Many would agree that the nursing profession isn’t for the faint of heart. RNs see it all. Although Sarah Lake, MS, RN, CCRN, 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.”
Sarah Lake, MS, RN, CCRN Clinical Program Manager, Caregility
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!
AI-Enhanced Telehealth: Hope or Hype?
ChatGPT and a plethora of other AI-powered applications are rapidly gaining popularity in today’s tech-driven world. In healthcare, AI and machine learning algorithms are being adopted to drive efficiency in patient-facing and back-office settings alike.
One of the clinical frontiers gaining attention is the augmentation of virtual care programs with AI tools such as computer vision, ambient clinical intelligence, and contactless monitoring. By bringing these AI enhancements into virtual workflows in the inpatient setting, healthcare organizations hope to positively impact patient safety, clinical outcomes, care team experience, and operational performance.
During a recent fireside chat, Caregility President and COO Mike Brandofino sat down with Healthcare Innovation editor Mark Hagland to explore the practicality, best practices, and perils associated with selecting and adopting AI technology to advance telehealth.
AI’s Potential in Acute Virtual Encounters
AI is showing promise in clinical use cases in acute care settings where staffing shortages and burnout are prominent. As Brandofino sees it, one of AI’s biggest benefits is in “augmenting the information that a clinician or caregiver has access to with more clinical insight than they’d be able to gather on their own.” When evaluating tools, he encourages stakeholders to consider the impact: “Is it taking tasks away that can potentially save staff time? Is it a tool that adds to productivity?”
One of the AI functions Brandofino sees potential in is radar-based contactless monitoring. These tools continuously capture patient vitals such as heart rate and breathing rate, as well as track motion in the room. This allows caregivers to see trends over time.
“The AI part of that is the algorithms can detect changes in that pattern that mean something,” Brandofino explains. He offers a practical use case example. “That radar device can tell you, based on telemetry, that a patient is starting to wake up. Now think of a post-op situation where the nurses have to be there when the patient wakes up disoriented. Can you just have a contactless device notify them when the patient is starting to wake up so they can get in there then instead of sitting there for 30 minutes waiting?”
Automated, contactless vitals monitoring also accelerates the frequency and timeliness of clinical documentation.
“If you think about what happens with nurses as they do their rounds and take vital signs, many times they don’t get that information into the EHR until the end of their shift or hours later,” Brandofino notes. AI tools can gather vital signs many times throughout the day and put it through an algorithm to evaluate if the patient is getting better or worse. This allows care teams to intervene earlier and potentially improve outcomes.
Ambient clinical intelligence uses AI tools like natural language processing to draft clinical notes and reports, posing similar efficiency benefits. In care environments where resources are thin and burnout is high, those incremental time savings can add up.
Caveats to Consider When Adopting Health AI
As you evaluate AI solutions to bring into patient care delivery, it’s important not to become enamored with the technology before understanding where it fits into the patient care workflow. Brandofino recommends including all stakeholders—clinical, IT, and operations—in evaluations. “How are you going to support your device fleet? Consider the clinical workflow as well as the experience on the patient side.”
“Think about the operational logistics of supporting what you’re doing,” Brandofino advises. “What we suggest to our customers is to understand the impact that you’re going to have on the staff on the floor and think about what that is going to be like at scale.” Nurses are some of the most interrupted people in healthcare. The last thing you want to do is introduce new tools that add to their stress level, whether that be an overabundance of false alarms or device overload.
Given the newness of many AI tools entering the market, it’s also important to consider who you’re partnering with. Has the tool been implemented in one or two patient rooms or thousands of rooms? Are there examples of in-market success that can offer a roadmap?
Combining AI and Telehealth to Empower Caregivers
By integrating AI with virtual care, healthcare organizations can modernize care delivery with innovative new tools and keep the human element of care intact. AI can drive intelligent clinical alerting, while virtual engagement channels serve as a bridge for immediate staff intervention. When combined, these resources amplify what virtual teams are capable of supporting remotely, doubling down on reducing the burdens on bedside staff.
“We believe that combining that remote nurse with smart technology to help gather telemetry in the room will be really impactful in improving care for patients in the long term,” says Brandofino. “Don’t feel like you have to put in a siloed solution just to get access to AI technology. Look for players that are capable of integrating with what you already have. If you already have high-end cameras and mics in the room with edge processing, what else can you gather in the patient room to give to caregivers?”
Ultimately, healthcare organizations that focus on applying technologies that solve real problems that exist today around the shortage of nurses, productivity, and quality of life for staff will have the most impact.
Interested in learning more about AI-enhanced hybrid care solutions? Contact us today!
Nurse Spotlight: Donna Gudmestad, MHL, BSN, RN, CCRN
Donna Gudmestad, MHL, BSN, RN, CCRN, will tell you she “took the long road into nursing.” As a college student considering her career options, Donna opted to pursue nursing based on exposure to the profession she had gained interacting with home nurses who helped care for her grandfather.
Drawing from that experience, her work as a caregiver began as a Certified Nursing Assistant (CNA) in a nursing home. Donna would go on to work as a Licensed Practical Nurse (LPN) for six years, taking a break to start a family before ultimately going on to become a Registered Nurse (RN).
Donna Gudmestad, MHL, BSN, RN, CCRN Director of Clinical Solutions, Caregility
Roughly twenty years would pass between Donna earning her BSN in Nursing from Indiana Wesleyan University and going on to earn her Master of Health Leadership from Western Governors University. Along the way, she gained experience in virtually every facet of the patient care journey, holding nursing roles in academic, long-term care, sub-acute care, rehab, and hospital-based settings.
Perhaps most notably, Donna was among a small but growing constituency of clinicians actively working to modernize care by introducing virtual workflows at the bedside. Using the expertise she cultivated working as an ICU nurse at St. Louis University Medical Center and as a nurse manager at Mercy Virtual, Donna was offered a role as the Director of Operations leading six virtual service lines across a four-state region.
Donna currently puts her 30+ years of nursing and 14+ years of telehealth implementation experience to use as
Director of Clinical Solutions at Caregility, where she works with some of the nation’s leading health systems to bring clinically sound virtual care programs to life. That includes emerging virtual nursing models.
Although virtual nursing is rightfully generating buzz, Donna observes that the concept is not new. “TeleICU is one flavor of virtual nursing,” she notes. “We have been doing medication second signature and other workflows virtually for 15 years within the critical care space.” She sees the expansion of those practices into lower acuity hospital units as a natural next step in improving patient care delivery.
“Whereas before it was a battle, COVID really opened people’s eyes to what technology can do to help nurses at the bedside.”
– Donna Gudmestad
Drawing from her experience as a clinician and virtual care forerunner, Donna is a wealth of knowledge for care teams standing up virtual programs. Her number one recommendation is to do your due diligence upfront. “Don’t stand something up and think you’re going to come back and clean it up,” Donna notes. “Do it right the first time. Decide which workflows you want to start with. What are your goals? What’s your measure of success? Align your metrics up front so you can measure your performance.”
Donna encourages leadership teams to involve bedside staff in program development early on to fully understand their challenges and build a program that adequately addresses them. “Sometimes we do things we think are helpful because we’re not in the hot seat every day,” says Donna. “The devil is in the details and bedside staff hold valuable knowledge that’s needed to really streamline workflows.”
When asked where she sees healthcare in 10 years, Donna is resolute in her perspective that virtual nursing and telemedicine will be normalized as a standard, additional mode of care delivery. “A nurse or provider will be able to come into a patient’s room virtually to accomplish much of what is done in person today,” she explains. “Peripherals and AI-supported transcription will support them, so they won’t have to type anything into their computer.”
Though critical care is destined to remain in-house, Donna sees an increased need for nurses beyond the four walls of the hospital. “A lot of care will be pushed out into the home whenever it’s appropriate,” she elaborates. “Many things can be done within the home, which more often than not increases patient comfort and reduces care costs.”
She views virtual nursing programs as practice for that future state and posits that “nursing will look very different in a decade.” That will likely entail a virtual-first engagement strategy where hands-on teams are deployed as needed – the inverse of what we typically see today. Donna is also optimistic about the broader use of AI in care delivery to make that future state possible, but notes that “with power comes responsibility.”
“Nurses have a thousand things on their plate,” she points out. “At the end of the day, the goal is to make it easier for clinicians to deliver high-quality care that is augmented by technology.”
Interested in connecting with a Caregility Clinical Program Manager to discuss your virtual care strategy? Contact us today!
Nurse Spotlight: Ben Cassidy, MBA, MSN, RN, CCRN
Ben Cassidy, MBA, MSN, RN, CCRN, always knew he wanted to work in the field of healthcare. What he may have underestimated was just how much his technical aptitude would propel his clinical career.
As an undergraduate at the University of North Carolina at Greensboro, Ben initially had his sights set on becoming a Certified Registered Nurse Anesthetist (CRNA). But real-world experience after earning his nursing degree would lead him in a different direction.
Ben Cassidy, MBA, MSN, RN, CCRN Clinical Program Manager, Caregility
What Ben really sought was an unconventional path, or what he calls “the 1% job – that small, specialized field within nursing” where he could make the most difference. Entering the healthcare workforce as a newly minted RN on the heels of the HITECH Act being passed, Ben embraced opportunities to meld his clinical and technical know-how. He eventually landed at North Carolina-based Cone Health, the first hospital in the state of North Carolina to launch a teleICU program.
“I found myself in a nurse supervisor role in my 20s where I was the youngest clinician on staff by about 30 years,” Ben shares. “Medical records had recently gone electronic. I got along very well with the clinicians who were older than me because they appreciated having someone young around who was familiar with electronic medical records.”
During his tenure with Cone Health, Ben spearheaded the health system’s migration to a new teleICU solution, which brought him into the medical device side of virtual care.
The teleICU project involved replacing over 160 telehealth endpoints on an accelerated schedule carefully orchestrated to avoid interfering with patient care and creating communication pathways between Cone Health’s Epic EHR and the in-room video solution. Ben and the Cone Health team customized Epic Monitor around their current and new clinical workflows while also collaborating with Caregility to build an integration to launch the camera from within the patient’s EHR record using context-aware linking. As a result, Cone Health was able to leverage the EHR to define predictive analytics for risk, stratifying patients for early identification and intervention.
Today, Ben brings 12 years of experience in critical care and 7 years of experience in the teleICU space to his role as a Clinical Program Manager at Caregility, where he helps clinical teams integrate virtual care into hospital workflows. As an AACN-certified Critical Care Registered Nurse (CCRN) with specialized knowledge in Virtual Nursing and medical device integration, he adds tremendous value to the Caregility team and the health system customers he consults.
“I’m passionate about using my technical skills and knowledge of the industry to help make healthcare more seamless and easier to navigate, not only for patients but for clinicians as well,” Ben shared. “As a clinician, you want a seamless flow of devices working for you so you can focus on the patient.”
“Too often, we have too many hands on medical devices and not enough hands on patients. My goal is to help change that.”
– Ben Cassidy
When asked what advice he’d give someone looking to implement a virtual care program, Ben recommended making sure you weigh all your options. “Look for a virtual care platform that supports use cases from the onset of a medical emergency through to when the patient leaves the facility – from ambulatory care to the inpatient setting and to the patient’s home. Solutions should take bedside activities off clinicians’ plates, not add to them. EMR integration is essential.”
Looking ahead, Ben sees medical device integrations playing an increasingly important role in healthcare delivery, offering clinicians new tools to identify changes in patient conditions and intervene earlier. “What we don’t need is another device that clinicians have to touch or type on, or another false alarm sounding throughout a nursing unit,” Ben shared. “Picking up patient data points without providers having to manually document them while also creating meaningful, actionable alerts is going to make it much easier for caregivers. Hopefully, in the future, if a camera sees it, you speak it, or a device senses it, the technology will capture it. We’re already seeing this in some of the new health AI solutions entering our ecosystem.”
“I also see our industry’s response to technology moving from fear to need, which is encouraging,” Ben elaborated. “There is less fear that healthcare technology will replace jobs and more open acceptance of health IT as another resource to help you do your job more effectively.”
“We’re never going to replace the bedside nurse, but I believe virtual care tools and models can help us better staff our units, reduce burnout for our nurses, and offer an alternative work arrangement to help us hold onto our more seasoned, experienced RNs. Giving them the option to be a remote knowledge resource strengthens the organization as a whole. I can easily envision a day when virtual clinical resources are integrated into every organization in healthcare.”
Interested in connecting with a Caregility Clinical Program Manager to discuss your virtual care strategy? Contact us today!
Is Health AI Finally Having its Heyday?
Artificial intelligence has been bandied about in the healthcare industry for years but, if the 2023 health IT tradeshow circuit is any indication, health AI may finally be entering its heyday.
The HIMSS23 conference recently wrapped up, with roughly 35,000 healthcare professionals gathering in Chicago to showcase and explore solutions aimed at improving care delivery, patient outcomes, and operational efficiency. And much like the recent ViVE conference, there was no shortage of health AI news and innovation on display:
The focus on AI is unsurprising given the explosive popularity of platforms like ChatGPT. Mainstream access to AI tools is fueling innovation across industries as stakeholders look to leverage the technology in their respective fields. For healthcare, AI is rapidly moving from hype to practical application in both clinical and operational use cases.
“AI is currently in the spotlight, with a mix of anticipation and apprehension about its potential to alleviate staffing shortages and expand care in a challenged healthcare system,” observed Caregility Chief Product and Engineering Officer Kedar Ganta, who was among those in attendance at HIMSS 2023. “While some are still struggling to grasp AI’s role beyond the buzz, others are already exploring its integration with various technologies.”
Many of the health AI solutions in and entering the market aim to help providers improve patient outcomes by supporting the early detection of patient deterioration and adverse events using things like computer vision and contactless monitoring. Health AI tools can also improve the clinician experience by adding a digital line of support to simplify tasks, for example, using ambient intelligence tools to support clinical documentation.
As Caregility President and COO Mike Brandofino put it, “AI advancements will enhance clinical insight and enable care for more patients, in spite of challenges related to limited staff resources.Nothing can replace a knowledgeable, experienced caregiver, but how much more effective can they be if we augment the information available to them? Continuous virtual observation of patients, data capture through wearables, and access to predictive algorithms that can help providers anticipate conditions affecting patient outcomes will combine to improve care.”
The potential benefits are undeniable, but health AI implementation won’t come without its challenges. An overwhelming array of innovative health AI solutions are entering the market. As healthcare organizations pilot emerging technologies, adopting health AI solutions without introducing new tech silos and solution sprawl that may congest networks will be pivotal.
In a recent interview with HIMSS TV, Brandofino touched on ways virtual care platform integration can help hospitals and health systems more easily integrate health AI solutions into clinical workflows.
“There are going to be a lot of things that come on the market – shiny new objects – and not all of it is going to work,” said Brandofino. “Our approach through our ecosystem is to show that we can integrate one system in a room with [a variety of] different AI platforms.”
In adopting a platform approach, health systems are equipped to experiment with health AI solutions in a way that leverages existing virtual care infrastructure, rather than introducing an additional framework to manage new resources that might become obsolete.
“Combining virtual care solutions and AI technology yields tremendous potential to enhance and improve a variety of clinical workflows in acute care settings,” said Pete McLain, Chief Strategy Officer at Caregility. “Artificial intelligence has the potential to enhance and augment – not replace – care teams, helping them save time, capture more meaningful patient data, and support clinical decisions and interventions that lead to better care and improved patient outcomes.”
To learn more about Caregility’s AI-enhanced hybrid care solutions, contact us today.
How Virtual Nursing Helps Address Nursing Shortages
The following guest blog features commentary from Marcia Murphy, VP of Clinical Operations and Nursing at Hicuity Health.
Concerns about clinician staffing and the future availability of highly trained physicians and nurses have been on the strategic dashboard of every attentive health system and healthcare leader for years.
Workforce shortages have been predicted repeatedly and consistently, as healthcare leaders modeled the anticipated impact of long-term trends such as increasing healthcare demands due to an aging patient population, the projected rate of clinician retirement, increasing turnover, and the slow rate at which new providers and nurses are being trained.
Recent Trends Fueling the Need for Virtual Nursing
In recent years, a range of potent forces added velocity to the growing shortage of nurses nationwide. The widely reported Great Resignation during the COVID-19 pandemic and ongoing burnout and turnover issues have created increased urgency around the issue of nurse staffing.
According to the Medscape Nurse Career Satisfaction Report 2022, 52% of RN respondents reported that the pandemic decreased their career satisfaction. Roughly one-third of all nursing respondents indicated feeling either “burned out” or “very burned out”. The 2023 NSI National Health Care Retention & RN Staffing Report, based on data gathered from hospital executives during the first quarter of 2023, revealed that 75.4% of hospitals reported an RN vacancy rate above 10%.
As a result, hospitals have been forced to create both short-term and longer-term solutions to the trio of staffing issues: shortages, burnout, and turnover. Whereas authorization to simply hire more nurses might have addressed similar situations in the past, recruiting efforts have proven to be increasingly difficult as the national need for RNs has led to more competition for scarce clinical resources.
Many hospitals turned to travel nurses in an attempt to bolster their staffing, typically at a high cost and with mixed results. Some hospitals were compelled to increase nurse-patient ratios or to engage additional non-nursing support, when available, which nominally addressed staffing shortages but risked intensifying nursing burnout.
Virtual Nursing: A New Way Forward
Against this backdrop, virtual nursing services have emerged to offer hope to short-staffed hospitals and their beleaguered frontline nurses. Technology-enabled virtual nursing ensures that the work that needs to be done gets done, while bedside nurses maintain a priority focus on those nursing elements that can only be done in person and at the bedside.
The nursing tasks that can be effectively performed by a virtual nurse are numerous. Examples include admission and discharge documentation, patient and family education, medication reconciliation, patient monitoring, precepting, and many others. The goal is not simply to relocate the workload but to enable, hospitals to improve patient care, staff support, and clinical outcomes.
The impact of adding virtual nursing care is multi-dimensional.
Virtual nursing allows the bedside nursing team to focus on hands-on patient care. Studies have found resulting increases in patient satisfaction scores.
Virtual nursing provides real-time support for the bedside team, helping to reduce stress and burnout and improve clinician experience and retention.
Virtual nursing enables the hospital to add staff without finding candidates locally, relocating them, or relying on travel nurses, which can materially improve the hospital’s nursing costs. The NSI study found that the average hospital could save more than $3M annually for every 20 travel nurses eliminated.
Virtual nursing can also allow hospitals to lean on virtual services providers to take on the responsibility for hiring, retaining, and seamlessly augmenting staff.
By fielding services such as continuous patient observation, hourly rounding, admission history, and documentation of activities of daily living (ADL) via a virtual nursing program, health systems can immediately offset nursing shortages while also ensuring that bedside nurses feel well-supported and better able to focus on hands-on patient care.
The hybrid care model also lays the groundwork that will help health systems modernize care models and capitalize on digital health innovation in the years to come. With technology enablement in place, virtual nursing equips care teams to leverage seasoned, remote telemedicine nurses to anticipate staff and patient needs, customize care programs and related workflows, and continue to ensure the highest levels of patient care throughout the hospital.
What the End of the PHE Means for Telehealth Policy
The announcement came on the heels of the December 2022 passing of the Consolidated Appropriations Act of 2023, the 2023 omnibus spending bill that extends many – but not all – of the telehealth flexibilities introduced during the pandemic.
In light of these developments, here is a breakdown of how the telehealth policy roadmap is shaping up for the next two years.
Permanent Telehealth Changes for Medicare Patients
Removal of geographic restrictions for the delivery of behavioral telehealth services to patients, including coverage of both in-home and audio-only services.
Temporary Telehealth Extensions (Through December 31, 2024)
Healthcare providers may continue to bill Medicare for telehealth services authorized in the Calendar Year 2023 Medicare Physician Fee Schedule with no geographic restrictions, including engagement in the patient’s home and with audio-only communication accepted for select services.
FQHCs and RHCs may act as distant-site providers of non-behavioral telehealth.
Removal of in-person visit requirements for behavioral telehealth.
Expansion of telehealth coverage to include physical therapy, occupational therapy, and speech-language pathologist services.
Extended coverage of Acute Hospital Care at Home care models.
Approval of the use of telehealth to recertify patient hospice eligibility.
Telehealth Flexibilities Expiring at the End of the PHE (Through May 11, 2023)
Use of non-public-facing applications to communicate with patients without risk of federal penalty if the application is not HIPAA compliant.
Telehealth’s protection as an excepted benefit.
Worth noting: In February 2023, House representatives introduced the bipartisan Telehealth Benefit Expansion for Workers Act, which aims to provide American workers with access to employer-sponsored standalone telehealth benefits that are separate from traditional health plans, similar to how vision and dental plans operate.
Provider ability to prescribe controlled substances without an in-person examination.
Worth noting: A February 2023 proposed rule by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Department of Health and Human Services is seeking to permanently allow providers to prescribe buprenorphine for opioid use disorder treatment without the requirement of an initial in-person visit.
These changes focus on putting safeguards around telehealth. Additional regulatory efforts are expected ahead of the waiver extension expiration on December 31, 2024.
In the meantime, two additional questions remain on the future of telehealth:
1) How will interstate telehealth services play out when temporary geographic flexibilities expire at the end of 2024?
Interstate telehealth services were temporarily allowed across state lines during the PHE, waiving state licensure requirements. As of February 7, 2023, 21 U.S. states have solidified interstate telehealth as a permanent or long-term option. You can learn more about state-by-state variation in telemedicine restrictions here.
2) Will payment parity for home-based telehealth services stick beyond 2023?
Flexibilities introduced during the pandemic reimburse telehealth visits with patients at home at a rate that is on par with in-person visits. As Healthcare Finance News reports, the current telehealth payment parity runs through the end of 2023. The annual physician fee schedule set by CMS will determine whether payment parity for home-based telehealth services will be extended into 2024. The 2024 draft proposal is anticipated in July 2023. Among commercial insurers, it’s estimated that roughly half of U.S. states have passed payment parity laws.
In a string of years marred by some of the most challenging times in recent healthcare history, one positive trend is the buzz that has been building around health equity. Recognition of health disparity and the push to reduce it is building.
As providers look to build more accessible and inclusive care models for patients, virtual care has an important role to play. Here are a few examples of how telehealth is helping the cause.
Rural Care Access
Telehealth has long been lauded for its ability to reduce rural health disparity by facilitating virtual access to specialist care for patients in medically underserved areas.
Virtual care encounters also reduce barriers to care for patients who reside far from their local providers. Recent research revealed that patients with longer commute times to care sites were more likely to use telemedicine services, and the likelihood of having a telemedicine appointment grew with increasing commute times. Virtual engagement options similarly improve care access for those who have schedule restrictions and those without reliable transportation, many of whom are also economically disadvantaged.
To mitigate the risk of amplifying health inequity for those without access to broadband or enabling technology, many healthcare organizations are dispensing devices to patients to ensure equitable access to virtual care. Local, community-based outlets are increasingly providing device access, as well.
Engaging with Disabled Patients
One area where virtual care and digital health innovation can play a tremendous role in promoting health equity is within the disabled community. Travel arrangements can be particularly difficult and costly for patients with mobility limitations.
More than 60 million adults in the US have a disability, including more than 4.7 million Veterans with a service-related disability. The CDC reports higher rates of obesity, smoking, heart disease, and diabetes among disabled populations, making it imperative that these patients receive proper care. Virtual-first models ensure the most convenient option is the first line of defense in healthcare delivery.
Virtual engagement is ripe for further innovation in disabled care. As advancements in computer vision and precision eye-tracking enter the market, non-verbal patients are empowered to engage with remote clinicians. The incorporation of eye-tracking into virtual care also introduces new possibilities in the field of remote clinical diagnostics for neurodegenerative conditions such as Alzheimer’s, autism, and Parkinson’s, where problems in the brain can typically be detected in eye function.
Language Interpretation Services
For many patients, healthcare can be out of reach due to communication barriers. This can lead to greater health disparity, particularly within healthcare organizations serving culturally diverse patient populations. Patients with limited English proficiency, or LEP, are at a disadvantage to receive equal access to services due to the language barrier.
By integrating virtual remote interpretation capabilities into telehealth programs, health systems are reducing health inequities for deaf, hard of hearing, and LEP patients. This ensures 24/7 access to high-quality remote interpreters trained to provide culturally competent communication to support patient care. Video-enabled virtual engagement additionally supports ASL-based communication and allows providers to pick up on non-verbal patient cues and body language.
Decentralized Clinical Trial Support
Telehealth is also being used to support greater diversity in clinical trials where minorities have traditionally been underrepresented. Some 50% of FDA trials are conducted in one to two percent of all US zip codes. This limits research into the efficacy of care treatments across diverse populations. Through virtually enabled remote clinical trials, medical researchers can cast a broader geographic net to ensure that the patient sample is more reflective of the population.
Each of these virtual care initiatives plays a part in reducing health disparities and advancing patient care. And we’re just beginning to scratch the surface of what’s possible. As hybrid care and digital health innovation continue to ramp up in the coming years, telehealth will continue to redefine how we think about patient engagement and care.
Hybrid Care: Making the Case for Telehealth in Every Patient Room
During the pandemic, many health systems adopted telehealth to meet one specific objective: to ensure access to care for patients isolated at home. Telehealth and virtual care delivered on that and more. Homebound patients maintained ties to their providers, and hospital-based care teams used telehealth resources to reduce COVID-19 exposure and keep families connected during visitation restrictions.
As isolation issues abate, new challenges are driving health systems to explore ways telehealth can further support care delivery within inpatient settings. Clinical workforce shortages, patient safety concerns, and increased competition are all taking a toll on hospitals.
Here we look at how the integration of virtual tools into bedside care can help health systems adapt and overcome, making a strong case for hybrid care and the push towards telehealth in every patient room.
The Immediate Need: Staffing Relief
The 2022 NSI National Health Care Retention and RN Staffing Report reveals that in 2021 hospital turnover increased 6.4 percent, resulting in a national average of 25.9 percent. McKinsey and Company research cites a 25 percent increase in labor costs per adjusted hospital discharge between 2019 and 2022, much of which was driven by the high cost of travel nurses and staff recruitment and relocation.
The potential for telehealth to help bridge staffing gaps and reduce labor costs is four-fold:
Virtual workflows like tele-rounding, tele-nursing, and tele-sitting free up valuable time for bedside clinicians, helping to reduce burnout.
Telehealth-enabled remote work opportunities can extend the careers of seasoned clinicians considering leaving or retiring.
Virtual mentoring programs between new hires at the bedside and experienced remote clinicians improve staff onboarding, training, and experience.
Telehealth platforms allow health systems to easily bring third-party clinical service support into hospital workflows as needed, regardless of where the clinician is located.
Virtual nursing is one area of opportunity that is gaining traction. Research and consulting firm ITIC reports a 34 percent increase in the number of virtual nursing programs around the U.S. in the past year.
The Primary Objective: Patient Safety
Research has repeatedly demonstrated that poor staffing ratios lead to poorer patient care and outcomes, including increased morbidity, medication errors, and risk of infection.
Additional factors are leading to worsening patient acuity levels. American Hospital Association recently issued areport that found that deferred patient care during the pandemic led to a 9.9 percent increase in the average length of stay from 2019 to 2021.
As hospitals treat sicker patients, often with fewer clinical resources, deploying telehealth endpoints in patient rooms across the hospital enterprise helps amplify patient coverage and safety and improve the speed of clinical intervention. Virtual observation programs, for example, are increasingly moving beyond critical care units to help care teams keep eyes on at-risk patients for things like fall prevention. The ability for care teams to move from a one-to-one in-person model to a one-to-many virtual caregiver-to-patient model maximizes staff resources while reducing the cost of care.
A single telehealth platform may serve many use cases in the patient care journey, from virtual rounding in the morning, to virtual behavioral health appointments in the afternoon, to virtual patient observation at night. When integrated with clinical decision support tools, virtual nursing can support patient stratification to detect and intervene when patients are in decline and potentially discharge those doing well early. Bringing virtual resources to the bedside also enhances clinical collaboration as well as family engagement, which reduces anxiety and speeds the recovery process.
The Future State: Strategic Differentiation
Another motivator driving health systems to adopt an enterprise approach to telehealth is the pursuit of competitive differentiation. Hospital Room of the Future initiatives are cropping up across the nation as healthcare organizations seek to attract tech-savvy consumers and partners. These digitally enabled rooms enhance the care experience for patients and care providers alike. Patients benefit from virtual access to their clinical team and interpreters, which can improve HCAHPS scores. Clinicians benefit from access to innovative connected health integrations that streamline workflows and improve efficiency.
Many additional healthcare initiatives that are on the horizon are only feasible when telehealth is involved. Hospital at Home, Chronic Care Management, Aging in Place, and even advancements in preventive care coordination all require or benefit significantly from the ability to virtually engage with patients between in-person encounters, representing additional use cases where telehealth can enhance patient care.
The Challenge and a Path Forward
Inflation, increased labor expenses, and a rise in patient acuity are all putting strain on hospital financials. According to recent research from Kaufman Hall, the hospital median operating margin was down by 29.9 percent year over year as of June 2022.
So how can health systems enable enterprise-wide telehealth in the midst of record-setting low margins? Many recognize the value and long-term ROI that augmenting inpatient care with virtual workflows can bring but struggle to invest the upfront capital typically associated with enterprise-wide implementations. Without a way for health systems to wade into enterprise telehealth, financially speaking, few will be swimming.
The good news is that new pricing and acquisition models are emerging to help providers step into hybrid care and enterprise telehealth. Subscription-based models that offer pay-as-you-go pricing reduce up-front capital investment requirements. New cost-effective endpoint options for lower-acuity patient engagement that does not warrant the same intensive clinical communications needed in higher-acuity environments like the tele-ICU are also entering the market.
Enterprise telehealth platforms that master the basics – security, centralized program and fleet management, integration adaptability, and scalability – offer a solid foundation to build on that will also help health systems mitigate solution sprawl and resource redundancy in the years to come.
Five Connected Health Integrations for Hospital-Based Virtual Care
Since reaching widespread adoption in 2020, telehealth has captured headline after headline. While the lion’s share of media attention has been centered on outpatient telehealth sessions connecting providers to patients at home, use cases within hospital settings have quietly been gaining momentum.
Many health systems are looking to build upon the success of virtual care programs used in the COVID-19 response and the tele-ICU. Chronic staff shortages have sparked interest in expanding bedside hybrid care models to bring virtual support into additional workflows for overburdened care teams.
In inpatient settings, where resources are scarce and care is the most complex, tele-nursing and virtual patient observation programs are gaining popularity as health systems seek to enhance patient coverage and safety. Recent innovations in telehealth are paving the way for virtual engagement at every patient bedside to support these efforts and other “hospital room of the future” initiatives.
Within hybrid care environments, integrated software, services, and devices play a crucial role in workflow optimization. Beyond requisite EMR integration, here are five connected health integrations frequently used in tandem with virtual care.
1) Digital Health Assessment Devices
A key component that’s traditionally been absent in virtual care is a physical patient examination. New digital health devices are helping to close that gap. Emerging technologies are enabling care teams to remotely assess patient vitals and body sounds in real time. Caregility recently announced an integration partnership with Eko’s digital stethoscope to help remote clinicians and bedside staff collaborate to perform high-quality auscultation quickly and easily during virtual rounding. Digital thermometers, pulse oximeters, respiratory rate monitors, electrocardiogram patches, blood pressure kits, accelerometers, and other biosensors similarly support remote patient assessment. These devices elevate virtual encounters to support earlier detection of patient deterioration, building clinician confidence and ultimately improving patient outcomes.
2) Clinical Decision Support Tools
Clinical decision support (CDS) tools play a central role in disease management at various stages of the patient journey, including early screening, diagnosis, and post-discharge care. Real-time clinical data collection supports timely decision making and evidence-based, proactive care delivery. To bring this vital care support tool into virtual care encounters, many health systems are integrating their CDS and telehealth platforms. PeraHealth’s Rothman Index, for example, is an FDA-cleared risk assessment measure that can be brought into virtual workflows to help care teams prioritize treatment plan changes, transfers, palliative care referrals, and discharges.
3) Interactive Patient Care Systems
Many “care room of the future” initiatives seek to improve patient care by delivering easy-to-use technology to the bedside that is focused on empowering patients and increasing their satisfaction during hospital stays. Interactive patient care (IPC) systems like OneView provide a range of in-room services to patients, from education and entertainment to meal ordering and care support. Integrating IPC systems with your telehealth platform allows you to support virtual care visits on smart TV devices, avoiding duplicative hardware costs and crowding the room with additional screens.
4) Interpreter Services
To support culturally diverse patient populations during virtual encounters, health systems often integrate interpreter services into their telehealth platform. Virtual remote interpretation (VRI) services like LanguageLine support language access compliance and reduce health inequities for deaf, hard of hearing, and limited English proficient patients. Remote access to on-demand interpreters ensures 24/7 language support when on-site resources may not be available. Video-enabled telehealth enables sign language support and helps interpreters pick up on non-verbal cues, reducing miscommunication.
5) Third-Party Clinical Services
As staffing challenges persist, some hospitals and health systems simply lack the existing personnel needed to support adequate patient coverage. Integration with third-party clinical service solutions like Equum allows care teams to bring outsourced staff into virtual clinical workflows to eliminate gaps in care. From enhanced RN support to specialist visit access, health systems can increase clinical capacity through either dedicated outsourced support programs or on an as-needed basis during peak surges.
Click here to explore the full Caregility Connected ecosystem of connected health integration partners enabling hybrid care.
