Category: Hybrid Care
Five Connected Health Integrations for Hospital-Based Virtual Care
Since reaching widespread adoption in 2020, telehealth has captured headline after headline. While the lion’s share of media attention has been centered on outpatient telehealth sessions connecting providers to patients at home, use cases within hospital settings have quietly been gaining momentum.
Many health systems are looking to build upon the success of virtual care programs used in the COVID-19 response and the tele-ICU. Chronic staff shortages have sparked interest in expanding bedside hybrid care models to bring virtual support into additional workflows for overburdened care teams.
In inpatient settings, where resources are scarce and care is the most complex, tele-nursing and virtual patient observation programs are gaining popularity as health systems seek to enhance patient coverage and safety. Recent innovations in telehealth are paving the way for virtual engagement at every patient bedside to support these efforts and other “hospital room of the future” initiatives.
Within hybrid care environments, integrated software, services, and devices play a crucial role in workflow optimization. Beyond requisite EMR integration, here are five connected health integrations frequently used in tandem with virtual care.
1) Digital Health Assessment Devices
A key component that’s traditionally been absent in virtual care is a physical patient examination. New digital health devices are helping to close that gap. Emerging technologies are enabling care teams to remotely assess patient vitals and body sounds in real time. Caregility recently announced an integration partnership with Eko’s digital stethoscope to help remote clinicians and bedside staff collaborate to perform high-quality auscultation quickly and easily during virtual rounding. Digital thermometers, pulse oximeters, respiratory rate monitors, electrocardiogram patches, blood pressure kits, accelerometers, and other biosensors similarly support remote patient assessment. These devices elevate virtual encounters to support earlier detection of patient deterioration, building clinician confidence and ultimately improving patient outcomes.
2) Clinical Decision Support Tools
Clinical decision support (CDS) tools play a central role in disease management at various stages of the patient journey, including early screening, diagnosis, and post-discharge care. Real-time clinical data collection supports timely decision making and evidence-based, proactive care delivery. To bring this vital care support tool into virtual care encounters, many health systems are integrating their CDS and telehealth platforms. PeraHealth’s Rothman Index, for example, is an FDA-cleared risk assessment measure that can be brought into virtual workflows to help care teams prioritize treatment plan changes, transfers, palliative care referrals, and discharges.
3) Interactive Patient Care Systems
Many “care room of the future” initiatives seek to improve patient care by delivering easy-to-use technology to the bedside that is focused on empowering patients and increasing their satisfaction during hospital stays. Interactive patient care (IPC) systems like OneView provide a range of in-room services to patients, from education and entertainment to meal ordering and care support. Integrating IPC systems with your telehealth platform allows you to support virtual care visits on smart TV devices, avoiding duplicative hardware costs and crowding the room with additional screens.
4) Interpreter Services
To support culturally diverse patient populations during virtual encounters, health systems often integrate interpreter services into their telehealth platform. Virtual remote interpretation (VRI) services like LanguageLine support language access compliance and reduce health inequities for deaf, hard of hearing, and limited English proficient patients. Remote access to on-demand interpreters ensures 24/7 language support when on-site resources may not be available. Video-enabled telehealth enables sign language support and helps interpreters pick up on non-verbal cues, reducing miscommunication.
5) Third-Party Clinical Services
As staffing challenges persist, some hospitals and health systems simply lack the existing personnel needed to support adequate patient coverage. Integration with third-party clinical service solutions like Equum allows care teams to bring outsourced staff into virtual clinical workflows to eliminate gaps in care. From enhanced RN support to specialist visit access, health systems can increase clinical capacity through either dedicated outsourced support programs or on an as-needed basis during peak surges.
Click here to explore the full Caregility Connected ecosystem of connected health integration partners enabling hybrid care.
Network Security Best Practices for Virtual Care
Since the tipping point of the pandemic, healthcare organizations have embraced telehealth and virtual care models that bring innovative clinical workflows into patient care. Now faced with a nationwide workforce shortage, many leading health systems are once again leaning into virtual care to reduce stress on care teams and enhance patient coverage and safety, especially in inpatient settings.
Tele-nursing, tele-sitting, and tele-consults represent just a few of the remote workflows gaining prominence in hospitals. Enterprise telehealth is paving the way for inpatient virtual engagement at every patient’s bedside.
Under this new paradigm, healthcare IT teams are understandably looking to drive security standards across virtual workflows. The challenge is that many corporate IT initiatives around network security and performance can disrupt patient care in always-on virtual environments. Some IT standards that make perfect sense for many IoT devices can actually impede healthcare delivery.
Common Network and Security Factors that Impede Virtual Care
Login expirations
It’s common for cybersecurity teams to force users to log out at certain intervals. That means tele-sitters may need to log back in multiple times during a shift, interrupting patient observation.
Device timeouts
To keep unused devices from overloading the network, sometimes idle systems that are on for a certain number of hours are automatically disconnected. If you’re in the middle of observing a patient and that connection drops, that creates a safety risk for that patient.
Firewall port restrictions
Firewall updates frequently disconnect virtual care applications. If you’re a sitter watching a patient, your system disconnects, and you can’t call back in, the time it takes to regain access to a high-risk patient can feel like an eternity.
DHCP registration requirements
When managing IP addresses, enterprises often reset assigned addresses, sometimes as often as every 30 minutes. This can cause disconnects. If many systems are trying to renew their IP lease, it can cause congestion. If you’re a doctor trying to call into a patient room that’s still in queue to get an IP address, that call will not connect.
Wi-Fi over-subscription
You can have excellent coverage when you evaluate your Wi-Fi heat map, but it’s really about network congestion: How many devices are connected to your access points transmitting data? That can really impact care.
Bandwidth restrictions
Most networks are designed for data applications, not two-way video. This leads to bandwidth strain during peak usage times when concurrent session rates are high.
These traditional approaches to security and network management warrant reassessment in clinical environments where devices need to be available 24/7 to support virtual care programs. Spending millions of dollars on your network doesn’t mean your network can effectively support virtual care. It’s critical to ensure that your network is designed to handle bidirectional video communications.
Optimizing Your Network for Always-On Care
As hospitals seek to amplify the reach of staff resources and improve the speed of clinical intervention, virtual care holds immense potential. However, the success of your hybrid care programs hinges on the ability of the network to support uninterrupted, high-quality video communications on a 24/7 basis. It’s essential that clinical and IT teams connect early on, collaborate, and compromise to ensure that security and network support are done in a way that improves rather than disrupts virtual patient care.
Here are network security best practices for virtual care to ensure your organization is optimized to support the critical nature of hybrid patient care.
- Compromise on staff login expirations by having automatic logouts coincide with shift changes.
- Avoid automatic disconnection of devices used in hybrid care models.
- Use static IP addresses for virtual care resources if you can. If not, at least have a reserve of IP addresses designated to virtual care support and set the IP lease to last a full shift.
- Measure the experience of your Wi-Fi-connected devices and calculate how many devices are within a wireless access point. How much are they being used? Can they be hijacked?
- Calculate your peak bandwidth. Look at your fleet of devices and review your network capacity and give an estimate of the number of concurrent connections that you can comfortably do. Then design your network to what that peak bandwidth threshold would be.
- Hardwire virtual care devices whenever possible to reduce the potential for connectivity interruption.
- Empower patients to connect with their family, care team, and interpreters but consider that impact on call volumes when multiplied across the entire hospital. Factor this into peak utilization because what you don’t want is to have a lot of patients socializing with their families while your doctors can’t access the tele-ICU because of bandwidth limitations.
- Remember that network conditions at clinician workstations will impact virtual session performance as well. Ensure nurses and physicians are allocated enough bandwidth to support multiple concurrent connections.
- Isolate high-intensity connections like tele-ICU traffic to a VLAN virtual network where their bandwidth is protected. Leave concurrency available for high-profile locations and only allow so many ad-hoc calls to happen simultaneously to ensure high-priority sessions are maintained.
- Isolate video traffic in a VLAN if possible or create a wireless environment that’s only for virtual communications. This is going to become particularly important as health systems deploy video systems in every patient room to support enterprise-wide virtual nursing and patient engagement.
- Invest in tools that help you monitor and assess your network to quickly pinpoint and proactively address issues.
- Get feedback from your clinical team. The easier you make virtual care to use, the less it becomes technology and the more it becomes a tool for clinicians to provide better care.
- Bring the cybersecurity team, the network team, and technology partners in early on. Talk through the impact of virtual workflows on the clinician and patient experience. Understand what you need to do to meet the cybersecurity and network demands within that environment.
The most important thing is to be willing to compromise on new best practices for virtual and hybrid care environments. Whether you’re exploring your first tele-sitting program or building the Hospital Room of the Future, virtual care is a high-demand application that you should take the time to design. One size doesn’t fit all and there’s no silver bullet. Taking a mindful approach to balancing security and new virtual workflows within the hospital environment contributes to greater success.
Hybrid Care Takes Center Stage at ATA22
The conversation around telehealth in the mainstream media has centered on direct-to-consumer use cases that allow providers to connect with patients at home – an invaluable resource during the pandemic. Meanwhile, however, telehealth use has also been quietly gaining momentum within inpatient care settings. As hospitals and health systems seek to overcome staffing challenges and meet the new demands of a rapidly evolving industry, hybrid care models that bring virtual workflows into bedside care have emerged, helping providers meet the challenges of both.
This trend was ever-present on the floor at the recent 2022 American Telemedicine Association (ATA) conference. This year’s gathering focused on “Creating Opportunity in a Time of Uncertainty.” In a recent conference recap article published by Healthcare IT Today, Caregility VP of Marketing Bryan Schnepf observed that ATA “sessions challenged attendees to reimagine telehealth beyond the transactional interactions we’ve come to know.” To illustrate the potential this poses for inpatient care, the Caregility team was on site to showcase the company’s new Inpatient Virtual Engagement solution.
Inpatient Virtual Engagement Makes Hybrid Care a Reality
Designed to improve both the patient and clinician experience, Inpatient Virtual Engagement offers health systems a cost-effective option for bedside hybrid care at scale – every room, every bed, every patient. Based on feedback from leading health system clients, the company saw a need for virtual resources that could expand the reach of limited clinical staff beyond high-acuity settings like the tele-ICU and extend across the healthcare enterprise. As healthcare teams battle the clinical staffing crisis, Inpatient Virtual Engagement can help reduce staff burnout by facilitating workflows such as virtual specialty coverage, tele-rounding, tele-nursing, and tele-sitting.
As Caregility President and COO Mike Brandofino noted in a recent article published by Health IT Answers, this type of hybrid care infrastructure addresses questions such as:
- What kind of care could be possible if an inpatient experience wasn’t constrained to overtaxed nurse/patient ratios?
- What might rounds look like if a clinical team could conveniently and efficiently reach patients scattered across the hospital without walking throughout a facility each day as they currently do?
- What happens if sitters are unavailable for patients that require supervision?
The company’s new Access Point of Care System (APS100) for lower-acuity patient settings is further leveraged by a subscription-based pricing model; centralized administration portal; and fleet management tool for governing and proactively monitoring thousands of telehealth endpoint devices. Hybrid care creates value by reducing clinical blind spots, improving patient coverage, and driving the speed of clinical intervention. Patients benefit from improved safety and engagement with their care team, interpreters, and loved ones during their inpatient stay, promoting patient wellbeing and positive outcomes.
Hybrid care, all the more essential given today’s staff shortfalls, lays important groundwork for successfully integrating patient experience expectations and clinical quality metrics. Caregility’s platform now supports incremental expansion and a broad range of EHR, clinical decision support, and smart medical device integrations. These support the full spectrum of inpatient settings (general acute care, specialty, rehabilitation, transitional, skilled nursing, memory care), as each considers its “hospital room of the future.”
Retail store clinics, convenience care, urgent care, outpatient providers, and integrated systems continue to compete for many of the same patients. Building on their unique economies of scale and care coordination, the integrated systems that can best plan, implement, and communicate their inpatient model, enabled by technology but delivered by caring humans, will maintain their competitive advantage. The use of remote observation and tele-nursing coupled with advanced EHR add-ons, while connecting levels and locations of care, is only the beginning of what Caregility’s evolving virtual care platform can help achieve.
Case in Point
Learn how SCL Health’s pivot to a system-wide virtual patient observation hub helped the health system reclaim CNA floor time, reduce patient falls, and set the stage for new tele-nursing initiatives. Read the case study here.
To speak with a Caregility specialist about hybrid care solutions for your health system, contact us today.
Healthcare’s Future Is a Hybrid Model
As the upheavals caused by the COVID-19 pandemic stabilize somewhat, healthcare in the United States is landing on a hybrid care model. That model lets providers leverage both in-person and virtual options to deliver outcomes sought by constituents within a resource-challenged framework.
Hybrid care offers a spectrum of tools that connect clinical partners, minimize risks, and provide greater insight into individual health through active remote monitoring. Comprehensive platforms increase patient engagement with reminders, educational content, chat features, and other services.
A hybrid approach has the potential to address significant issues that continue to undermine healthcare delivery and accessibility. These include ongoing shortages of nursing, clinical specialists, and primary care providers. Another pressing concern, driven by the aging US population, is the growing prevalence of chronic conditions and an increasing desire to age in place. Healthcare utilization is expanding, and national healthcare spending will likely reach $6.2 trillion by 2028.
As healthcare organizations identify new virtual collaboration opportunities, the future of hybrid healthcare depends on technology partners to develop purpose-built solutions suited to the care setting. Virtual care programs in hospitals require access to telehealth in every patient room and fast access to relevant data and patient records. Advanced systems implement permanent bidirectional audiovisual connectivity with remote control capabilities, integrating with observation stations.
Inpatient hybrid care
Inpatient settings have utilized virtual solutions since long before the pandemic. However, comprehensive, adaptable virtual care programs in hospitals are relatively new and continue to become more prevalent. Today, many health systems have adopted technology that supports acute care providers and hospital ICUs with telemedicine and 24-hour observation services. Readily available on-demand virtual tools have simplified no-contact care delivery for COVID-19 patients and other high-acuity patients. Telenursing and telerounding streamline clinician workflows, increasing efficiency and decreasing provider burnout.
The interest and funding around hybrid care initially focused on high-acuity care settings, such as the ICU and step-down units. Now, organizations are recognizing that a hybrid model can support lower-acuity hospital care across departments, ensuring that all functions that can add value are “on the same page,” communicating together and with the patient and family or other caregivers. For example, the nurse or physician can be in a room with the patient while the specialist, primary care provider, interpreter, and family members are also virtually present at the bedside. Hybrid care also supports early, timely specialist involvement, and facilitates direct communication from the first EHR review and patient interaction.
That same “just in time, all needed present” paradigm can continue after discharge through remote monitoring using wearables, smartphone apps, e-prescriptions, and virtual check-ins. Whether the patient attends remotely or in-person, the care team, interpreter, and family can stay present at appointments. A recent paper outlining a clinically relevant telemedicine model for kidney transplant patients shows how postoperative hybrid care can benefit vulnerable patients and bend utilization costs.
Hybrid nursing programs
Larger health systems are starting to embrace hybrid care to remediate nursing shortages. We’ve seen telenursing expand, where a nursing corps in one physical location can cover several hospitals virtually. Virtual sitting, where observers track patient activity and notify clinical staff about concerns or distress, is a new way to leverage hybrid care for risk management and reduced bedside staff burden.
There’s more that hybrid care can do to ease the burden on lean nursing staff. A large health system recently leveraged Caregility Cloud™, our award-winning virtual care platform, to connect experienced nurses who have retired from bedside nursing, with the in-room nursing staff. In this scenario, a nurse with decades of experience but physical limitations can offer their knowledge to early and mid-career nurses on a full-time, part-time, or short-term basis. Besides the benefits to patients, the telenurse provides much-needed mentoring to newer nurses who otherwise may not have the opportunity to learn from seasoned staff at work.
Hybrid emergency care
Another use case that we’ve seen at Caregility is hybrid care in offsite emergency settings. An ambulance service installed our platform on 5G-enabled tablets, which enabled a triage nurse or an emergency physician to consult with first responders just as EMTs arrived on the scene, or during transport.
Hybrid care technology brings specialists right into the ED. This highlights how an integrated virtual solution impacts care quality since time is of the essence in emergency care. So, in treating an injury to the mouth or jaw, the ER doctor may need input from a dentist; teledentistry can do that instantly. In the event of a stroke, telestroke programs enable a neurologist to assess stroke type faster and authorize treatment sooner.
Other care settings
Hybrid isn’t just for hospitals. Smaller practices deploy virtual care platforms for a range of services, from primary care and urgent appointments to behavioral health sessions. Integrating virtual visits with in-person appointments as needed protects immunosuppressed patients, offers greater flexibility, and supports health equity by increasing availability and helping patients manage out-of-pocket costs that can otherwise become a barrier to access.
Moving forward with hybrid care
Many healthcare services require some in-person care, and physical presence has healing benefits. Technology will not replace the human element, nor should it strive to do so. Ideally, technology blends into the background, almost unnoticed. Hybrid care can be tailored to fit a wide variety of circumstances and care settings; however, its benefits are contingent on optimal clinical outcomes, staff burden, and patient experiences.
Most critical is that agile virtual care platforms are embedded in organizational strategies that support patients through an integrated healthcare journey, rather than an assortment of tools “stuffed into workflows.” That requires purpose-built virtual solutions with a wide array of customizable features that connect interdisciplinary collaborative partners. Likewise, solutions must minimize technical distractions, focusing on interactive, personalized, value-based care delivery.
Caregility’s award-winning, HIPAA-certified, virtual care platform connects patients, providers family members, interpreters, and clinical teams. Our ecosystem of partners offers value-based clinical services, including virtual nursing, specialty, and behavioral healthcare. Caregility provides administrative management, data, analytics, and robust decision support for acute and ambulatory settings across the care continuum.
To learn more about our virtual care platform, contact us today.
How do you make the most of hybrid healthcare?
Although pandemic restrictions have been relaxed in most areas for months, telehealth remains a significant component of healthcare delivery across the United States.
Telehealth’s long-overdue acceptanceis a testament not only to expanded insurer reimbursement policies because of the pandemic, but also to emerging consumer preferences.
“Telehealth is an expectation for patients now,” Amber Humphrey, Vanderbilt University Medical Center Director of Telehealth, told HealthTech Magazine. “They like the convenience and knowing they can include long-distance family members in their care.”
Still, many essential components of medical care cannot be handled virtually – such as physical exams and procedures. Many healthcare leaders and policymakers envision a hybrid healthcare delivery paradigm taking root in the pandemic’s aftermath.
“There are many things that can be done well in a telehealth visit, and having that option allows the patient more flexibility,” said Ryan Palmer, a principal at strategic advisory firm Kennedy, also shared in HealthTech Magazine. “I see the two models of care (in-person and virtual) as complementary.”
What is hybrid healthcare?
Hybrid healthcare is just like it sounds – a combination of in-person and virtual care.
The American Telemedicine Association (ATA) describes hybrid care as going “beyond just the virtual visit and providing a more personalized, flexible, and seamless patient journey, improving both the in-person experience as well as giving patients more autonomy over their care.”
Mobile devices and wearables play a significant role in a hybrid care environment—instead of requiring patients to come into the office for every check-up, these connected devices will allow physicians to remotely monitor patients’ vital signs, such as blood pressure or blood sugar, as well as determine whether patients need to come in for a physical visit or schedule a telehealth appointment.
“Instead of a more generalized approach to patient care, this type of technology harnesses patient data to further personalize care without ever having to leave home,” the ATA wrote.
Hybrid healthcare in action
Atrium Health, a nonprofit hospital system in the Charlotte, N.C., area, started using a hybrid model in April 2020 when it launched a “virtual hospital” at the onset of the pandemic.
The hospital operates on two “floors:” One provides observational care, such as a phone assessment with a nurse, and the other provides acute care, including remote monitoring of vital signs and in-home visits from providers when needed. A Healthcare Dive article about Atrium’s efforts states that the virtual hospital had seen more than 15,000 patients as of September 2020. Of those 15,000 encounters, 13,000 were discharged and only 3 percent needed to escalate to inpatient hospital care.
“The silos were completely destroyed,” Scott Rissmiller, Atrium Health’s Chief Physician Executive told Healthcare Dive. “People were focused just on trying to care for the patient, as we should be.”
One of the areas where the hybrid-healthmodel is being incorporated from the ground level is in care for “long COVID” patients. Cleveland Clinic’s reCOVer Clinic, one of a growing number of programs dedicated to caring for these particular patients, opened in spring 2021.
“While we don’t currently have treatments for (long COVID), we have the ability to help patients with their symptoms and try to understand it better,” Kristen Englund, a Cleveland Clinic infectious disease specialist, told HealthTech Magazine.
Patients begin their reCOVer Clinic journey with a physical examination and a health history review. In a follow-up appointment delivered via telehealth, patients and doctors discuss the results of any tests and review next steps in the patients’ care.
A similar clinic at the University of Washington’s Harborview Medical Center uses data submitted by patients via mobile devices to their electronic health records to better understand and treat COVID’s long-term physical and cognitive effects.
Telehealth—an extension of quality care
The speed with which healthcare organizations will adopt hybrid care models like these is up for debate. But for many experts like Sean Kelly, Chief Medical Officer at digital security firm Imprivata, the widespread adoption of hybrid care models is inevitable.
“Take banking, for example: Most banking activities can be done virtually, but nobody calls it ‘telebanking’ – it’s just banking,” Kelly said in a Healthcare IT News article.
“Mobile devices and virtual technology will become so ingrained in healthcare that the term ‘telehealth’ may disappear from our vocabularies, or at least be absorbed into the accepted vernacular as just an extension of good care.”
Caregility offers a comprehensive virtual care platform that brings care to wherever the patient is located, including the ICU, inpatient, post-acute, and outpatient settings. If you would like to learn more about how Caregility’s award-winning virtual care platform can help your organization make the shift to hybrid care, contact us today.
