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.”
For some, the call to care for others is a lifelong passion. One such individual is Irene Goliash, RN. Drawing inspiration from a nurturing home environment, including a mother who often cared for family members and an aunt who was a nurse, Irene always knew she wanted to be a caregiver.
She began her journey into healthcare at an early age. A neighbor who recognized Irene’s intrinsic desire to support others suggested she try her hand at a nursing home role, noting that if she could manage that, she could likely handle any challenge a career in nursing might throw at her. And Irene did just that. “Working as a nursing home CNA gave me my start in nursing, which I found deeply rewarding,” she says.
Irene Goliash, RN Clinical Program Manager, Caregility
After graduating from Alexandria Hospital School of Nursing, Irene stepped into her first registered nurse role at Washington Hospital Center, a 900+ bed tertiary care facility in D.C. “I started on the medical telemetry floor,” shares Irene. “I always knew I wanted to be in critical care. After gaining experience and becoming comfortable with cardiac rhythms, I moved into the ICU, primarily working in surgical, critical, trauma, neurosurgery, and cardiac surgery care.”
From there, Irene transitioned to a role as a Cardiovascular ICU nurse at Georgetown University Hospital. She spent the next seven years providing comprehensive nursing care, patient education, and discharge planning for cardiovascular surgical patients on a combined ICU/Stepdown unit. During her tenure at Georgetown, Irene served as a charge nurse for the entire unit, acted as a preceptor for nurses during orientation, and developed and implemented a unit-based Peer Review system.
Along the way, Irene’s robust nursing experience attracted the interest of health IT stakeholders. A significant turn in her career came when Irene joined Apache Medical Systems (acquired by Cerner) to oversee the development of clinical end-user training programs. Irene was later recruited by VISICU (acquired by Philips) where she would spend the next 16 years managing the clinical transformation process for clients adopting the eICU program.
Irene’s work and connections eventually led her to Caregility, where she currently serves as a Clinical Program Manager working to alleviate the burdens of bedside teams and ensure a smoother healthcare process for patients through telehealth enablement.
“I know from first-hand experience that sometimes at the bedside you feel like you’re just running around putting out fires,” Irene shares. “It’s easy to get burned out thinking of the list of things you didn’t do. I’m all about helping the bedside team. It’s about alleviating their pain points and making the job more satisfying. Both clinicians and patients should feel the benefit.”
“You can significantly improve patient, family, and staff satisfaction just by shifting clinical workload to someone who has time to devote to the specific activity.”
– Irene Goliash
For those looking to implement a virtual care program, Irene stresses the importance of multidisciplinary involvement. “Pull your direct caregivers into the process from the very beginning,” she advises. “Without their buy-in, no matter how good your program is, it will fail. One of the biggest challenges I’ve seen is when customers think it’s an IT project because of equipment procurement and installation, but it’s not. It truly is a clinical project.” Irene recommends involving clinicians when determining program goals, where to focus, and where you grow from there.
Irene sees tremendous potential in emerging virtual nursing programs. She encourages healthcare organizations exploring the hybrid care model to “start small and take baby steps. You don’t have to come in and save the world. Maybe the best thing I can do as a virtual nurse is record your code for you or do the documentation or page people. Let me do the more mundane things so you can focus on hands-on patient care.”
“All it takes is one big win to prove the value,” Irene elaborates. “This can be particularly beneficial in areas where there is just not enough time to devote to things like patient education. We’re often dinged there by patients and families. Having a remote nurse resource who can teach without interruption is a great way to improve that.”
Irene envisions a future where every care team encompasses both bedside and virtual nurses. “Virtual roles can be a great way to harness the experience of nurses who have the knowledge but may not be physically up to a 12-hour shift, which is harder as you get older, keeping 20 to 30 years of nursing experience in my health system to support my bedside team.”Virtual roles can also be outsourced in rural areas where staffing shortages may leave facilities hard-pressed to pull from existing staff.
Irene’s journey is a testament to the limitless potential and adaptability of nursing. She continues to hone her skills as a member of the American Association of Critical Care Nurses and in her work with ATA developing TeleICU nursing guidelines.
As healthcare pivots to a more integrated approach to virtual care, the experiences and insights of nurse professionals like Irene will continue to illuminate the path to better supporting our patients and bedside teams, retaining experienced clinicians, and innovating care delivery.
Interested in connecting with a Caregility Clinical Program Manager to discuss your hybrid care strategy? Contact us today!
