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.
ChatGPT and a plethora of other AI-powered applications are rapidly gaining popularity in today’s tech-driven world. In healthcare, AI and machine learning algorithms are being adopted to drive efficiency in patient-facing and back-office settings alike.
One of the clinical frontiers gaining attention is the augmentation of virtual care programs with AI tools such as computer vision, ambient clinical intelligence, and contactless monitoring. By bringing these AI enhancements into virtual workflows in the inpatient setting, healthcare organizations hope to positively impact patient safety, clinical outcomes, care team experience, and operational performance.
During a recent fireside chat, Caregility President and COO Mike Brandofino sat down with Healthcare Innovation editor Mark Hagland to explore the practicality, best practices, and perils associated with selecting and adopting AI technology to advance telehealth.
AI’s Potential in Acute Virtual Encounters
AI is showing promise in clinical use cases in acute care settings where staffing shortages and burnout are prominent. As Brandofino sees it, one of AI’s biggest benefits is in “augmenting the information that a clinician or caregiver has access to with more clinical insight than they’d be able to gather on their own.” When evaluating tools, he encourages stakeholders to consider the impact: “Is it taking tasks away that can potentially save staff time? Is it a tool that adds to productivity?”
One of the AI functions Brandofino sees potential in is radar-based contactless monitoring. These tools continuously capture patient vitals such as heart rate and breathing rate, as well as track motion in the room. This allows caregivers to see trends over time.
“The AI part of that is the algorithms can detect changes in that pattern that mean something,” Brandofino explains. He offers a practical use case example. “That radar device can tell you, based on telemetry, that a patient is starting to wake up. Now think of a post-op situation where the nurses have to be there when the patient wakes up disoriented. Can you just have a contactless device notify them when the patient is starting to wake up so they can get in there then instead of sitting there for 30 minutes waiting?”
Automated, contactless vitals monitoring also accelerates the frequency and timeliness of clinical documentation.
“If you think about what happens with nurses as they do their rounds and take vital signs, many times they don’t get that information into the EHR until the end of their shift or hours later,” Brandofino notes. AI tools can gather vital signs many times throughout the day and put it through an algorithm to evaluate if the patient is getting better or worse. This allows care teams to intervene earlier and potentially improve outcomes.
Ambient clinical intelligence uses AI tools like natural language processing to draft clinical notes and reports, posing similar efficiency benefits. In care environments where resources are thin and burnout is high, those incremental time savings can add up.
Caveats to Consider When Adopting Health AI
As you evaluate AI solutions to bring into patient care delivery, it’s important not to become enamored with the technology before understanding where it fits into the patient care workflow. Brandofino recommends including all stakeholders—clinical, IT, and operations—in evaluations. “How are you going to support your device fleet? Consider the clinical workflow as well as the experience on the patient side.”
“Think about the operational logistics of supporting what you’re doing,” Brandofino advises. “What we suggest to our customers is to understand the impact that you’re going to have on the staff on the floor and think about what that is going to be like at scale.” Nurses are some of the most interrupted people in healthcare. The last thing you want to do is introduce new tools that add to their stress level, whether that be an overabundance of false alarms or device overload.
Given the newness of many AI tools entering the market, it’s also important to consider who you’re partnering with. Has the tool been implemented in one or two patient rooms or thousands of rooms? Are there examples of in-market success that can offer a roadmap?
Combining AI and Telehealth to Empower Caregivers
By integrating AI with virtual care, healthcare organizations can modernize care delivery with innovative new tools and keep the human element of care intact. AI can drive intelligent clinical alerting, while virtual engagement channels serve as a bridge for immediate staff intervention. When combined, these resources amplify what virtual teams are capable of supporting remotely, doubling down on reducing the burdens on bedside staff.
“We believe that combining that remote nurse with smart technology to help gather telemetry in the room will be really impactful in improving care for patients in the long term,” says Brandofino. “Don’t feel like you have to put in a siloed solution just to get access to AI technology. Look for players that are capable of integrating with what you already have. If you already have high-end cameras and mics in the room with edge processing, what else can you gather in the patient room to give to caregivers?”
Ultimately, healthcare organizations that focus on applying technologies that solve real problems that exist today around the shortage of nurses, productivity, and quality of life for staff will have the most impact.
Interested in learning more about AI-enhanced hybrid care solutions? Contact us today!
Buzz around virtual nursing is building. As telehealth sheds its COVID skin, the virtual care technology is entering a new phase of growth helping health systems advance acute care models to mitigate hospital workforce challenges.
In a recent interview with Commercial Integrator editor-in-chief Dan Ferrisi, Caregility President and COO Mike Brandofino addressed the rise of inpatient virtual care and, more specifically, virtual nursing.
“We lost a lot of nurses during COVID who retired, can no longer work, or just decided they didn’t want to [do it] anymore and we don’t have enough nurses coming in so there’s a huge shortage,” said Brandofino. “Virtual care is being used now to augment that.”
Nursing shortages during the pandemic led to labor cost inflation as hospitals battled for scarce resources. Recent CNBC coverage revealed that the “average pay for travel nurses was $150 an hour in early 2022, which analysts say tempted more nurses to leave staff jobs, increasing turnover and exacerbating shortages.”
That pay rate is three times higher than the national average for full-time staff nurses.
Virtual nursing offers health systems an alternative to expensive contract nurses that not only acts as a force multiplier for care teams but also enhances care collaboration and improves patient and clinician experience.
How Virtual Nursing Can Help Solve Many Workforce Shortage Woes
Healthcare IT News
Virtual care pioneer and Caregility Chief Nursing Officer Wendy Deibert, EMBA, BSN, RN, recently sat down with Healthcare IT News editor Bill Siwicki to offer a deep dive into the benefits of a hybrid approach to nursing that employs telehealth.
Virtual nursing programs are typically campus-based and staffed internally but can also be supported by third-party clinical services or a combination of the two. Workflows vary from campus to campus.
“Some organizations use virtual nurses for patient admissions and assessments or discharge education,” shared Deibert. “Others implement more comprehensive 24/7 patient surveillance and deterioration management programs. The fact that there is no one universal approach is really the beauty of telenursing. Programs can and should be tailored depending on your health system’s specific needs.”
Deibert noted that multiple organizations are actively working with stakeholders within the nursing community to develop virtual nurse certification programs to help establish standards for programs.
Virtual Nursing Programs Adapting to Organizational Needs
Meanwhile, organizations like Mary Washington Healthcare are forging their own path as early adopters of virtual nursing.
HealthTech Magazine editor Teta Alim highlighted the health system’s journey into virtual nursing in coverage of the 2023 American Telemedicine Association conference. Debra Marinari, Associate Vice President of Hospital Operations at Mary Washington Healthcare’s Stafford Hospital, and Heidi Steiner, MD, Clinical Program Manager at Caregility, were on site to share insight into the nursing workflows the hospital is working to virtualize, including admission assessment, plan of care, patient education, and discharge, to name a few.
Mary Washington Healthcare deployed an Inpatient Virtual Engagement solution to support its new virtual nursing program. According to Marinari, the leadership team will assess nurse engagement, patient satisfaction, the rate of nurse turnover, quality and safety metrics, and readmissions to measure program success.
Experts Weigh in on the Joys and Woes of Virtual Nursing
The Atlanta-Journal Constitution
Given the elevated rates of nurse attrition during and since the pandemic, many care teams are onboarding new hires who have limited field experience. As Atlanta Journal-Constitution writer Hunter Boyce shared, another benefit of virtual nursing is its ability to connect new nurses with experienced remote nurse resources who can help guide and mentor them. That secondary line of clinical reinforcement boots confidence for care team members, improving clinician experience and increasing the likelihood of retention.
As Walsh University nicely sums it up:
“The impact of technology on nursing practice cannot be overstated. When nursing technology takes over time-consuming routine processes, streamlining communication and delivering accurate diagnoses and personalized treatment plans, NPs are freed up to do the work that only humans can: providing one-on-one, compassionate care.”
Scaling Virtual Care
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.
What the End of the PHE Means for Telehealth Policy
The announcement came on the heels of the December 2022 passing of the Consolidated Appropriations Act of 2023, the 2023 omnibus spending bill that extends many – but not all – of the telehealth flexibilities introduced during the pandemic.
In light of these developments, here is a breakdown of how the telehealth policy roadmap is shaping up for the next two years.
Permanent Telehealth Changes for Medicare Patients
Removal of geographic restrictions for the delivery of behavioral telehealth services to patients, including coverage of both in-home and audio-only services.
Temporary Telehealth Extensions (Through December 31, 2024)
Healthcare providers may continue to bill Medicare for telehealth services authorized in the Calendar Year 2023 Medicare Physician Fee Schedule with no geographic restrictions, including engagement in the patient’s home and with audio-only communication accepted for select services.
FQHCs and RHCs may act as distant-site providers of non-behavioral telehealth.
Removal of in-person visit requirements for behavioral telehealth.
Expansion of telehealth coverage to include physical therapy, occupational therapy, and speech-language pathologist services.
Extended coverage of Acute Hospital Care at Home care models.
Approval of the use of telehealth to recertify patient hospice eligibility.
Telehealth Flexibilities Expiring at the End of the PHE (Through May 11, 2023)
Use of non-public-facing applications to communicate with patients without risk of federal penalty if the application is not HIPAA compliant.
Telehealth’s protection as an excepted benefit.
Worth noting: In February 2023, House representatives introduced the bipartisan Telehealth Benefit Expansion for Workers Act, which aims to provide American workers with access to employer-sponsored standalone telehealth benefits that are separate from traditional health plans, similar to how vision and dental plans operate.
Provider ability to prescribe controlled substances without an in-person examination.
Worth noting: A February 2023 proposed rule by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Department of Health and Human Services is seeking to permanently allow providers to prescribe buprenorphine for opioid use disorder treatment without the requirement of an initial in-person visit.
These changes focus on putting safeguards around telehealth. Additional regulatory efforts are expected ahead of the waiver extension expiration on December 31, 2024.
In the meantime, two additional questions remain on the future of telehealth:
1) How will interstate telehealth services play out when temporary geographic flexibilities expire at the end of 2024?
Interstate telehealth services were temporarily allowed across state lines during the PHE, waiving state licensure requirements. As of February 7, 2023, 21 U.S. states have solidified interstate telehealth as a permanent or long-term option. You can learn more about state-by-state variation in telemedicine restrictions here.
2) Will payment parity for home-based telehealth services stick beyond 2023?
Flexibilities introduced during the pandemic reimburse telehealth visits with patients at home at a rate that is on par with in-person visits. As Healthcare Finance News reports, the current telehealth payment parity runs through the end of 2023. The annual physician fee schedule set by CMS will determine whether payment parity for home-based telehealth services will be extended into 2024. The 2024 draft proposal is anticipated in July 2023. Among commercial insurers, it’s estimated that roughly half of U.S. states have passed payment parity laws.
Virtual care is one of the biggest developments to fuel digital transformation in recent healthcare history. What began as a solution to mitigate exposure and maintain ties between providers and patients at home during the pandemic has since spawned a hybrid care movement that seeks to further integrate virtual engagement into the standard of care within inpatient settings.
In 2023, virtual care will continue to carve out its place as a complementary care modality, rather than an add-on or alternative to traditional care. Here are some predictions on what’s in store for virtual care in inpatient settings in the year ahead.
Health Systems will Take a More Strategic Approach to Telehealth
“In 2023, I think we’ll see hospitals and health systems take a more strategic approach to telehealth, in large part to address the staffing crisis, from burnout to the shortage of qualified resources. Inpatient hybrid care models will make virtual engagement available to every patient, giving clinicians and third-party providers remote access to every room. We are rapidly moving to a world where we drop the word telehealth and it just becomes how healthcare is delivered.” – Mike Brandofino, President and COO, Caregility (as quoted in Will We See a Value-Based World in 2023?)
Providers will Consolidate Siloed Telehealth Programs onto Platform-Based Solutions
“Given the tough economic conditions of the past few years, consolidation will be a key driver in health IT initiatives in 2023. Providers will look to centralize siloed telehealth programs onto platform-based solutions that are flexible enough to 1) support use cases across the enterprise, and 2) support integration with innovative connected care devices entering the market. The proper implementation and timely deployment of these resources will play an important role in supporting quality care delivery with a diminished healthcare workforce.” – Ron Gaboury, CEO, Caregility (as quoted in Will Technology Continue to Solve our Healthcare Challenges in 2023?)
Virtual Nursing will Move from Concept to Practical Application
“We’ll see virtual nursing move from concept to practical application as health systems seek to put a dent in workforce shortages in 2023. Hybrid nursing programs introduce virtual support resources and remote work flexibility to nursing teams, which can have a tremendous positive impact on nurse training, clinician experience, and care delivery.” – Wendy Deibert, SVP of Clinical Solutions, Caregility (as quoted in Healthcare Workforce – 2023 Health IT Predictions)
AI and Sensor-Based Tech will Redefine what Care Teams can Accomplish Remotely
“Broader integration of virtual resources into bedside care will create new value for health systems in 2023. Accelerated adoption of virtual workflows in hospitals and home-based care is introducing new use cases for AI and sensor-based technologies that will redefine what care teams can accomplish remotely.” – Pete McLain, Chief Strategy Officer, Caregility
As virtual care and adjacent technologies continue to evolve, they will become vital tools within inpatient care delivery that give health systems new ways to deliver care in a safe, convenient, and cost-effective way.
Virtual Care’s Role in Building Health Equity
In a string of years marred by some of the most challenging times in recent healthcare history, one positive trend is the buzz that has been building around health equity. Recognition of health disparity and the push to reduce it is building.
As providers look to build more accessible and inclusive care models for patients, virtual care has an important role to play. Here are a few examples of how telehealth is helping the cause.
Rural Care Access
Telehealth has long been lauded for its ability to reduce rural health disparity by facilitating virtual access to specialist care for patients in medically underserved areas.
Virtual care encounters also reduce barriers to care for patients who reside far from their local providers. Recent research revealed that patients with longer commute times to care sites were more likely to use telemedicine services, and the likelihood of having a telemedicine appointment grew with increasing commute times. Virtual engagement options similarly improve care access for those who have schedule restrictions and those without reliable transportation, many of whom are also economically disadvantaged.
To mitigate the risk of amplifying health inequity for those without access to broadband or enabling technology, many healthcare organizations are dispensing devices to patients to ensure equitable access to virtual care. Local, community-based outlets are increasingly providing device access, as well.
Engaging with Disabled Patients
One area where virtual care and digital health innovation can play a tremendous role in promoting health equity is within the disabled community. Travel arrangements can be particularly difficult and costly for patients with mobility limitations.
Virtual engagement is ripe for further innovation in disabled care. As advancements in computer vision and precision eye-tracking enter the market, non-verbal patients are empowered to engage with remote clinicians. The incorporation of eye-tracking into virtual care also introduces new possibilities in the field of remote clinical diagnostics for neurodegenerative conditions such as Alzheimer’s, autism, and Parkinson’s, where problems in the brain can typically be detected in eye function.
Language Interpretation Services
For many patients, healthcare can be out of reach due to communication barriers. This can lead to greater health disparity, particularly within healthcare organizations serving culturally diverse patient populations. Patients with limited English proficiency, or LEP, are at a disadvantage to receive equal access to services due to the language barrier.
By integrating virtual remote interpretation capabilities into telehealth programs, health systems are reducing health inequities for deaf, hard of hearing, and LEP patients. This ensures 24/7 access to high-quality remote interpreters trained to provide culturally competent communication to support patient care. Video-enabled virtual engagement additionally supports ASL-based communication and allows providers to pick up on non-verbal patient cues and body language.
Decentralized Clinical Trial Support
Telehealth is also being used to support greater diversity in clinical trials where minorities have traditionally been underrepresented. Some 50% of FDA trials are conducted in one to two percent of all US zip codes. This limits research into the efficacy of care treatments across diverse populations. Through virtually enabled remote clinical trials, medical researchers can cast a broader geographic net to ensure that the patient sample is more reflective of the population.
Each of these virtual care initiatives plays a part in reducing health disparities and advancing patient care. And we’re just beginning to scratch the surface of what’s possible. As hybrid care and digital health innovation continue to ramp up in the coming years, telehealth will continue to redefine how we think about patient engagement and care.
Virtual Nursing for Post-Acute and Transitional Care
Virtual nursing programs continue to make headway as health systems look for new solutions to the ongoing staffing crisis. Many of the virtual workflows sprouting up in inpatient departments have applicability in post-acute and transitional care, as well, where the impact of workforce shortages is also being felt.
Here is a look into how virtual nursing can support transitional care management, home care, population health, post-acute care, and hospital-at-home models.
Transitional Care Management
A patient’s discharge signals the start of a 30-day period where Medicare pays for services to help the patient transition from inpatient services to a community-based setting. Patients are typically moved to either a home, long-term care, or assisted living facility.
Many of the processes to prepare patients for care transitions can be fielded virtually. Providers are required to contact the patient within two business days of discharge, followed by a face-to-face visit within 14 calendar days of discharge for moderate-complexity patients and within 7 days for high-complexity patients. Supportive services provided by a virtual nurse can include:
Coordinate follow-up visits, durable medical equipment delivery, etc.
Educate the patient and/or caregiver on self-care, activities of daily living, etc.
Support adherence to the treatment plan, including medication management
Provide access to community resources and assist with care navigation
Traditionally, care has been delivered in person when patients transition to a home setting.
Hybrid “tele-home” care models are emerging where a home care nurse may see a patient in person on the first visit and then virtually after that unless hands-on nursing care is required (i.e., dressing changes, wound vac care, etc.) or in-person visits are deemed necessary.
If practitioner-ordered virtual visits are incorporated as part of the patient’s Plan of Care (POC), the virtual visit must address specific patient needs identified in the comprehensive assessment and incorporate interventions and measurable outcomes identified in the POC.
Many home health agencies provide patients with Bluetooth or wireless devices such as pulse oximeters, blood pressure cuffs, glucose monitors, and scales connected to a tablet. This allows virtual nurses to track patients more frequently, between formal visits, to catch trends and head off deterioration before resulting in an ED visit. A home care aide acting as a telepresenter for the virtual nurse can also be used for virtual nurse visits.
In a study of nearly 1,400 patients with 314 patients belonging to a hybrid model, there was a significant reduction in hospitalizations in both the 30- and 60-day time period for those in the hybrid model. This patient group also demonstrated better clinical outcomes across a variety of measures.
Population Health & Chronic Disease Management
Chronic diseases continue to plague approximately 46% of Americans, with almost 30 million people living with five or more chronic diseases. Leveraging virtual care can dramatically improve outcomes for patients living with difficult-to-manage chronic illnesses.
Employing virtual nursing to support chronic disease management increases patient adherence to their POC. It also provides a quick and easy way to connect with their care team more often for early intervention to prevent unnecessary trips to the ED or hospital.
Remote Patient Monitoring
Remote patient monitoring (RPM) helps achieve chronic disease management goals while reducing patient travel costs and infection risk. Conditions that are appropriate for RMP include hypertension, diabetes, cardiovascular heart disease, COPD, and asthma. RPM tools are sent to the patient’s home and may include scales, digital stethoscopes, blood pressure monitors, pulse oximeters, blood glucose meters, and questionnaires.
Use cases reimbursed by Medicare include remote monitoring of physiologic parameters such as weight, blood pressure, pulse oximetry, and respiratory flow rate, set-up and patient education for equipment use, and treatment management services.
Knowing how to manage risk alerts is a key to success and guides the actions and interventions of the virtual nurse. In this way, patients are informed of self-care interventions, thus improving and reinforcing what they need to know the next time. In addition, alerts from remote monitoring devices help the virtual nurse monitor the maximum number of patients.
Skilled Nursing Facility & Long-Term Post-Acute Care
Telehealth can address over 50% of resident cases typically sent to the hospital, potentially avoiding readmission. To qualify for Medicare coverage, there must be a “qualifying event” that includes a three-night hospital stay that requires skilled nursing or rehabilitation for at least one hour daily, five days a week. Medicare SNF benefits last 100 days without a new qualifying event.
Post-acute workflows that can be performed virtually include:
Provider virtual visits: SNF patients are typically seen by a nursing home provider on admission, then monthly for the first 90 days and every 60 days after, or as concerns present.
Specialty virtual visits: Specialists can be brought in virtually, avoiding patient transport needs.
Ancillary visits: Virtual visits with pastoral care, hospice, family, and friends.
Continuous virtual observation or tele-sitting: Patients at high risk for falls or other safety concerns can be observed continuously and redirected.
Virtual Nursing: Admission, discharge, care planning, chart review, and assessment can be fielded virtually to offset some of the administrative burdens of bedside nursing staff.
Long-term care (LTC) facilities can utilize the same workflows, albeit at a lower frequency given lower patient acuity. LTC facilities provide long-term custodial care that is typically paid for byeither Medicaid, personal finances, or long-term care insurance.The use of a telepresenter is especially helpful within both populations.
Long-Term Acute Care Hospitals
Patients moving to a Long-Term Acute Care Hospital (LTACH) require direct skilled nursing care and have complex medical needs such as ventilator weaning and or complex wound care that can’t be met at a lower level of care. Patients are typically transferred from a hospital’s ICU to an LTACH.
LTACHs must maintain an average length of stay greater than 25 days. For optimal reimbursement, it’s imperative that the acute care hospital discharge patients to the LTACH as soon as feasibly appropriate. Every extra day spent in an ICU instead of the LTACH hinders LTACH reimbursement by minimizing LTACH length-of-stay (LOS), increasing costs and LOS for the acute care hospital.
Like other post-acute inpatient facilities, virtual workflows can support a multitude of use cases. Virtual observation can be more broadly used to support workflows beyond fall and safety monitoring by unlicensed personnel. Ventilator-dependent and other complex patients at high risk for deterioration or readmission can be observed continuously or rounded on more frequently by a virtual nurse.
These workflows can help to interrupt deterioration requiring hospital readmission, decrease adverse events, and keep the LTACH’s LOS intact by treating patients in place.
Hospital at Home
The Hospital at Home (HaH) care model has shown promise for reducing cost, improving outcomes, and enhancing the patient experience. HaH offers hospitals more flexibility to care for patients in the comfort of their own home.
Programs vary based on hospital capacity and patient population needs, but may include:
Medium-acuity patients who need hospital care but are considered stable enough for home
Patients with defined treatment protocols such as pneumonia, COPD, diabetes, etc.
A combination of in-person visits, virtual visits, and continuous biometric monitoring
Diagnostic studies (electrocardiograms, echocardiograms, X-rays), treatments (oxygen therapy, IV fluids, IV antibiotics, and other medications) and services (respiratory therapy, pharmacy, virtual nursing)
The combination of in-person and virtual nursing visits provides patients with 24/7 access to care. If necessary, the patient can visit the acute hospital for treatments that cannot be provided in the home (i.e., CT scan, MRI, etc.). The patient is discharged when stable.
When we think about keeping patients out of high-cost care settings and preventing unnecessary use of the ED and inpatient settings, virtual nurses are key players. They can advise multiple patients during their shift, provide timely care, perform competent assessments, document results in the EMR, and guide patients to the most appropriate level of care.
Nurse triage and advanced practice nurses do what they can to alleviate the pressure on providers who are in short supply and overtaxed. By providing sound care advice to patients on-demand, any time of the day or night, virtual nurses enable physicians to direct their expertise to patients who are high-risk, have chronic diseases, or are in the most fragile condition.
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.
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.
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.
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.