] program can be used in other situations in which options for in-person evaluation are limited.” As care teams manage overcrowded EDs and shrinking staff, virtual emergency care programs can provide much-needed relief.
Hybrid Care: Making the Case for Telehealth in Every Patient Room
During the pandemic, many health systems adopted telehealth to meet one specific objective: to ensure access to care for patients isolated at home. Telehealth and virtual care delivered on that and more. Homebound patients maintained ties to their providers, and hospital-based care teams used telehealth resources to reduce COVID-19 exposure and keep families connected during visitation restrictions.
As isolation issues abate, new challenges are driving health systems to explore ways telehealth can further support care delivery within inpatient settings. Clinical workforce shortages, patient safety concerns, and increased competition are all taking a toll on hospitals.
Here we look at how the integration of virtual tools into bedside care can help health systems adapt and overcome, making a strong case for hybrid care and the push towards telehealth in every patient room.
The Immediate Need: Staffing Relief
The 2022 NSI National Health Care Retention and RN Staffing Report reveals that in 2021 hospital turnover increased 6.4 percent, resulting in a national average of 25.9 percent. McKinsey and Company research cites a 25 percent increase in labor costs per adjusted hospital discharge between 2019 and 2022, much of which was driven by the high cost of travel nurses and staff recruitment and relocation.
The potential for telehealth to help bridge staffing gaps and reduce labor costs is four-fold:
Virtual workflows like tele-rounding, tele-nursing, and tele-sitting free up valuable time for bedside clinicians, helping to reduce burnout.
Telehealth-enabled remote work opportunities can extend the careers of seasoned clinicians considering leaving or retiring.
Virtual mentoring programs between new hires at the bedside and experienced remote clinicians improve staff onboarding, training, and experience.
Telehealth platforms allow health systems to easily bring third-party clinical service support into hospital workflows as needed, regardless of where the clinician is located.
Virtual nursing is one area of opportunity that is gaining traction. Research and consulting firm ITIC reports a 34 percent increase in the number of virtual nursing programs around the U.S. in the past year.
The Primary Objective: Patient Safety
Research has repeatedly demonstrated that poor staffing ratios lead to poorer patient care and outcomes, including increased morbidity, medication errors, and risk of infection.
Additional factors are leading to worsening patient acuity levels. American Hospital Association recently issued areport that found that deferred patient care during the pandemic led to a 9.9 percent increase in the average length of stay from 2019 to 2021.
As hospitals treat sicker patients, often with fewer clinical resources, deploying telehealth endpoints in patient rooms across the hospital enterprise helps amplify patient coverage and safety and improve the speed of clinical intervention. Virtual observation programs, for example, are increasingly moving beyond critical care units to help care teams keep eyes on at-risk patients for things like fall prevention. The ability for care teams to move from a one-to-one in-person model to a one-to-many virtual caregiver-to-patient model maximizes staff resources while reducing the cost of care.
A single telehealth platform may serve many use cases in the patient care journey, from virtual rounding in the morning, to virtual behavioral health appointments in the afternoon, to virtual patient observation at night. When integrated with clinical decision support tools, virtual nursing can support patient stratification to detect and intervene when patients are in decline and potentially discharge those doing well early. Bringing virtual resources to the bedside also enhances clinical collaboration as well as family engagement, which reduces anxiety and speeds the recovery process.
The Future State: Strategic Differentiation
Another motivator driving health systems to adopt an enterprise approach to telehealth is the pursuit of competitive differentiation. Hospital Room of the Future initiatives are cropping up across the nation as healthcare organizations seek to attract tech-savvy consumers and partners. These digitally enabled rooms enhance the care experience for patients and care providers alike. Patients benefit from virtual access to their clinical team and interpreters, which can improve HCAHPS scores. Clinicians benefit from access to innovative connected health integrations that streamline workflows and improve efficiency.
Many additional healthcare initiatives that are on the horizon are only feasible when telehealth is involved. Hospital at Home, Chronic Care Management, Aging in Place, and even advancements in preventive care coordination all require or benefit significantly from the ability to virtually engage with patients between in-person encounters, representing additional use cases where telehealth can enhance patient care.
The Challenge and a Path Forward
Inflation, increased labor expenses, and a rise in patient acuity are all putting strain on hospital financials. According to recent research from Kaufman Hall, the hospital median operating margin was down by 29.9 percent year over year as of June 2022.
So how can health systems enable enterprise-wide telehealth in the midst of record-setting low margins? Many recognize the value and long-term ROI that augmenting inpatient care with virtual workflows can bring but struggle to invest the upfront capital typically associated with enterprise-wide implementations. Without a way for health systems to wade into enterprise telehealth, financially speaking, few will be swimming.
The good news is that new pricing and acquisition models are emerging to help providers step into hybrid care and enterprise telehealth. Subscription-based models that offer pay-as-you-go pricing reduce up-front capital investment requirements. New cost-effective endpoint options for lower-acuity patient engagement that does not warrant the same intensive clinical communications needed in higher-acuity environments like the tele-ICU are also entering the market.
Enterprise telehealth platforms that master the basics – security, centralized program and fleet management, integration adaptability, and scalability – offer a solid foundation to build on that will also help health systems mitigate solution sprawl and resource redundancy in the years to come.
