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Category: virtual care

Modern Patient Room Design with Peter O’Connor from Inova

Digital Health Frontiers – Podcast Ep. 3

Peter O’Connor
IT Director, Eastern Region & IT Solutions Design Group, Inova
Mike Brandofino, President and COO, Caregility
Mike Brandofino
President and COO

In this episode of the Digital Health Frontiers, Caregility President and COO Mike Brandofino sits down with Peter O’Connor, Director of IT for Inova’s Eastern Region Development Program, to discuss the health system’s approach to modern patient room design. Drawing from over 30 years of experience in healthcare technology design and facility architecture, Peter shares insights into Inova’s highly collaborative approach to clinical IT enablement, which seeks to elevate patient and staff experience through hybrid care models that integrate telehealth and other technologies into bedside care.

Mike and Peter explore the integration of technology in patient care delivery, the unique task of bridging gaps between design, construction, and clinical processes, and the innovative virtual care programs that are transforming bedside care at Inova. Peter highlights the importance of culture, leadership support, and strong partnerships in driving these initiatives forward. Tune in to learn how Inova is setting new standards in healthcare delivery using technology to create seamless, patient-first experiences.

Read the Transcript

Welcome to Digital Health Frontiers, where we explore the cutting edge of healthcare technology, policy, and innovation, hosted by Mike Brandofino, President and COO of Caregility. Today Mike is joined by Peter O’Connor, the Director of IT for Inova’s Eastern Region Development Program which includes two new state-of-the-art hospital campuses totaling over 1.5 million square feet, as well as a new ambulatory facility that will include a full-service emergency room, ambulatory surgery, imaging services, a family medicine center and medical offices. Peter leverages his 33 years of technology design, implementation, and consulting experience to ensure that clinical process is enabled by technologies that meet the immediate clinical need, fit within Inova’s clinical IT ecosystem, and support the health system’s long-term digital strategy. Today Peter joins Mike to share insight into his approach to patient room design at Inova.  

Mike Brandofino:

Hello everybody. Today with me, I have Peter O’Connor from Inova to talk about some of the experiences that they’ve had implementing virtual care within their health system. Hey Peter. Thank you very much for joining.

Peter O’Connor:

It’s my pleasure, Mike. Thanks for having me.


Can you just describe the health system for the audience, so they get a little idea of what you guys are up to?


Sure. Inova is Northern Virginia’s leading not-for-profit healthcare provider. So our mission is to provide world-class healthcare every time, every touch, to every person in every community that we have the privilege to serve. We’ve got about 20,000 team members that provide more than two million patient visits a year. We have an integrated network of five hospitals, approximately 2,000 beds, and lots of primary and specialty care practices. And interestingly enough, we’re the fourth busiest emergency room in the nation, so our hospitals are recognized with the US News and world reports. In fact, our Fairfax Hospital is the number one hospital in the DC metro area. We’re in the top 50 in neonatology, and top 20 in the nation for OBGYN.


So, can you talk a little bit about your role? I think it’s a little unique, although I think some health systems are starting to put some focus around this. But can you talk a little about your focus and your position?


Sure. It’s been really fantastic and it’s been a role that I really feel like my career – which is going on 33 years – I feel like the last 30 years have really prepared me for. We have a unique team at Inova for design and construction. I’d say we have a bit of a dream team. We’ve got our own engineers, architects, former contractors, & Clinical and operation experts. So, in my almost now 40 years I’ve never seen in healthcare design and construction an owner’s team with this level of experience.

So my role is pretty interesting. I bridge the gap between design and construction, IT, clinical engineering, and operations, which are typically siloed in a design process. The Inova leadership team saw an opportunity to have somebody with experience in all of those bridge the gaps and translate clinical process and what it’s going to look like in 2028 into enabling technologies and then turn that into something that can be procured and also built.


You know, it’s such an interesting role and I wish more health systems would have that. So many times we’ll be talking just to the clinical side and then then when you start talking about implementing any kind of solution then either the technical side or even the facility side comes in and goes “oh, no, no -you can’t do that because of this,” or “hey, did you know there’s a lead plate in the wall next to the room that you wanted to do that Wi-Fi in?” So, I think it’s really an interesting role.

What’s it like to bridge that gap and pull those people into the same room, so to speak?


It’s honestly exciting. It’s knowing that we can pull those people together in a collaborative space and brainstorm and learn from each other and really feed off of each other’s energy. It’s one of the reasons I came to Inova. I’ve had the privilege of working with lots of hospitals throughout my career in the architecture and engineering world and I’ve found that a lot of — if you could imagine folks swimming in a pool — that a lot of times it’s exactly what you said. Biomed may be going one direction, clinicians may be going in another, IT may be going another, and everyone’s swimming in a different direction. At Inova, I found that everybody was swimming in the same direction and with the same objectives and my role allows me to lift those little buoys in between the swim lanes and have everybody kind of work together and go in that same direction and see what other people are doing and leverage those experiences and come up with some really innovative solutions.


How much does the patient experience fit into what you guys are trying to do?


Patient experience is obviously essential. From my perspective, from a technology perspective, we want that technology to be seamless, and transparent, and to always enhance the patient and caregiver experience. When that technology becomes front-of-mind, kind of replacing healing and care front-of-mind, we’ve done something wrong. We have a tremendous responsibility to design places that heal, places that – on somebody’s worst day, whenever they feel they’ve lost all control over their environment – use technology as one of those ways to help them find some level of control and normalcy through access to information, access to education, control over their environment, access to the amazing bedside team, and make that as simple as possible for the patient. That patient experience and bringing some level of normalcy and control to a very hectic time in their world is critical for us.


We spend so much time focusing, even as Caregility, on the clinician, primarily the nurse because they’re the ones using the technology the most, but we can’t forget the patient experience and what they’re going through. So that’s great that you guys have focus on that.


Our IT and nursing leadership consistently remind all 650 of us IT teammates that were part of the care team. They encourage our IT team, whether you’re in leadership or you’re an analyst or you’re in the service side, to round just like the clinicians do. So, spending time on those various units gives you that real perspective of the patient and the teammate experience. Simply put, our mission is to get the right information to the right people at the right time to make great decisions.


Sure. Well, stay on the clinical team. We have we have a chief nursing officer and some nurses on staff and I constantly get, “But Mike, you don’t understand what the nurse is going through in the room at the time. You’ve got to consider that.”

What insights are you getting from your clinical team as it relates to helping them in the day-in-the-life of a caregiver?


We’ve had this pretty extensive design process for our new Eastern region expansion, which is two full size hospitals, full medical campuses, a Cancer Center, a specialty care center, about a million and a half square feet. So over the last two years, we’ve had thousands of hours of clinical input. We even built full-scale mock-ups of patient rooms, treatment rooms, ORs, imaging spaces, even the team stations to ensure that those designs work within that clinical workflow.

But, also, they were prepared for future technology and clinical processes. So having the clinical team come into, let’s say, a hybrid OR and they can move all the pieces around and they can mock a code or they can mock a certain procedure – gives us insight that you can’t get out of looking at a floor plan, or even can’t really get out of some of the 3D modeling. It’s just nothing beats walking into a room that’s fully constructed, and they can move things around, which is fantastic.

I would say that one of the keys to our success has been that our projects are led by a clinical team. It’s a million and a half square foot Eastern Region Expansion led by a clinical team. Heather Russell is our VP of Eastern Region Development. Eric Miller is our director of Eastern Region Development. They both have extensive clinical backgrounds. They’ve been instrumental in ensuring that the clinical voice is not only heard, but also that the clinical process is understood by everybody involved – all of us internal experts, the design construction and architecture teams. So having a construction project led by clinical operations and supported by in-house industry experts has really been our secret to success and taking that clinical voice and translating it into something that can actually be built.


That’s great. Having the buy-in it is going to help. What are your biggest challenges? Sometimes the challenge is just people having an aversion to change and others are just that some of these hospitals are old or challenging to change, especially with patients in rooms and it’s kind of like changing the chassis on the car while it’s moving.

What are some of your biggest challenges?


I guess from a change perspective, you’re talking about physical change from an infrastructure, but also change from a culture and thought process perspective. The good news is our CEO, Dr. Steven Jones, reminds us all – and this is in all of our Web leadership meetings, in-person leadership meetings, any time that we’re fortunate to spend with him – he reminds us to challenge the status quo and always ask why. That spirit of unrestrained curiosity has led us to either reevaluate and reconfirm current processes or quite often, it’s been the catalyst for change and to explore the why-nots and make them real. So, from a culture perspective, we are well positioned to embrace change, look for change, ask for change from the clinical level through the IT level, and design, and construction, and facilities – you name it.

But some of the challenges that we have is taking all of that that we’ve envisioned for change and documenting it well. When you’re looking at a million and a half square feet of design and you’re trying to coordinate architecture, MEP, medical equipment and technologies, security, AV, there’s a lot of moving sites or moving parts for three sites that we’re building. Traditionally projects like this, the lack of decision or direction is usually the biggest challenge. Fortunately, with our clinical leadership team on the project that’s not been a challenge really. It’s making sure that all those voices and all those hours of work and working through the clinical processes and translating that into a built environment gets documented well and gets constructed the way we expect it.


That’s great. It sounds like the executive team is close to these projects and provides you that aircover that you need. That’s great to see. We’re seeing some customers who lack that kind of centralized support. You have pockets of folks fighting to try and get the attention, the funding, and get their program projects through. It seems like you guys have kind of centralized that and have the executive team providing overall air cover.


We do. Our executive team, our C-level team, knows about every square foot of the new construction. Heather, being a nurse herself and a senior member of our core leadership team, that visibility and that voice – anything that we need, decisions to be made, executive direction – it’s one phone call away with Heather. And from an IT perspective, our Chief Digital Information Officer and our Chief Technology Officer are highly engaged as well as all the senior members of our networking cybersecurity infrastructure team. So, from day one, everybody’s been engaged in these projects. Throughout my career – as I’ve mentioned, I’ve worked on other projects – I haven’t seen that level of engagement. As you said, I’ve seen pockets of engagement. I don’t think I’ve ever seen the systemwide level of investment of time, energy and, direction in projects like this.


That’s great. In projects this scale and size, you have multiple vendors and partners – we like to consider ourselves a partner because we’re in this for the long haul with our customers.

What are you looking for in vendors and partners as these projects progress?


The scale of what we’re doing – we’re adding a million and a half square feet, two new campuses, but we also have five existing campuses and 7,000 nurses and so you’ve got a very complex existing enterprise environment and then you’re adding on to it with new construction and innovation. How do you take some of that new technology and put it into the existing environment and how do you take ideas that we want to do today and translate that into something in 2028?

What we look for are industry segment leaders that want to collaborate. Folks that are innovative themselves. They’re looking to the future. We want partners to have that same “why or why not” conversation with us and that we can have with them. It is truly that partnership of collaboration. Folks that fit into the Inova culture, that have that mindset. We need partners that are willing to work with other partners and create enhanced integrations that enable that seamless experience that I identified earlier. Without that type of collaboration and partnership – and as you said, in for the long haul – it’s not going to be easy. We’re going to be pushing and pulling on each other. But I’m a firm believer that sometimes you go through a little heat, and you create relationships. The strongest bonds are formed with heat sometimes and so you get a great partner that will get in the trenches with you and help figure this out. And then everything just seems to work out for the best. So, we’re fortunate to have wonderful, wonderful partners.


That’s great. So, the buzzword right now in healthcare is Virtual Nursing. Hybrid care is another term for it. We’re actually seeing some tremendous feedback. Customer satisfaction is up. Nurse retention is up because of it in some of our health systems.

How is your organization thinking about hybrid care? Is it being embraced and are you seeing any success at it yet if you’re actually going down that path?


We’ve transitioned from thinking about virtual care to living it and breathing it every day. We’ve got some innovative thought leaders from our Chief Nursing Information Officer, Maggie, our Chief Health Information Officer, Dr. Kramer, and our Senior Director of Telemedicine, Steve. We have implemented an industry-leading Virtual Nurse program, which began with some basic use cases with virtual admit and discharge, patient education, patient pain reassessment. Those use cases alone have reduced bedside time by roughly 30 minutes per nurse per shift. So, you can imagine giving 30 minutes per nurse per shift back to that bedside nurse to do the things that he or she is really, you know, in their heart, they want to do. They want to deliver bedside care, right? Not be going through a lot of things, so it’s a great use to those resources and somebody that can step in virtually and assist that patient in whatever they may need.

So now, since that’s been so successful, we’re now looking to dual consent, we’re looking to case management and wound care as additional telemedicine applications or virtual care applications. So again, expanding that footprint, that technology that we’ve invested in. You guys have been a phenomenal partner with us in doing that. So just extending that program, so all of our five sites are connected back to what we consider a very innovative high-reliability Operations Center, which is our rock where Virtual Nursing, our Central Telemetry, our Central Sitting Resource Management, our Transfer Team all operate out of the same suite on one of our floors in our corporate campus. So, you can imagine all those folks are together to make great decisions about moving patients, taking care of patients, all in that same area. We’re looking at serving 2,000 beds out of a central location. It’s been pretty innovative and it’s been open almost a year now and we’ve had nothing but tremendous feedback from our nursing teams and our patients.


That’s great. We love to hear that because I think we’re getting close to a time where you could just cross out “tele” and “virtual” and it is just healthcare. It’s the way we have to deliver healthcare these days. You mentioned in the partnership, the need to be able to work together.

So how important are integrations? And from that perspective, what do you think the vision is of patient experience in Inova as you go forward?


I keep on coming back to that word “transparent.” Those integrations have to be what I consider invisibly critical. And today, you know, in our personal lives, we all expect context in our alerts and how we integrate with our devices and you know the ability to delineate the noise from what’s really important and the same goes for our healthcare environment. You know the EHR gives us context, the nurse call is that patient’s lifeline, the interactive patient engagement system is that medium to provide education and information, and virtual care is that reassurance that you have a multidisciplinary team ready and available to be there whenever our patients need them, whether it’s in the patient room setting or it’s in the emergency room or it’s at home.

To your point, I think it is just healthcare. It is just a different way to meet people where they are and I think so often healthcare institutions have this mindset of “you have to come to our site, you have to be in our room.” We have two million patients that we have the privilege to serve and finding the best way possible to do that in whatever environment it needs to be is really where we need to be as an industry.


Something that’s been top of mind for a lot of folks — from an ROI perspective, there’s soft-dollar ROI, there’s hard-dollar ROI – how does your CFO look at some of this? Do they consider the soft-dollar ROI as well? That patient satisfaction, the nurse satisfaction. Does that play into your ability to continue to expand these programs?


Oh, absolutely. So we’re always patient-first. Fortunately, we’re a very successful not-for-profit healthcare system, and our ability to reinvest in our infrastructure, reinvest in our people, reinvest in the community and programs, we’re very blessed to be able to do that. But in order to do that, we have to be operationally efficient. We have to have the volume of patients that people want to come to Inova and want to be treated at Inova. So it does come down to those soft dollars. They are really hard to put a number on or a value on, but, again, we’re patient first so having our care team enabled with the best technology, having them to do what they do best at the bedside, having the best diagnostics and ability to intervene and deliver care – it is the most important thing to us at the end of the day. If we’re successful financially doing that it just gives us the ability to do that even more in more places to more people and have better technology.

Being a not-for-profit, private healthcare institution is a really unique thing and we’re really in control of our destiny and how we apply those resources. Our leadership team has done a wonderful job with that balance of growth and reinvesting in our infrastructure and also caring for our communities and the people who are less fortunate who can’t afford care.


Clearly, you guys are a leader, and your role alone. What to me is unique in the space is really taking this seriously and putting some resources around it that really understand how to move these projects forward.

So for those health systems that are watching this, that maybe haven’t gotten started yet or had some stop/starts, can you give them a nugget of advice that can help them on their way?


I think for us it’s been creating a culture where people are open and willing to listen to what doesn’t work and have the courage to ask “why not.” Having executive leadership supporting change and having partners that can collaborate and not be afraid to add a couple of destinations on the road map for us is critical. I think that the key to our success, it really does come down to – at least for me – it’s culture. It’s having an environment that lets us explore and innovate without being so adherent to recorded direction. We’re always asked the question or encouraged to ask the question “why” so for me, it’s been a culture thing.

You would think that this is all tech and innovation and being able to try different things. If you’re not in an environment that supports that, all the technology in the world is not going to help you. So it’s having the culture. Change starts with the culture.


You speak my language. I always have said technology for technology’s sake is just not the way to go. If you can get the buy-in, if you have that culture that is willing to try things and fail fast, right? Not everything is going to work the first time, but if you’re willing to fail fast and try new things, I think you end up accomplishing a lot more than those who kind of wait for that perfect thing, whatever it is.


Absolutely. The ability to do pilot programs and having partners willing to help us out and see what works and what doesn’t work. In an environment where you’ve you’re confident and you’ve got the confidence in your leadership team that you can try and fail and then you get up and you try again and this works. Having that environment is fantastic. We have a lot of exciting things ahead of us and we look forward to building an infrastructure where we have virtual health in every patient room. All of our new construction, we’ve got it planned and we’re working on processes and plans to move that into existing care spaces today. So you just have to position yourself and look towards the future and the future is, to your point, just healthcare. It’s not virtual health, it’s not inpatient healthcare. It’s just healthcare.


Well, Peter, thank you very much for taking the time to share your experience and your story with hopefully a lot of healthcare systems that will learn from this. I really appreciate it and thanks for joining.


Thanks for having me. Have a wonderful day.

Transforming Healthcare Through Virtual Care with Jonathan Witenko of Lee Health

Digital Health Frontiers – Podcast Ep. 2

Jonathan Witenko, System Director of Virtual Health and Telemedicine, Lee Health
Jonathan Witenko
System Director of Virtual Health and Telemedicine, Lee Health
Mike Brandofino, President and COO, Caregility
Mike Brandofino
President and COO

In the second episode of the Digital Health Frontiers, host Mike Brandofino, President and COO of Caregility, discusses virtual care transformation with Jonathan Witenko, System Director of Virtual Health and Telemedicine at Lee Health. Jon shares Lee Health’s journey from an experimental telehealth project to cultivating a new cornerstone of modern healthcare delivery.

Jon reveals the intriguing origin story of telehealth at Lee Health, beginning with a focus on stroke care to overcome geographical challenges and improve patient outcomes. Learn about the innovative programs at Lee Health that propelled virtual care from a niche service to a comprehensive strategy encompassing inpatient, outpatient, ambulatory, and population health.

Read the Transcript

Welcome to Digital Health Frontiers, where we explore the cutting edge of healthcare technology, policy, and innovation, hosted by Mike Brandofino, president and COO of Caregility. Today, Mike is talking to Jonathan Witenko, the system director of virtual health and telemedicine at Florida-based Lee Health. Holding multiple certifications from CHIME, Microsoft, Cisco, and others, Jon helped design and implement telehealth at Lee Health in 2014 with inpatient stroke and over the years grew the program from one project to a systematic rollout of inpatient, outpatient, ambulatory, and population health programs. Lee Health is a great example of how virtual care has evolved from a nice-to-have to a critical application. In this episode, Mike talks to Jon about this transformation along with the responsibilities and new challenges it brings to healthcare.

Mike Brandofino:

Hi everybody. Welcome to Caregility’s podcast. Virtual care has been around for many years, but recently it’s kind of gone from nice-to-have to a critical application, and I’m happy to have with me Jon Witenko, who drives virtual health for Lee Health system to talk about that path, that journey, if you will, from nice-to-have to critical. Thanks for joining us, Jon.

Jon Witenko:

Absolutely. Good to see you, Mike.


So if you could share with everybody, how did it start? So when virtual care started for you and Lee, what was it like? What were the challenges you were facing and how many people were involved?


Yeah, absolutely. So we started virtual care actually in 2014. It was a one-off project. We had a group of neurologists, excuse me, that were doing stroke care. And geographically, one of the challenges is there’s non-value added time of driving from hospital to hospital. So ideal state, we’d have a neurologist sitting there 24/7 twiddling their thumbs, waiting for patients to come in and have a stroke. Well, the reality is it’s not cost-effective. So we have one physician covering four or five different hospitals, and depending on where the patient comes in, they may have to drive from facility to facility. And this is the model that’s existed for a hundred years, as long as we’ve had hospitals. Well, contractually we’re facing that issue of the windshield time, as they call it, of driving from hospital to hospital. And the patient, all the time, has this block in their brain, a brain bleed, and I’m not adding any value just sitting in the car.

So can you do something cool to help that? Can you teleport me? Can you do something? And so that’s where for us, telehealth was part of everybody back in the day, 10 years ago was, alright, you either start with behavioral health, the clear Baker Act, or you start with stroke. And so for right, wrong, or indifferent, we started with stroke and I started working with Dr. Carracino at the time who was our neurologist and I think maybe had been our CMIO, I’m not sure his role, but was a neurologist taking call and said, all right, what does this look like? And I said, well, I am not a clinician. I’m an engineer by trade, a computer engineer, so tell me what you need. And he said, well, for me to do an assessment, I need look in the patient’s eyes, see their pupil dilation, hear their speech, do they have a tremor? Are they coherent? And then a little bit of a physical assessment. So they have to squeeze and range of motion kind of things. Okay, so do you need to physically touch the patient?

He said, other than the squeeze and there’s a stroke scale, but somebody else in the room could do that. Okay. I said, well just get the doc on site to do all that stuff. He said, no, that’s why I went to neurology school. I’m specifically trained and I have to make an evaluation. Do I give this patient TPA this drug or not? I’m the only person, it has to be a neurologist that gives that order. Okay, so let’s figure out, can we do it with a camera and what does that look like? Let’s just put a webcam in the room. Again, this is 10 years ago and there wasn’t a lot of folks doing it. And so we really started to look at who’s building a telemedicine cart, if you will. And there were a couple of big-name vendors, but it was really cost-prohibitive. It was about $80,000 a cart for a beautiful touch model. And we said, well, we don’t have that much money. We have about a hundred grand and we have five different hospitals, so we can’t divvy it up and get it in the car and drive it.

So we ended up buying the technology. I built the carts myself in my garage and we put it out there and then crossed our fingers and said, okay, does this work? And Dr. Carracino came in, he was actually the first one to use it and he came in one day and he goes, Jon, great news. Last night, I’m sitting at home and the phone rings. And he goes, well, it’s at Gulf Coast. And at the time they couldn’t get paid for telehealth. He said, I’m just going to drive into the office. I live two minutes away. I’m going to drive in. Well as I’m about to drive in, the phone rings again or the pager goes off, I get a second consult. And this one was for across town, across the bridge. He said, uh-oh, now that’s the defining moment. I have two stroke alerts. Usually never happens. You get about one every two hours and I have two in a minute, so I’m going to have to use telehealth. So he gets on and all of a sudden a third page and then a fourth page while he was on. So within a 15-minute span, he had four pages for three different hospitals, different patients, all this stuff.

I said, well, what happened? He said, no big deal. I saved four people and triaged appropriately and saved them all. I said, well, what would you have done last week if we didn’t have this system? And he said, well, I would’ve triaged and picked the younger patient or the most important – whatever I would’ve based on protocols – and I would’ve seen one out of the four, and the other three would’ve had months of rehab or maybe not made it or whatever it was. And so at that point, he was bought in and it became, we transitioned it from, okay, we’re going to somewhat use it to, no, this is the way you have to do care because the old way is no longer safe. We can no longer wait 45 minutes to see the doc. We need to see him in three minutes. Sure. We quickly transitioned over and then it became the next, goodness, five years let’s say, until COVID, of expanding that, taking that vision out to the organization and the community, and saying, this is beneficial. This is a game-changer for us to deliver care not only for the physicians. Yes, it’s convenient for the system, it’s more financially feasible.

And for the patients, again, back in the day, reluctant – why do I have to see a guy on a TV? Well, okay, the alternative is you wait 45 minutes while your brain is incapacitated. Alright, fine. I’ll see somebody now. And so it was a little bit of evangelism. It was a little bit of goodwill and talking about benefits and selling the concept and then COVID happened.


Yeah, that’s interesting because obviously telestroke has been around a long time and it’s interesting to hear the stories about how it got started and then you kind of think to yourself, wow, how did we ever operate without it? Right. You mentioned COVID. Was that the watershed moment for you guys at Lee where it obviously sounds like stroke became a critical app earlier, but where virtual care in general, this whole idea of hybrid care, was that the watershed moment for you and the executive team at Lee?


Yeah, absolutely. I remember actually December of 2019 it was, I presented to our senior leaders, our board of directors – here’s what we’re doing with telehealth and here’s the vision, here’s the plan. And it was met with a little reluctance of it’s great and all it has specific niche use cases, behavioral health, neurology, hard-to-reach, niche environments, genetics, et cetera. But for the bulk of it, internal medicine, no, we can see the patient all day long. And really the challenge was we weren’t getting paid. Unfortunately, we’re a mission-based organization, but at the end of the day, no margin, no mission. How do you financially feed the beast without reimbursement? It’s beneficial, saving lives, all this stuff, but if you don’t get paid from insurance… And so I think we were always waiting, we’re in a non-parity state in the state of Florida, and so we’re waiting and watching. Goodness, 30 of our fellow states in the nation had passed this, but Florida hadn’t. So we’re stuck and struggling. And then the senior leaders are like, it’s great, but just continue to kind of grow and grow and grow and we’re not going to expend a lot of time, energy, resources into this.

And then March of 2020, so four months later, three months later, we were looking going, okay, this is where we want to go and this is a slow and steady progression, and then suddenly we shut our doors just like everybody else. And I remember getting on a call, I was on spring break with my family and I get a call from the senior leaders and they’re like, Hey, that telehealth thing you were talking about, we need it now. Okay, well it’s going to take, and they said, and we need it by Friday. I was like, well, today’s Wednesday. What do you mean by Friday? And they said, well, we’re shutting down everything. We’re going a hundred percent virtual. Well, our system can handle five at a time, and we needed to flip that over to 500 at a time or a thousand at a time.

So that became the moment of, wow, this is how we’re going to not just improve business, but this is how we’re going to sustain as a company. We either shut our doors and safely distance from patients, or we pivot. And so it became we need to pivot now.


And I remember going through that with you guys and it was a crazy time with you and obviously a lot of other customers. And so that was definitely I think a watershed moment for the healthcare industry to figure out how we can continue to operate and give care during the global pandemic. But then coming out of that, it’s kind of interesting to me that during that time, I think most of the focus and even the media’s attention was on that physician/patient – I can’t see them in person, so I’m going to schedule a remote telehealth session with them and give them a prescription – that outpatient model was most focused on. But the interesting thing coming out of COVID, what we’ve seen and we’ve seen it with you guys as well, is expanding programs on the inpatient side and how this hybrid model has really started to take off. And I’m wondering if at some point it’s table stakes to be able to see and hear in every room. And so maybe you can talk a little bit about the expanding programs now on the inpatient side and what your thoughts are around – do we take the word “tele” out of healthcare now and is it just how we deliver healthcare?


I love that line. Yeah, it’s interesting. Again, it’s hard being an evangelist, a prophet in your own land, if you will. And as we’ve been beating the drum, and I remember sitting probably, I don’t know, April, May of 2020, my parents called me up and they’re like, we’re seeing our doctor over telehealth. Do you know anything about this? And I was like, this is what I’ve been doing for the last five years. And they finally understood it. And I think a lot of folks are still of that mindset. It’s taken a while. I mean, I sat in a meeting this week as we’re talking about, we will shift to inpatient in a second, but for ambulatory, how do we move from, sure, we have some docs doing it, but we’re not a high percent. Three, four percent of our visits from an ambulatory perspective are telehealth and we’re pieces and parcels.

But we have newer physicians coming in out of residency saying, okay, what day is my telehealth day? And that’s not a like, Hey, I’d really love to do this, that’s a demand coming in of which day. Okay, great, I’m in the clinic four days, which day am I at home? And it’s no longer a bargaining tactic, it’s really, this is my demand coming in. And we’re trying to figure that out. So again, we’re a little slow strategically, how do we move to a virtual-first model? The effecient ones aren’t, okay, I’ll do telehealth one out of every 17 visits. That doesn’t work. It needs to be batched. So we had a physician call out the other day and they said, Hey, I’m sick. I can’t get kid care or whatever. I’m switching to virtual today. And our system’s broken and it was like, no, we need three weeks a month to schedule you out. And it’s like, so some of the tools are still slow to adopt. How do we change that visit type, immediately switch the whole thing. And we’re still of the mindset of, well, come into the office. This is what we’ve done for, like Henry Ford, this is how the factory runs. We’ve done this for a hundred years. And shifting that thinking is a little tough. It requires a little more thought of what’s more efficient.

And then moving to the inpatient model, it’s the same kind of thing. We’ve done nursing forever. We know nurses at the bedside. It works all day long, this is what they do. And suddenly we’re starting this virtual nursing program and we’re met with some cultural reluctance of is this really going to work? Are we going to, it’s an extra cost. Well, it is if you’re thinking short term, if you’re thinking shortsighted, yes, we have to put another person in the room, we have to staff this. So there is an extra layer of cost to it. But then you start looking at the efficiencies. I was looking last night, our time to discharge, M7, length of stay, readmissions, education, patient satisfaction, everything is through the roof.




So it’s a little bit different of that ROI model of how you can’t just look at, yes, it’s an extra cost, but it’s really the big picture of what is the cost to deliver care, and then when does this become part of the standard? As you said, it’s no longer the virtual care, it’s part of your care team. It’s part of the expectation. I come in the hospital, I want that. We’re calling it internally the operation warm hug of I want to know that you’re there for me when I need it, and I want to know that you’re there for me when I don’t know I need it.


Right, right. Yeah. It’s got to be part of the healthcare process because you never know when you’re going to need it. Right. So you were there at the beginning, you made it through COVID. We all kind of weathered the storm and we’re seeing growth in Lee’s expanding programs. What has changed in that time from an executive involvement and oversight on these programs and the exposure? It would seem like it’s now reached the top levels and it’s no longer just you and Dr. Carracino going off and doing some things. So what has changed as this has become more critical?


Yeah, I think COVID revealed a lot of stuff. One, it changed the consumer expectations and perceptions of, Hey, I want that personalization. I want care the way I want it. So we’ve had to rethink a lot of stuff in terms of simplest notifications. Do you want to be called, do you want to be texted? Do you want a hot air balloon? We’re dealing with a patient right now who said, I don’t want you to call. Okay, well, so we’re having to trigger those individual notifications, and it’s the same as, why do I have to be seen in person? I’m going to come in for my follow-up to read an X-ray that I already have the results immediately through my patient portal. You’re going to make me come in? Again, some of it is stuck in the old way. So what I’m enjoying now is the conversation has shifted from reactionary to how do we really want to deliver care and what do our patients want, what do we want?

It can’t just be great for the patients. That may not work for us. And it can’t just be great for the docs. It can’t just be great for the system. It has to be a mutually beneficial relationship of saying, you know what? One out of every – let’s say you come into the PCP twice a year above 65 kind of wellness – so one of those is in person, one of those is virtual and pushing that. So maybe some patients can’t. I get health equity and we’ve got to make sure everybody’s on the same page, but we need to figure out that better model. And those are the conversations we’re getting to have now, wrestling through not from a reactionary of, Hey, let’s just put it in, we’ll figure it out later and let the chips fall as they may – now it becomes the pragmatic question of we’re struggling with resources, reimbursement is getting cut constantly. We just went through cat five hurricane, so that’s a whole separate issue. So now how do we think smarter? And we brought in new leaders, we’re looking at the system saying, what is our strategic course of events? How do we compete in the competitive landscape? And so it really becomes that proactive, let’s make intentional, targeted, rational decisions about the future of care delivery. And those are the fun. I mean, it is painful, it’s exhausting, it’s deep, it’s heavy. But those are the good conversations rather than lemme just put out another fire.


The competitive nature of health systems is something that I learned as I got involved in healthcare when we launched Caregility and it was a surprise to me, and I think it was actually you that said to me or maybe Dr. Carracino, we want to own the experience throughout the continuum of healthcare for our patients. And that’s why it was so important for you guys when you expanded the outpatient to continue that experience and give that to patients throughout. And so it’s just great to see you guys driving that vision. And it is a competitive thing. If you can capture those patients and give them a quality experience, they’re going to stay with you throughout their healthcare continuum.


And again, you really have one shot to win the patient, to lose the patient. Really gone are the days where, okay, I’m going to experience quality care. We can stand on that quality. Well, everybody should be doing quality. There’s enough data out there and metrics that you’re getting a quality experience. Now it becomes how efficient are they, how optimal are they? Are we getting you out sooner? As beautiful as our hospitals are, nobody wants to sit there. I’d rather spend a week on a cruise than a week in our hospital, better food, prettier view, all that kind of goodness. And with insurance, probably it’s a lot cheaper to be on the cruise. So how can you get me out sooner and while I’m there make it as enjoyable as experience?

So as I’m sitting there watching the virtual nurses, they’re connecting with their patients. The normal bedside nurse is so busy, we’ve layered so many things on those poor nurses and they run in the room, they do their task and they’re out. Well, the virtual nurse has not flex time, but the ability to come in the room. They’re not there for that quick or they’re doing multiple, they’re able to multitask. They’re not transactional. They come in and they’re starting to be relational. And this is where you run into the culture rub of why do they know my virtual nurse? The virtual nurse isn’t the one that cared for them. I’m the one that put the bed pan there, They should love me. And all these survey scores are coming back saying, I love my virtual nurse. And so again, it’s creating that friction point. We as a system, but overall the benefit for the patient, the patients love it. You’re getting that individualized attention, that care, that connection that you’re getting me out sooner. You’re getting me seen, you’re bringing in my wife to a conversation, the translator, the education, all those components right there at their fingertips. And that’s what rather than, all right, I’ll sit in the room and listen to watch The Price Is Right on reruns again, they really want that. Give me an experience. I can get it home. And then that becomes, that’s what we’re working on now. That hospital at home is really that end goal. I don’t want to sit in your hospital. I don’t want to acquire something else while I’m there or get more sick. Can I do the same safe treatment at home? And what does that look like? And logistics and food and DME and all that kind of stuff. But it’s doable. There’s programs out there that are running a hospital at home. It’s how we delivered care a hundred years ago. So that paradigm’s going to shift, I think massively heavy in the next probably 20 years.


So Jon, fast forward three years, what do you vision? What’s your vision for Lee? I know we’ve talked about a lot of different things, but what would you like to see or where would you like to see Lee be in three to five years?


So I saw something recently, and I don’t know if it was Mayo or Cleveland Clinic. I kind of give them credit of it: The room is aware of me. And so it’s not, the room becomes part of the care team and suddenly now you start layering AI on top of that and the room is cognizantly aware and contributing to the care team. So it’s saying, Hey, this patient is sleeping. Whatever state they’re in, their patient is sleeping, they’re agitated, their voice as we’re rolling out voice detection kind of stuff from a security aspect. But what if it’s the same in the room? Hey, this patient is depressed, the patient hasn’t seen anybody. There’s been no visitors for a day. Let’s send our therapy dogs in there or whatever. So having that awareness of the room, of the state of the patient, or do we need to, is the patient in distress physically? We can start looking at the vitals in the room? Can we start to record just the temperature of the room or then the patient’s gone, okay, can we make sure the room’s turned over for the next patient? Those type of things – we become more efficient as a system. We become more reactionary to the patient and start to anticipate their needs.

We’ve done the same thing with predictive modeling, with risk of readmission, sepsis, deterioration index. We start looking at data points and we’re looking at those data points based on vitals, based on clinical data. Can we start to incorporate those – the epigenetics term or I can’t think of it – off the epi-vitals of what is the next closest? And don’t just tell me my heart rate, but what about the other stuff that’s going on? And again, that room becomes part of the care team. So the easy ones, yes, we’ve got to put a device in the room to start to aggregate that data. We’ve got to have a way to connect to the patient. The patient has the way to connect to us. And outside of that, and really we’ve built so many different applications and pieces now you start to integrate all those and that’s where the magic happens.


Yeah, I love that. And that’s our thought as well. I’ve been using the term responsible AI because just having technology doesn’t mean anything, but in how you describe it, if you think of the room as having multiple sensors in it that we could gather information from and then provide that information to the right people at the right time, augments care. And that’s the key. So it’s great to hear what your vision is and obviously we’re looking forward to trying to be a part of that.

So you guys are a little ahead of some customers. You may be a little behind some of the big guys like Mayo in some things, but what advice would you give to some of those health systems that maybe have only done outpatient and they really haven’t crossed the line into inpatient or really making virtual care part of their just healthcare strategy? You have a couple of pieces of advice for folks that are in that stage?


Yeah, and the advice probably hasn’t changed since COVUD. I was fielding calls – again, we’ve been doing it for a while, so we’re a step ahead of the others. And so I remember throughout COVID people calling and going, what do I do? And referenced Apollo Levin where they’re sitting in the room and Gene Hackman walks in the room, dumps the box and says, this is what they have on the ship. How do we make it work? There’s a roll of duct tape, a cheeseburger, and a hammer. And they’re like, okay. And so it’s really, the guidance is start somewhere. It’s find those physician champions, the nursing champions, the advocates that’ll experiment and learn through the process. So for us, again, we started with neurology. Should we have started there? Maybe, I don’t know. We started somewhere.

Then suddenly genetics called me. I didn’t even know we had a genetics team, and they called and saw the vision and said, could we connect to babies? Then our pediatric neurology said, I’ve got patients driving two hours because we’re the only pediatric neurologist in the Quad County area. It was just, you start somewhere and then you figure it out and go, well, this was good. This wasn’t, okay, let’s pivot a little here. It doesn’t have to be this massive big bang. We’re trying to put devices in every room. We started in a couple rooms and we started on a pilot unit. Same thing with virtual nursing. We started on a pilot unit. We learned quickly, we had these visions that, yes, it’s going to go this way, this way, this way. Okay, maybe that wasn’t right.

So dream state, yes, I’ve got a virtual command center, a hundred thousand square feet with 500 people in there, all monitoring SpaceX. The reality is I’ve got three people in a broom closet and it’s working. And so then it’s those small wins, the flywheel concept that you just continue to build and build on those. And then suddenly we hit critical mass where I’ve got 17 broom closets and I put in a strategic capital request to say, this is what I’m going for – I can consolidate my 17 broom closets and 38 people sitting in nine different locations, and now I’ll gain even more efficiencies. So that’s where the wins start to compile and win games.


Well, I appreciate you joining and sharing your story with us, Jon. And you do participate in our SIGs. So if there’s folks that are listening to this and want to talk to Jon, please come join our SIGs and I’m sure he’d be willing to share with you. Thank you very much. Appreciate you joining.


No problem. Hopefully I’ll see you soon.


Sounds good. Thanks a lot.


Appreciate the opportunity, Mike.

Virtual Care’s Evolution with Dr. David Shulkin and Mike Brandofino

Digital Health Frontiers – Podcast Ep. 1

David Shulkin, MD
former Secretary of the US Department of Veterans Affairs
Mike Brandofino, President and COO, Caregility
Mike Brandofino
President and COO

In the inaugural episode of Digital Health Frontiers, host Mike Brandofino, President and COO of Caregility, has the honor of interviewing Dr. David Shulkin, former Secretary of the US Department of Veterans Affairs. Dr. Shulkin shares his deep insights on the evolution of virtual care, its critical role during the pandemic, the potential for addressing clinician shortages, and the necessity of regulatory support for telehealth’s future. This episode is a must-listen for healthcare professionals looking to shape the future of healthcare delivery.

Read the Transcript

Welcome to Digital Health Frontiers, where we explore the cutting edge of healthcare technology, policy, and innovation, hosted by Mike Brandofino, President and COO of Caregility. Today we’re honored to have a distinguished guest, Dr. David Shulkin, whose career has been at the forefront of healthcare transformation. Dr. Shulkin has served in several key leadership roles, most notably as the ninth Secretary of the US Department of Veterans Affairs, and prior to that as the undersecretary of health for the VA. During his tenure, Dr. Shulkin made significant strides in expanding access to care for our nation’s Veterans. Through the innovative use of telehealth services as a board-certified Internist and a widely respected authority in the field of healthcare management, Dr. Shulkin’s insights into the evolution of virtual care are both invaluable and timely. Please join us in welcoming Dr. David Shulkin to Digital Health Frontiers.

Mike Brandofino:

Hi, Dr. Shulkin. Thank you for joining our podcast. It’s great to have you. You have so much experience. I look forward to the conversation.

David Shulkin, MD:

Mike, I am glad to be with you today.


So Dr. Shulkin, based on your extensive experience, especially with the Veterans Administration, how do you see the evolution of virtual care impacting patients across the US, particularly in underserved areas?


Well, there’s no doubt that this is a technology that’s been around a long time. It was dramatically unutilized until the pandemic and then, out of necessity, became essentially a mainstay of much of the way that we delivered healthcare. And, unfortunately, now it’s sort of coming backwards and people are returning to the old ways. I think that what we saw in the pandemic and what we now know is that healthcare can be delivered either in person or virtually, but the virtual option, when it’s most appropriate, really does provide access to care to many populations that have struggled to get access to care not only in rural settings, but those who have disabilities, those who have cost issues with transportation, and those who quite frankly wouldn’t be receiving care like in tele-behavioral health if it weren’t for the anonymity and the convenience of being able to get care when and where they want it.


We definitely saw that during COVID; the extensive use of virtual care across many modalities, not just the Teladoc in your home version with the extensions due to expire. What are your thoughts on whether there’ll be an action taken this year or a concern for the future of virtual care?


Well, you’re right, Mike, the regulatory relief that was given to telehealth has been extended only to December of 2024. That’s important because it gets us past the election in November, and then I think that there clearly is an expectation that there’s bipartisan interest in extending, if not expanding this regulatory relief in telehealth. And there are many bills that have been introduced in terms of the Telehealth Improvement Act. Most of them have strong bipartisan support, but I think, as most people see, it’s a challenge to get almost any piece of regulation or law through Congress at this point just because of the political nature and the divisiveness over so many of the key issues that frankly Americans just wish that Congress could work together on to get done. But I do have confidence that these regulations will not expire and go away, but that they will be extended and in fact enhanced and improved to allow telehealth to operate in the way that frankly, it contributes positively to American healthcare.


Yeah, I think especially with the shortage of care providers, it really helped to allow cross-border use and people to really work across multiple hospitals at the same time. So, we hope that it gets extended as well. During your time at the VA, I’m sure you’ve learned some key lessons that could probably be applied to the commercial space. Do you have any thoughts on how what you learned and experienced at the VA can be applied to improve virtual care and patient outcomes?


Yeah, I entered the VA largely because of VA’s inability to provide adequate access to Veterans. Veterans were waiting too long for care, many of them not able to frankly get the care that they had earned because of their service and their sacrifices. And so, in order to solve that — dealing with all of the issues that you mentioned, particularly workforce shortages and the fact that many Veterans live in rural settings out of choice where you don’t have many healthcare professionals at all — we relied heavily upon virtual care in order to improve wait times to improve access. And I think part of what I learned, again out of necessity, was that even though I was the head of the agency having the ability to utilize federal supremacy, which means the ability of the federal government to go above state law, I still struggled with this cross-licensure, cross-state issue because when I tried to implement federal supremacy laws, the states challenged it.

I ultimately needed to ask the President to personally intervene, which I did, and the President did intervene, and we were able to get federal supremacy so that VA was able to operate across all 50 states. And I saw the impact that that allowed us to make, where we had healthcare professional expertise to where Veterans needed it throughout the country. And the playbook that we used in terms of this regulatory relief and being able to use telehealth in the way that I just described was actually the playbook that CMS used in the pandemic. When they acted very quickly and decisively to initiate this regulatory relief, they were able to follow the playbook that we did in the VA. And so, I felt very comfortable that that was going to be very positive for the country. We had watched that, several years earlier, make such a big difference among our Veteran population.


Well, like you, I hope calmer heads prevail on the regulatory front, basically assuming that something does happen. How do you envision the future role of virtual care and what should healthcare providers do now to prepare to take more advantage of virtual care?


Well, there’s no doubt in my mind that virtual care is going to be a permanent and important part of the way that we deliver healthcare still. Unfortunately, access to care is a big issue, and telehealth not only provides easier access to care and frankly, in many cases, more efficient access, but some of the models that I think are going to develop are that it will allow an easier way to provide interdisciplinary or team-based care, which I think for many chronic illnesses is really an essential component that’s missing from the healthcare model as we know it today. So, imagine a primary care provider taking care of their patient using a telehealth model. They need to bring in a behavioral healthcare provider, bring in a specialist into the discussion, bring in ancillary healthcare professionals, maybe addressing social determinants issues, and you can actually bring all those people together in a model much like you see happening in a Teams meeting or in a Zoom setting, and even think about bringing the caregiver into the model, family members and peer support.

So I think the future of telehealth is not only going to be to address access, but to really advance the model of care. And of course, I believe that you can also personalize healthcare much easier using a virtual model, matching what the patient needs to the provider’s competence, but also the type of provider — whether it’s to match gender, culture, educational backgrounds — so that patients get the type of experience that they feel that they do best with and that frankly that they deserve to have. So, I think that we’re just in the early phases of integrating technology into the patient care model. Of course, think about the implications of AI running in the background of telehealth visits and bringing in information that both the provider and the patient should be aware of and new findings and new diagnostic and therapeutic opportunities that present themselves because of the artificial intelligence and the natural language processing that can go on at the same time.

So I think we are in the early innings, but that’s not to say that virtual care is going to replace traditional care. I think that we’re really looking at a hybrid model. I think that there are absolutely times that patients need to be physically examined where touch is important, where face-to-face interactions are going to be needed, where procedures are going to have to be done, lab tests and others that will need to be done in person. So, I think the healthcare providers and the payers who think about integrated hybrid systems of care are probably the ones that I think are headed in the right direction.


Absolutely. You mentioned social determinants is definitely being a factor. The digital divide is also a challenge and I guess the lack of trust in some communities of healthcare systems and healthcare providers. What do you think virtual care can do in improving the accessibility and the equitable distribution of healthcare for those?


Well, look, I think that sometimes the stereotypes of different people and their use of technology is probably beyond what the reality is. I hear people say that older people are technophobic and aren’t using smartphones and internet, and frankly, that’s just not true. I think that people are quickly adapting to the new world of technology, and those that haven’t, it’s because they’re not offered the opportunity to learn or to provide access. But there are many government programs providing significantly discounted access to internet or actually free. There are other health plans that are helping people connect in a technical way. And quite frankly, and I don’t mean this in a humorous way, but when I am in many cities and you see the significant issue with homelessness around the country, and of course there are 45,000 homeless Veterans, even many homeless people you can see have their smartphones with them, and it’s in fact their only way that they can stay connected and frankly to reach them and for them to reach back into the medical system. So, I think that technology, it may not be the answer for everybody, and I think that a good healthcare system has to have numerous ways of communicating and interacting with their patients, but I think technology really is increasingly the important foundation on which to build future models of care based upon integrating technology.


Sure. It’s interesting. We’ve had a number of our customers implement virtual nursing programs, and what we’re seeing, and it’s a little bit surprising, is a huge uptick in patient satisfaction when they’re in a hybrid care model. And we dug into that a little bit, and it really seems to be because the virtual care giver has more time to spend in a face-to-face, albeit through a video call with the patient, and the patients feel like they’re getting more attention. So, what are your thoughts on that whole idea of improving quality of care in this hybrid model and what technology do you think will even enhance that more?


Well, it doesn’t surprise me that you’re finding that there is an increased satisfaction with the customer experience. But look, when people, particularly in hospital settings, need assistance, they want quick access to care, right? If you’re in discomfort, if you need help with something, you don’t want to be waiting as that call button goes off and five, ten minutes go by because nurses or other people are busy with other patients that may need their help. So, if the system provides you with more immediate access that can address your issue, frankly, that is what people are going to describe as a better experience. And I do think that this hybrid model is really the way to do it. If you can get quick access to somebody to speak to them who can sort out whether you need somebody in your room at that time or whether the issue can be addressed virtually, I think then that really is the way to design the optimal type of patient experience.


So we talked a little bit about policymakers. If you had the opportunity to talk to lawmakers, what would your recommendations be? And hopefully you do have access to lawmakers and you’re whispering in their ears. What types of things would you like to see happen that would really help us grow virtual care?


Yeah, I tend to be, particularly when it comes to policy and large-scale government programs, I tend to be one who thinks about when you’re going to legislatively change something, when you’re going to put taxpayer resources into something, you should be looking for big significant change, not incremental change. All of these bills that add a little tiny piece of improvement may be important, but I don’t think that’s the way, at least when I approach government and legislation. So, when it comes to telehealth, I’m actually in favor of starting with the patient. What does the patient need? How do you provide them the right type of medical care and access? And that would mean, quite frankly, the way that I put it together, that all of these state regulatory requirements, separate licensing requirements, separate state restrictions, frankly don’t serve the patient very well, and in fact represent barriers to the delivery of care.

So I would go for a design of a system that actually says, let’s put first what the patient needs, and let’s put second the protection of the current business models and the protection of state rights. Now, look, I’m not a constitutional scholar, but I understand the architects of the constitution inherently wanted there to be state federal tension so that there wasn’t a centralization and a power among the federal government. And I understand that. But healthcare, I think one can argue should be somewhat different. And if somebody is not able to get access to care, whether it’s behavioral care or specialized medical care, because there aren’t professionals, I hate to see state regulatory requirements in place that frankly, I view as mostly protectionism of current business models. So, I’m more in favor of radical change. But one thing you learn when you spend time in Washington, you can’t always get your way.

And compromise, which is a dirty word in Washington, in my mind, is still the only way to govern. You never get your way completely. So, you do look for those opportunities to support the bills that will get you the most bang for the buck, which means make the most difference for patients. And it probably won’t be a wholesale elimination of state’s rights. I think that’s probably unrealistic. But what I like that I’m seeing are the pacts, the consortiums of state licensing. You see the psych pact happening, psychologists, you see the nursing pacts that are happening. There are some medical licensing pacts. Although they are very complicated, burdensome, difficult to use, I think they can be improved. And I think that telehealth, frankly, can be an exception to many of the regulations that we’ve had. And CMSs has implemented a number of them, but I think there are others that are important for us to look at as well.


Sure. Well, that’s great. And David, thank you so much for joining us today. This has really, hopefully been insightful for folks who are going to watch the podcast. This is such an important topic. We’ve been helping customers, and our philosophy is to get care to wherever the patient is. And it sounds like that’s what you propose as far as the lawmakers are concerned. And I hope they listen to that, and I hope we get some movement this year. So, thank you very much for joining the podcast. I appreciate it.


No, listen. Thank you. I think your comments right there are exactly right. This has never really been a technologic issue, and certainly with what you described, I’m confident that the technology is there. This is really something that is more us challenging ourselves. Can we do better for patients? And do we have the courage to take the steps necessary to do that? But this is very possible to do in the near future, and I appreciate all the work that you and Caregility are doing to advance the model of care.


Thank you very much.

Virtual Nursing Smart Rooms & Clinical Workflow Optimization

Staffing shortages, clinician burnout, and overwhelmed new hires – sound familiar? The same challenges hindering hospitals across the nation prompted the team at OhioHealth to create Virtual Nursing “smart rooms” to help stem the tides of nurse attrition. Executives from the health system and their technology partners recently shared their experience getting the emerging care model off the ground in the webinar “Clinical Workflow Optimization: The Role of Virtual Nursing.”

Arika Thomas, MBA, BSN, RN, Director of Nursing for Inpatient Services at OhioHealth’s new Pickerington Methodist Hospital; Erica Braun, MFA, User Experience and Product Design Advisor for OhioHealth; and Tom Gutman, MBA, Senior Consultant of Simulation Technology for OhioHealth, joined eVideon Clinical Implementation Director Erin Pangallo, MS, BSN, RN, and Caregility Clinical Program Manager Ben Cassidy, MBA, MSN, RN, CCRN, to discuss the health system’s approach.

Access the full webinar recording here.

Using Smart Room Technology to Deliver Virtual Care

OhioHealth’s Pickerington Methodist Hospital, which opened on December 6, 2023, was built with Virtual Nursing and digital patient engagement in mind. Patient rooms at the hospital are outfitted with a 65-inch smart TV connected to Caregility’s new APS100 Pro telehealth edge device.

Each “smart room” is powered by the Vibe Health by eVideon smart room platform, which includes the Insight digital whiteboard, Aware digital door sign, Companion bedside tablet, and interactive Engage TV solution. These solutions elevate the inpatient experience with personalized communication, tailored education, and self-service tools that improve patient satisfaction, loyalty, and outcomes while alleviating non-clinical responsibilities for bedside nurses.

Integration with the Caregility Cloud™ virtual care platform allows the OhioHealth team to seamlessly facilitate bedside Virtual Nursing and Virtual Patient Observation sessions via the footwall TV. Together, the platforms create a digital health hub in every patient room that allows hybrid care teams (virtual and in-person) to work together seamlessly to provide patients with the highest level of care and meaningful interaction throughout their care journey.

A Co-Caring Approach to Nursing

OhioHealth’s Virtual Nursing journey was methodical and collaborative, beginning with a co-design phase that involved an in-depth review of internal workflows alongside floor nurses. This phase aimed to identify and eliminate “pebbles in the shoe” of RNs, as Thomas puts it – small, yet significant inefficiencies in workflows and routines. Following a nine-month pilot at two sister site units, the program was refined and launched at Pickerington, with the hospital now reaping the benefits of this innovative approach to nursing.

The co-caring model, a cornerstone of OhioHealth’s program, blends traditional and virtual nursing roles to create a hybrid care team. This model includes bedside RNs and LPNs handling direct patient care, patient support assistants (PSAs) managing daily living activities, and virtual nurses focusing on administrative tasks, patient education, and care coordination. Virtual nurses support 15 to 20 patients assigned to their nursing team.

Just two months into the program, OhioHealth’s collaborative approach has led to significant improvements in patient and nurse satisfaction, with nurses reporting reduced stress and more time for bedside care. Patients appreciate the added care provided by virtual nurses.

“Something that we've noticed is now that nurses have support with that admission, our dead-bed time has shrunk.”
Erica Braun
User Experience and Product Design Advisor, OhioHealth

“We’re also looking at usability and frequency metrics,” said Braun. “Caregility has a great backend dashboard we’re monitoring to see how many calls our virtual nurses are taking in a day, on certain days, and at certain times of day. Right now, we have two virtual nurses per shift. We’re trying to assess, as we grow at Pickerington and beyond, is this enough? Are they covering too many or too few patients? We’re really trying to understand their productivity to inform how we could scale.”

How to Start and Scale Virtual Nursing

During the discussion, speakers offered advice to other health systems looking to get started with or scale Virtual Nursing.

“Our recommendation is to start with a big win that’s easy to implement,” said Cassidy. “Once you have that one device set up in one patient’s room and one virtual nurse, you can carry out simple workflows. Think about admissions and discharges as well as hourly rounding and assessments. Those are where you’ll see the biggest time savings. You may also see some reduction in incremental overtime by taking some of that heavy documentation off the bedside.”


“Then you can move over to more complex workflows,” Cassidy continued. “You can have multiple use cases using the same device in that patient’s room at the same time. You can have a wound care nurse go in to do their assessment and on top of that, you can have someone virtually observing the patient in a sitter format. Expanding that model is a big lift but it’s also needed. Making that “room of the future” allows you to impact care throughout the entire organization, not just one unit or facility.”

Elevating the Standard of Care

The success of Pickerington Methodist Hospital’s Virtual Nursing program is a testament to the power of innovation and collaboration in healthcare. The hospital has set a new standard for nursing care that better addresses staffing shortages, enhances nurse and patient satisfaction, and improves overall care quality. As the program scales, its impact is expected to grow, offering a blueprint for other institutions seeking to embrace virtual nursing “smart room” technology.

OhioHealth’s journey from conceptualization to successful implementation highlights the transformative potential of technology in healthcare. By prioritizing co-design, embracing technological solutions, and fostering a collaborative care model, the health system has not only enhanced care delivery but also positioned itself as a leader in healthcare innovation.

Do you have questions about Virtual Nursing? Set up a discovery call with one of our specialists today!

Nurse Spotlight: Wendy Deibert, EMBA, BSN, RN

As a teen, Wendy Deibert experienced a near-death healthcare episode that resulted in an eight-week hospital stay punctuated by four surgeries. That harrowing experience became an enlightening window into what patients go through, igniting a fire in her to be on the other side of the bed taking care of those in need.

Wendy Deibert, EMBA, BSN, RN
Chief Nursing Officer, Caregility
Wendy Deibert, EMBA, BSN, RN
Chief Nursing Officer, Caregility

As a young adult, Wendy dove headfirst into nursing, specializing as a neurologist ICU nurse. She would go on to spend two decades at the bedside at Barnes-Jewish Hospital, eventually managing the ICU. Along the way, her exposure to the whirlwind of emotions surrounding patient care allowed her to see healthcare engagement from multiple angles. When personal experience saw her husband and father become patients, inefficiencies in the healthcare journey sparked a new mission in Wendy to help make care more accessible and easier to navigate for patients.

Determined to make a difference, Wendy took a leap of faith and transitioned into the realm of healthcare technology at St. Louis-based Mercy health system. From ensuring patient medication safety to learning the intricacies of interfacing and formulary building, her IT journey began. But it wasn’t just about incorporating new tools; it was about understanding how technology could serve patients better.

Wendy’s most transformative phase was a tele-ICU project where she oversaw the implementation of e-ICU across 350 beds. This venture brought together diverse care groups, introduced Wendy to the magic of virtual care, and showcased the technology’s potential to bridge the gap between remote areas and big cities. From there, Wendy played an integral role in rolling out more than 70 telehealth programs across six states with Mercy, ultimately culminating in the creation of Mercy Virtual – a mammoth hub of 160 virtual caregivers.

As an employee at Mercy, Wendy was a Caregility customer, using the company’s telehealth solutions to support several of the health system’s virtual care initiatives. After parting ways with Mercy to launch her own consulting business, Wendy eventually joined the Caregility team, where additional resources could support shared growth. She currently serves as Caregility’s Chief Nursing Officer, where she supports clinical integrity on behalf of the virtual care company and its hospital and health system customers.

“My passion is getting care into the home or as close to the home as possible instead of having patients travel. Virtual care is also a wonderful early warning system in inpatient settings like the ICU, enabling faster, more proactive care interventions.”

– Wendy Deibert

Wendy has learned through experience the importance of tailoring tech solutions to organizational needs, emphasizing that it’s not about replacing current processes but optimizing them. Integration, she believes, is vital. Separate systems, she’s found, tend to create bottlenecks, while a universal platform offers streamlined care.

“One patient, one record,” Wendy stresses. “No one wants to use a secondary system. Leverage EMR integration to embed processes and boost adoption. One thing I learned at Mercy is that telehealth programs grow organically. Disparate solutions for different units can be terrible for IT to manage and clinicians really prefer to live in one environment. Get onto one platform you can use across settings.” She encourages care teams to identify telehealth solutions that support broad use cases to simplify program growth and technology management.

“Make the technology, the clinician, and the process equal parts of the process,” Wendy also advises. “Collaboration between clinical and IT stakeholders establishes common ground and common language. If you just drop technology in without formally defining virtual care workflows, roles, and protocols, your program won’t be sustainable.”

Wendy’s unique position as someone with both clinical and technical expertise has given her a holistic view of the healthcare arena. Her journey from an eight-week hospital stay to her leadership role at Caregility has been nothing short of inspiring. Today, Wendy continues to leverage her expertise, advocating for best practices and pioneering the seamless integration of technology in patient care delivery to improve both patient and clinician experience.

Interested in connecting with clinical experts to discuss your hybrid care strategy? Contact Us

AI’s Potential in Inpatient Clinical Care

Traditionally, healthcare has been regarded as a laggard in embracing IT innovations, primarily due to the inherent complexity of care delivery and the stringent regulatory environment. However, this perception is undergoing a significant transformation. The widespread adoption of acute telehealth has played a pivotal role in this shift, providing care teams with valuable hands-on experience that has helped build trust in health technology. As a result, healthcare professionals have become more comfortable with and open to leveraging digital health tools in their daily practices.

This newfound receptivity to digital enablement has set the stage for a remarkable leap forward in the industry. This is evidenced by the recent surge of interest in artificial intelligence (AI) in healthcare. The proliferation of generative AI and the urgent need to find new solutions to the ongoing staffing crisis are further fueling interest in exploring AI’s place in clinical care.

AI-Enhanced Telehealth

Although headway has been made regarding operational use cases for machine learning-based AI in backend process improvements, healthcare teams are eager to identify and implement AI solutions that can enhance clinical workflows, produce more precise diagnoses, and improve patient outcomes. For the many hospitals equipped with synchronous, audio/video-based telehealth services at the bedside, infrastructure exists to introduce AI services at the point of care as well.

In the realm of virtual care, the evolution of intelligent telehealth endpoints has been remarkable. As telehealth has evolved from audio-only interactions to feature-rich video encounters, camera and microphone quality have improved to keep pace. One noteworthy development is the integration of edge computing capabilities into telehealth endpoints, enabling the support of AI applications. New multiplexing technology supports multiple cameras, allowing care teams to simultaneously support virtual patient engagement and video-based AI solutions.

In addition to high-fidelity camera and microphone arrays, new sensors such as radar technology are making their way into telehealth platforms. These sensors are capable of continuously capturing valuable clinical data while minimizing disruption to the care process. These advancements in telehealth are allowing care teams to infuse AI services such as Augmented Observation and Vitals Trending into bedside care processes, arming clinical teams with patient safety reinforcement tools that reduce pressure on staff and lead to better outcomes.

Promise and Precautions in Clinical AI

While the adoption of AI in healthcare holds immense promise, it also comes with its set of challenges and precautions.

In a recent interview with Healthcare IT Today editor John Lynn at the 2023 HLTH conference, Caregility Chief Product and Engineering Officer Kedar Ganta lauded AI’s ability to bring in ambient intelligence from audio, video, and sensor feeds, “whether it’s collecting vitals or documenting notes for the clinician.” This technology operates in the background, collecting vital patient information and supporting care processes without causing disruption.

Ganta does note, however, that amidst the excitement surrounding AI, the topics of trust and accountability often receive insufficient attention. Establishing patient and provider trust in AI systems is crucial. “This is where regulation comes into the picture,” says Ganta. “It’s a balance between over-regulating something versus promoting innovation.” Reliable data and transparency in AI solutions are essential for building trust, and the inner workings of AI algorithms should be shared with providers to enhance visibility into these factors.

Additionally, “providers should have the ability to override the AI decision” Ganta advises. Creating a regulatory framework and an independent body to oversee AI in healthcare is vital to address these concerns. As AI continues to reshape the healthcare landscape, these discussions about trust, regulation, and accountability are essential for harnessing the full potential of AI while safeguarding patient wellbeing.

As the healthcare industry continues to embrace these advancements, the future holds exciting possibilities for improved patient outcomes and experiences.

Hospital Leaders Weigh in on Virtual Nursing

Healthcare delivery is undergoing a transformation and virtual nursing is at the forefront. In a recent webinar co-hosted by Caregility and the American Telemedicine Association (ATA), healthcare leaders from institutions at various stages of implementing Virtual Nursing programs gathered to discuss their experiences.

Virtual care pioneer and Caregility CNO Wendy Deibert led the illuminating panel discussion featuring Tracey Kopenhaver, Operations Manager, Geisinger Inpatient Virtual Care; Christine Coriell, Director of Nursing Operations, OhioHealth Resource Center; and Debra Marinari, Associate Vice President, Hospital Operations, Mary Washington Healthcare.


Access the webinar recording here.

Here are some key takeaways from the discussion:

Adoption Drivers

All panelists pointed to nursing workforce challenges as key motivators to pursue Virtual Nursing, but technology and ROI had to line up.

Addressing Nursing Shortages and Burnout

The virtual nursing model allows healthcare organizations to tackle staffing shortages and burnout by distributing the workload more evenly.

“We were motivated by a few things – primarily the nursing shortage, nurse turnover, nurse burnout, and really looking at our care team redesign. Looking at current state, where we don’t have quite enough nurses to go around, and our nurses are overworked and busy and can’t get to all the things that they need to do in a day… How can we try to future-proof or buffer that?” – Tracey Kopenhaver

Technology Aligns with Strategic Goals

By leveraging existing technology that supports remote patient observation teams and tele-ICU programs, Virtual Nursing programs align well with strategic goals to centralize and scale virtual care.

“When we think about our Nursing strategic goals at OhioHealth, one is having a flexible workforce and second is maximizing the technology we have at OhioHealh. So, this was just a natural next step into the virtual world.” – Christine Coriell

Demonstrated ROI

Panelists addressed the importance of justifying costs, typically vetted through pilot programs.

“It had to be cost neutral – that’s the model that we took. So, we had to make sure that whatever we brought in was going to have a good return on investment – not just the quality metrics, but [improving] satisfaction and decreasing turnover.” – Debra Marinari


While there is variation in how Virtual Nursing workloads are assigned within each organization, some standard practices emerged. Each panelist’s healthcare organization uses Epic’s EHR in different capacities for streamlining workflows. Each organization also staffs virtual nurses onsite, with Geisinger employing a hybrid model that also includes nurses working from home.

Getting Started

“The number one recommendation I would give to anybody who is thinking about starting a virtual nurse program is don’t let perfection get in the way of progress. We started very low budget. We repurposed carts. We hired per-diem staff to start with and borrowed some staff from our virtual ICU program. We really went in on a shoestring to get it off the ground. We’ve been able to demonstrate the return and we have the financial support to move ahead with a more permanent solution.” – Tracey Kopenhaver

Staffing Models

Virtual nurse staffing models varied across panelists. Coriell noted that, in their current phase, OhioHealth virtual nurses work Monday through Friday from 7 a.m. to 7 p.m., with plans to extend to 24/7 coverage.

“The virtual nurse will be assigned to patients that all will roll up to the many nurses overseeing that care at the bedside. We’re utilizing a flex team of nurses with knowledge across different care sites for now. A future focus is on having dedicated full-time employees (FTEs) for the program.” – Christine Coriell

Geisinger takes a slightly different approach, with Virtual Nursing overseeing specific tasks.

“There are no specific patient assignments for virtual nurses since they currently focus mainly on admissions and discharges.” – Tracey Kopenhaver

Meanwhile, Marinari and the Mary Washington Healthcare team elected to bring on additional FTEs for virtual nursing from the very beginning.

“The model had to be really such that the nurses at the bedside did not feel like they had less resources, but actually more. We had to balance the FTEs for each of the departments, and what that workload was going to be [in terms of] patient ratios. The virtual nurses are assigned to patients, currently managing around 15 to 16 patients during the day and up to 20 at night.” – Debra Marinari

Goals and Results

Positively impacting nurse and patient experience are core objectives for each organization.


“Key outcomes that we really want from this program [include] retention of nurses, decreasing that workload and stress at the bedside, increasing time for the bedside nurses to be able to provide care for their patients, improving nurse satisfaction [and] patient satisfaction, and then some cost savings. Ultimately, we would look at time saved with length of stay and a few other metrics as well.” – Christine Coriell

“We’re looking at our HCAHPS – nurse responsiveness and communication with the nurse scores in particular.” – Tracey Kopenhaver

Time Management & Efficiency

All panelists agreed that virtual nursing significantly improves time management, reducing the workload of bedside nurses.

“The thing that we’ve been able to measure the most is the time saved for the bedside nurses.” – Tracey Kopenhaver

Marinari and the Mary Washington Healthcare team conducted time studies to demonstrate time savings, assessing the time from when the discharge order is written to the time the patient leaves as a metric. Coriell highlighted the role of existing relationships between virtual nurses and unit staff in speeding up tasks and improving efficiency.


Virtual Nursing programs are not just a trend; they are a substantial step toward enhancing healthcare delivery. These programs alleviate staff burnout, improve patient experience, and provide financial returns. With insights from leaders in the field mounting, it’s clear that Virtual Nursing is a viable and vital part of the future of healthcare.

Watch the full Virtual Nursing panel discussion with Geisinger, OhioHealth, and Mary Washington Healthcare here.

Looking for guidance on how to implement, optimize, or expand your Virtual Nursing Program? Set up a Virtual Nursing discovery call today.

Nurse Spotlight: Heidi Steiner, DNP, RN-BC, NE-BC

It’s not uncommon to meet professionals inspired by their family legacy working in healthcare. Although Heidi Steiner grew up surrounded by a family of nurses – including her mother, aunt, cousin, and godmother – she initially resisted the unspoken pressure to tread a similar path. Instead, Heidi was drawn towards community health education. Her dream was to promote health, prevent illness, and keep people out of the hospital.

Heidi Stiener, DNP, RN-BC, NE-BC
Product Manager, Caregility

However, life often takes us in unexpected directions. As Heidi navigated her early career, she conceded to nursing, working as a hospital aide and later as a nurse extern. She grew to appreciate the hospital setting but her core passion always remained: educating people to prevent illness.

This led her to the rehabilitation side of nursing, where she found immense satisfaction in guiding patients and their families through recovery. As Heidi puts it, “The nurse is the quarterback for the team, ensuring patients and their families are equipped with knowledge and care tailored to their needs.”

After relocating to Michigan, Heidi advanced to a nursing leadership role managing a 24-bed inpatient rehabilitation unit. Her interest in collaboration, patient education, and interdisciplinary teams stood out. When the hospital introduced Cerner, Heidi stepped in to represent the nursing department and found herself immersed in the world of informatics, changing the course of her career yet again.

After spending several years leading healthcare teams through the adoption of electronic health records, and then acting as a consultant for Cerner, Heidi ventured into developing a cross-continuum patient education strategy at Trinity Health. Working on a patient engagement portal, she emphasized that hospital care is only a fragment of the patient’s healthcare journey. The real challenge? Ensuring sustained care and knowledge once the patient returns home.

Heidi’s journey eventually brought her to Caregility and the realm of virtual care. As a Product Manager for the company’s virtual clinical consultation software, she influences tech design, features, and strategies that directly affect patient and clinician end-users. Her goal remains consistent: supporting patients, families, and clinicians throughout the healthcare journey. She believes that technology empowers clinicians to deliver their best care.

“Our job as a technology company is to provide tools that empower clinicians to give the best care they can deliver. This aligns with my passions, which have always been working as a team, collaborating in the best interest of the patient and their family, and supporting clinicians to deliver excellent care.”

– Heidi Steiner

When asked about her ideal vision for healthcare, Heidi paints a picture of seamless health information sharing, patient-driven care plans, and more holistic approaches to meeting patient needs. She sees virtual care bridging the gaps in episodic care, providing continuous insight into patients’ health patterns, and introducing new pathways for earlier intervention when necessary.

Heidi’s advice for anyone looking to venture into virtual care? “Walk, then run. Planning is essential, as is stakeholder involvement and a clear roadmap. ID your KPIs upfront and conduct routine milestone tracking to evaluate the success of your program. Evaluate as you go so you can change course as needed.”

With her certification in nursing informatics and a doctorate degree, Heidi exemplifies the importance of continuous iteration and learning. Her story serves as an inspiring reminder that while legacy can light the way, it’s our individual choices, commitment, and adaptability that truly shape our journey. Whether you’re a nurse pursuing your passion or a patient navigating your care plan post-discharge, that’s timeless wisdom.

Interested in connecting with clinical experts to discuss your hybrid care strategy? Contact us today!

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.

What Nurse Unions, CNIOs, and Virtual Care Have in Common

Workforce challenges continue to be a chief obstacle for healthcare provider organizations. Nurse burnout and attrition reached a fever pitch during the pandemic, leading to a surge in nursing strikes nationwide. Nursing unions are at the forefront, championing better staff-to-patient ratios, safety measures, wages, and working conditions for their members.

2023 research from the Health Management Academy sheds light on some of the ways hospital clinical leadership is working to tackle nursing concerns. Developing more sustainable documentation protocols to reduce the burden on nursing teams and leveraging technology to reduce workplace violence were among the top priorities cited by Chief Nursing Information Officers (CNIOs) in leading health systems.

Integrating virtual nursing into care offerings, monitoring technology’s influence on nursing labor cost trends, and streamlining tech stacks to improve clinical efficiency were also cited as key focus areas. CNIOs are keenly attuned to technology’s impact on clinical workflows and experience, and rightfully so.

Recent McKinsey research suggests that hospitals could free up as much as 20% of nurses’ time during a 12-hour shiftthrough tech enablement.

McKinsey Research - Nurse Tech Enablement

Many of the tasks the McKinsey research highlights as being ripe for tech enablement – documentation, hunting and gathering, and interdisciplinary communication – align with virtual nursing objectives.

[White Paper: A Guide to Virtual Nursing in Inpatient Settings]

Virtual Nurse: Friend or Foe?

Given the fair share of turmoil and turnover in the nursing profession in recent years, it’s unsurprising that the concept of virtual nursing has encountered naysayers. Clinical resistance to the hybrid care model largely centers on the misconception that virtual nurses will replace bedside RNs. Virtual nurses are intended to augment and support existing teams, not supersede them, by taking tasks off of overburdened nurses’ plates.

“It’s about alleviating [nurses’] pain points and making the job more satisfying,” says Caregility Clinical Program Manager Irene Goliash, RN. “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.”

Virtual nursing introduces remote resources floor nurses can tap for patient care support and staff safety monitoring. It also introduces a succession plan that allows hospitals to move experienced nurses who age out of bedside care into virtual roles to preserve institutional knowledge.

Selecting the right virtual care platform can also impact the perception of virtual nursing. To appeal to clinicians, solutions should offer a consistent, simple interface and include things like training components that reduce total onboarding time for new nurses. Identifying a solution that is agile enough to be leveraged enterprise-wide can help health systems achieve goals related to clinical resource consolidation.

[Learn more about Caregility Cloud™ virtual care platform]

The Shared Mission to Elevate Nursing

Nursing unions, hospital clinical leadership, and virtual nursing programs all have one thing in common: They support a shared mission to address nursing pain points to improve clinician experience, reduce burnout, drive efficiency, and positively impact patient care.

The challenges faced by the nursing workforce are multi-faceted and require a comprehensive approach to address them effectively. Integrating virtual nursing into comprehensive care offerings is one way to alleviate some of the pressures faced by bedside RNs, without replacing them. Leveraging technology, healthcare organizations can ultimately improve the experience for clinicians and, in turn, patient outcomes.