Digital Health Frontiers: Virtual Care’s Evolution with Dr. David Shulkin
For the inaugural episode of our Digital Health Frontiers podcast, we had the honor of hosting Dr. David Shulkin, former Secretary of the US Department of Veterans Affairs. Dr. Shulkin shared his deep insights on the evolution of virtual care, its critical role during the pandemic, its potential for addressing clinician shortages, and the necessity of regulatory support for telehealth’s future. A must-listen for healthcare professionals looking to shape the future of healthcare delivery. Listen in or read the transcript below!
Read the Transcript
Welcome to Digital Health Frontiers, where we explore the cutting edge of healthcare technology, policy, and innovation, hosted by Mike Brando, 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.
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.
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.
Using Smart Room Technology to Deliver Virtual Care
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.”
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.
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 today!
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.
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.
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
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.
“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
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.
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.
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.
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.
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.
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.
Nurse Spotlight: Irene Goliash, RN
For some, the call to care for others is a lifelong passion. One such individual is Irene Goliash, RN. Drawing inspiration from a nurturing home environment, including a mother who often cared for family members and an aunt who was a nurse, Irene always knew she wanted to be a caregiver.
She began her journey into healthcare at an early age. A neighbor who recognized Irene’s intrinsic desire to support others suggested she try her hand at a nursing home role, noting that if she could manage that, she could likely handle any challenge a career in nursing might throw at her. And Irene did just that. “Working as a nursing home CNA gave me my start in nursing, which I found deeply rewarding,” she says.
After graduating from Alexandria Hospital School of Nursing, Irene stepped into her first registered nurse role at Washington Hospital Center, a 900+ bed tertiary care facility in D.C. “I started on the medical telemetry floor,” shares Irene. “I always knew I wanted to be in critical care. After gaining experience and becoming comfortable with cardiac rhythms, I moved into the ICU, primarily working in surgical, critical, trauma, neurosurgery, and cardiac surgery care.”
From there, Irene transitioned to a role as a Cardiovascular ICU nurse at Georgetown University Hospital. She spent the next seven years providing comprehensive nursing care, patient education, and discharge planning for cardiovascular surgical patients on a combined ICU/Stepdown unit. During her tenure at Georgetown, Irene served as a charge nurse for the entire unit, acted as a preceptor for nurses during orientation, and developed and implemented a unit-based Peer Review system.
Along the way, Irene’s robust nursing experience attracted the interest of health IT stakeholders. A significant turn in her career came when Irene joined Apache Medical Systems (acquired by Cerner) to oversee the development of clinical end-user training programs. Irene was later recruited by VISICU (acquired by Philips) where she would spend the next 16 years managing the clinical transformation process for clients adopting the eICU program.
Irene’s work and connections eventually led her to Caregility, where she currently serves as a Clinical Program Manager working to alleviate the burdens of bedside teams and ensure a smoother healthcare process for patients through telehealth enablement.
“I know from first-hand experience that sometimes at the bedside you feel like you’re just running around putting out fires,” Irene shares. “It’s easy to get burned out thinking of the list of things you didn’t do. I’m all about helping the bedside team. It’s about alleviating their pain points and making the job more satisfying. Both clinicians and patients should feel the benefit.”
“You can significantly improve patient, family, and staff satisfaction just by shifting clinical workload to someone who has time to devote to the specific activity.”
– Irene Goliash
For those looking to implement a virtual care program, Irene stresses the importance of multidisciplinary involvement. “Pull your direct caregivers into the process from the very beginning,” she advises. “Without their buy-in, no matter how good your program is, it will fail. One of the biggest challenges I’ve seen is when customers think it’s an IT project because of equipment procurement and installation, but it’s not. It truly is a clinical project.” Irene recommends involving clinicians when determining program goals, where to focus, and where you grow from there.
Irene sees tremendous potential in emerging virtual nursing programs. She encourages healthcare organizations exploring the hybrid care model to “start small and take baby steps. You don’t have to come in and save the world. Maybe the best thing I can do as a virtual nurse is record your code for you or do the documentation or page people. Let me do the more mundane things so you can focus on hands-on patient care.”
“All it takes is one big win to prove the value,” Irene elaborates. “This can be particularly beneficial in areas where there is just not enough time to devote to things like patient education. We’re often dinged there by patients and families. Having a remote nurse resource who can teach without interruption is a great way to improve that.”
Irene envisions a future where every care team encompasses both bedside and virtual nurses. “Virtual roles can be a great way to harness the experience of nurses who have the knowledge but may not be physically up to a 12-hour shift, which is harder as you get older, keeping 20 to 30 years of nursing experience in my health system to support my bedside team.”Virtual roles can also be outsourced in rural areas where staffing shortages may leave facilities hard-pressed to pull from existing staff.
Irene’s journey is a testament to the limitless potential and adaptability of nursing. She continues to hone her skills as a member of the American Association of Critical Care Nurses and in her work with ATA developing TeleICU nursing guidelines.
As healthcare pivots to a more integrated approach to virtual care, the experiences and insights of nurse professionals like Irene will continue to illuminate the path to better supporting our patients and bedside teams, retaining experienced clinicians, and innovating care delivery.
Interested in connecting with a Caregility Clinical Program Manager to discuss your hybrid care strategy? Contact us today!
Nurse Spotlight: Sarah Lake, MS, RN, CCRN-K
Many would agree that the nursing profession isn’t for the faint of heart. RNs see it all. Although Sarah Lake, MS, RN, CCRN-K, didn’t initially set out to be a nurse, her early years working in the criminal justice system offered plenty of parallels.
Sarah first pursued undergraduate studies in political science and criminal justice, earning her bachelor’s degree at the University of South Dakota (USD). The Sioux Falls native then held positions as a correctional officer and a court services officer, doing what she describes as “the equivalent of felony probation and supervision for community members who don’t go to prison.”
Like the clinical work she’d eventually embark on, Sarah’s Corrections roles operated under a paradigm that put emphasis on prevention through early intervention. The challenge was that she oversaw a population that was profoundly underserved with no access to social services. Sarah recognized that the lack of support services was an impediment to her ability to adequately help those in her community. This point of frustration led her back to school to find a different way she could help.
Sarah earned her nursing degree at USD intending to go into community, public, or mental health. After a preceptorship at the Department of Health setting up points of distribution during H1N1, she landed a critical access nursing role in Chamberlain, SD, at Sanford Chamberlain, ultimately returning to Pierre, her home community, with a role in Avera St. Mary Hospital’s ICU. That role introduced Sarah to a relatively new theory of care. Avera St. Mary’s eICU program allowed patients to receive services from remote clinicians while remaining close to home and family.
“The hospital had an eICU system that allowed clinicians to push a button to get instant access to intensivists and critical care nurses to help take care of critical patients whom we would have otherwise had to transport to tertiary care,” Sarah explains. “When I pushed the button for the first time [to get help] on a drip I was unsure of, I was sold.” Sarah immediately recognized the potential that virtual care posed to broader use cases.
“The thing I am the most passionate about is improving the delivery of patient care.”
– Sarah Lake
“During my career, I did temp work outside of hospitals and worked as a flight nurse, but I always came back to the eICU at Avel eCare (then Avera eCare) because I liked virtual care’s ability to give folks world-class care in their home community. When I came back to work full time in the Sioux Falls area at Avel eCare, one of the service lines was a multi-specialty clinic offering specialties to IHS. Sixty percent of the services we were supporting were mental health or psych related – precisely the kind of services I thought we needed when I was in Corrections.”
When COVID-19 hit, Sarah and her team again turned to telehealth to remotely support patients isolated at home. It wasn’t long before Sarah was recruited by Caregility to put her virtual care experience to work supporting hospitals across the nation looking to follow suit. Today, Sarah helps health systems hone their telehealth strategy, design virtual clinical workflows, and stand up EMR-integrated programs that improve care delivery for patients and providers.
Sarah sees hybrid care fueling what’s possible in healthcare. That includes the ability to support remote family involvement or group visits, patient and staff education, and patient monitoring as an added safety layer and another way to build relationships with patients.
“Post-COVID, patients are sicker and there aren’t as many clinicians available to take care of them,” Sarah notes. “Adopting a virtual nurse is one way teams can meet in the middle. Medicine is also getting much smarter. Wearables and home-based apps have tremendous potential to further personalize care and proactively improve outcomes. Increased use of AI will not only enhance care delivery but also optimize operations. It will account for things people don’t think about when they’re putting patients into beds – like higher fall risk if the patient is placed at the end of the hall – to support the best utilization of space. What locations are best for the recovery of specific conditions? What staff do we have to take care of them? We’ll see the use of AI in those operations.”
For those looking to implement a virtual care program, Sarah offers five points of advice:
Work with a multidisciplinary team including clinical, administrative, and IT stakeholders to define your goals and objectives based on your unique pain points.
Conduct a feasibility study to determine what it will take to launch your program. Consider time and resource requirements, seeking outside expertise as needed.
Define your clinical protocol. Demonstrate ways the solution will benefit patients, lighten staff workload, and foster new professional development skills among staff who will use the tools.
Select technology that supports your identified workflows. Will telehealth endpoints be cart-based or wall-mounted? What integrations are desired? Be mindful of regulatory compliance and network factors.
Iterate and re-iterate constantly.
“Virtual care and telehealth bring us to a whole new level of being able to deliver care to absolutely everybody in a quick, cost-effective manner, even in geographically isolated communities with socioeconomic struggles,” says Sarah. “Today we can have a diabetes patient see a world-class endocrinologist at home on an iPhone. Virtual care lessons I’ve learned along the way have only broadened what I see as the future potential.”
Interested in connecting with a Caregility Clinical Program Manager to discuss your hybrid care strategy? Contact us today!