A Virtual Healthcare System

Many healthcare companies are looking at having a virtual healthcare system. With virtual reality on the rise, it can give people the chance to seek medical help from wherever they are. One hospital in Saint Louis Missouri has taken this virtual healthcare to a whole new level. They have embarked on a new model for remote patient monitoring for patients living with complex conditions. Below is an article published by Healthcare It News, you can read the full article here.

The Problem with Virtual Healthcare

The program was born out of a need to better manage the sickest tier of Mercy’s patients. The sickest 5% of this cohort are responsible for 50-60% of expenditures. Despite this high-cost care, these patients experienced fragmented care, frequently cycling in and out of inpatient and outpatient settings. Historically, the traditional healthcare system was not equipped to deliver the high-intensity care required to manage this group of complex patients, she noted.

“Patients with chronic diseases often deal with daily symptom burden,” Bannister explained. “Before the system was not set up to offer on-demand daily symptom triage and management. Sadly, after attempting to navigate this messy world of chronic disease alone, many patients stop trying to figure out what symptoms to be most worried about.” “Also, many patients with chronic disease do not want to be a burden to family members,” she continued. “Because of this, many patients wait until symptoms are so bad that they have no choice but to call 911. The need for daily communication to help a patient navigate ‘Is what I’m feeling normal today?’ 

They noticed a gap in care for this particular group of patients and believed virtual care could bridge this gap between ambulatory and inpatient. They hoped to replace fragmentation with cohesive, integrated, patient-centered, data-driven care delivery.

With the early introduction of home biometric monitoring, daily surveys, and real-time access to providers, the virtual team was able to deliver the high-intensity, comprehensive, individualized care that was previously not possible.

Proposal

During the RPM pilot’s first few years, patients’ days in the hospital decreased and satisfaction shot up. Consequently, with the pilot’s success, the objective was to scale this intervention to reach as many high-risk lives as possible.

Bottom line, staff reasons for considering technology adoption were twofold: One was that once a care team becomes larger, the management infrastructure required to serve a team that size becomes unwieldy. The second reason is that they would soon run out of healthcare workers to hire and, from a fiscal and operational standpoint, program expansion no longer made sense to continue without automation. Further, staff people were sitting on a mountain of productivity data just waiting to be unlocked.

First, risk-stratify the patient population. This strategy was necessary to deliver the right intensity of care to every patient based on their needs at a moment. Staff members were still applying a “one size fits all.” If they wanted to add more patients, they needed to know which patients were stable and could have their care de-escalated and which patients needed frequent touchpoints.

Second, leverage asynchronous messaging. Then, patient communication was happening over the phone and through video. The staff knew these modes were not the fastest and most convenient for patients to access care.

Third, reduce alert volume. Chasing alerts was by far how many of the Mercy caregivers spent most of their day. Complex, chronically ill patients take their vital signs daily, which are automatically transmitted to the care team.

Certain alerts trigger if vital signs are outside the individual patient’s threshold. For example, if blood pressure is greater than a certain number an alert flag the provider. But if thousands of patients are entering daily vitals, the number of alerts being generated skyrockets.

Meeting the Challenge of Virtual Healthcare

Myia Health equips Mercy Virtual patients with RPM kits containing a tablet to monitor their vital signs and online capabilities to call, text, or conduct a video consult with their virtual care team; biometric monitoring devices such as a blood pressure device, scale, pulse oximeter, and thermometer.

Mercy Virtual implemented its second strategy by developing a closed-loop asynchronous system for messaging patients. With this system, providers are alerted to any message that goes “unread.” This closed-loop allowed providers to push much of the conversation previously occurring over the phone to messaging.

To date, staff have gained a deeper understanding of the different types of alerts and found that the weight alerts were the highest volume of alerts, accounting for 44%. These alerts, volume-wise, are in the thousands of numbers that staff are clearing on a monthly basis. Low-weight alerts result in a change in care only 1.7% of the time. High-weight alerts resulted in a change in care only 9.8% of the time.

But when combining a symptom-based patient survey response with vitals, for example, if their weight is abnormal and the patient says they’re short of breath or experiencing swelling, that would increase the likelihood that staff would change care by two to three times. About 71% of all alerts result in care changes less than 10% of the time.

If the patient answers a survey that they are feeling worse than usual or has vital sign readings out of range, they move into this bucket of priority patients. That gives the provider a chance to see their entire group including priority patients at a glance.

The “watch list” used to be a sticky note on every provider’s desk listing the names of patients who they worried about. Having a list of all patients about whom they are concerned is not only a time saver but increases the quality and safety of the care provided, Bannister said.

Marie Wikoff is the creator of Wikoff Design Studio based out of Reno, Nevada. Her expertise in healthcare design has helped modernize healthcare organizations locally, regionally, and internationally, improving patient experience and outcomes. Her credentials include Evidence-Based Design Accreditation and Certification (EDAC), American Academy of Healthcare Interior Designer (CHID), the National Council of Interior Design Qualification (NCIDQ) and LEED AP. Contact Marie Wikoff

Source: Siwicki, Bill. “Mercy Virtual Care Center: A Deep Dive into a Virtual Hospital.” Healthcare IT News, 4 Jan. 2023, https://www.healthcareitnews.com/news/mercy-virtual-care-center-deep-dive-virtual-hospital.