The Providence health system has an internal service available to its 51 hospitals and other rural and community hospitals in its eight-state service area, bringing specialists and other high-demand providers virtually to the hospital bedside.
This acute care telemedicine service – built by and for Providence – seamlessly integrates with clinical workflows and processes to provide quality care to any hospitalized patient in the Providence hospital ecosystem.
THE CHALLENGE
Anyone caring for critically ill patients knows that access to specialists and high-demand providers within hospitals is essential to achieving good outcomes and supporting patients and caregivers. Scheduled and on-demand access to neurologists, infectious disease specialists, hospitalists, intensivists and psychiatrists is proven to address these goals. However, the workforce crisis is making the job of staffing to need a tough battle.
The problem is three pronged – revolving around provider supply, demand and distribution of clinical expertise, said Sherene Schlegel, RN, COO and CNO, virtual care and digital health, at Providence.
“First, on the supply side, we have significant shortfalls in the number of physicians who can treat specific conditions due to a broad set of factors – but the aging population of our current physicians and burnout are playing a significant role,” she explained.
“Nationally, 41% of ICU physicians have reported a high level of burnout, 55% of physicians will be age 75 or older by 2036, and more than half of infectious disease residency training programs go unfilled,” she continued.
“So, this problem is real. On the demand side, aging patient populations and new treatment options are increasing the demand for specialists. In fact, most hospital stays require at least one specialty consultation.”
In such a supply-and-demand constrained environment, the distribution of physicians – where they are geographically in the world – starts to make a tremendous difference. In the acute care environment, a strong telemedicine program can get excellent specialists and high-demand providers to the bedside of any hospitalized patient in a service area, she added.
That’s why the health system has been developing the Providence Virtual Acute Care program over the last 10 or so years.
PROPOSAL
“Here at Providence, we have been at the forefront of delivering virtual acute care services since the beginning – so we’ve been developing and learning what makes an effective program,” Schlegel said.
“For us, our high-quality, mission-based care is non-negotiable – so we wanted to develop a program that focused on enabling our own Providence providers to be available at the patient’s bedside within the hospital,” she continued. “Having our virtual team be Providence providers – who meet the high quality, credentialing and governance requirements used across our system and who know our internal systems, protocols and workflows – was essential.”
The virtual providers are colleagues of those at the hospital site, and staff believe that makes a tremendous difference.
“Over the years, we’ve also learned a lot about the delicate balance that exists between operational scalability and hospital-specific requirements,” Schlegel noted. “To make the program operationally feasible, we needed to take advantage of the economies of scale that a health system like Providence has.
“With 51 hospitals and hundreds of referral hospitals within our service area, program scalability is both possible and essential,” she continued. “But we also are keenly aware each hospital brings its own unique challenges that must be embraced through the program.”
Utilization, staffing and recruiting preferences and constraints, the nuances of the community served, and the services available to care for them – all have an impact on how care decisions are made. Providence needed to assure it was able to consider the hospital-specific requirements as well.
“For these reasons, national telemedicine services really fall short – so for us, developing a Providence-specific virtual acute telemedicine program was essential,” Schlegel stated.
MEETING THE CHALLENGE
Over the years, the Providence Virtual Acute Care service has evolved into a highly valuable, comprehensive and scalable program that is meeting the needs of the health system’s hospitals and other hospitals in the referral networks.
There are six core components to the program.
First, Providence providers. The service starts with providers.
“We don’t just integrate with Providence, we are Providence,” Schlegel explained. “Our service was built by and for our hospitals and referral hospitals, and our providers are Providence employees who meet or exceed our standards for employment and service levels.
“We are full-service teams focused on delivering mission-based care and helping our colleagues deliver on their patient care goals,” she added. ” We use the same systems they use and are focused on providing our unique Providence brand of mission-based care.”
Next, clinical quality programs and analytics. Staff layer on top of all of this a standards-based quality program that incorporates ongoing monitoring for adherence and reporting against established KPIs – including quality of patient care, programs and physicians.
Then, customized clinical design. The hospital-specific clinical design process recognizes the unique service availability, referral preferences and operational norms of a hospital and optimizes workflows accordingly. The system is deeply integrated into existing workflow, processes and operations, while adhering to and supporting Providence standards of care, governance models and mission.
Next, one-call-for-all service. “Our unprecedented ‘one-call-for-all,’ real-time patient support manages immediate action for any hospital requirement or issue,” Schlegel explained. “Our Digital Access Center ensures clinicians and stakeholders get the crucial assistance they need to perform at their best. This includes a 24/7 virtual response team, stakeholder support and service levels.”
Further, cross-Providence exam technology.
“We are equipped with high-definition cameras and integrated peripheral devices that allow the facilitation of comprehensive, remote examinations,” Schlegel noted. “Our exam hardware and software are standardized across Providence to deliver a price, support and experience advantage.
“We use highly reliable bidirectional audio/video technology, including carts, wall-mounted units and tablets, as well as examination tools such as Bluetooth-enabled stethoscopes and peripheral devices – delivered at a price advantage through cross-Providence, volume-based contracts,” she continued.
“Our clinician portal supports request triage and case assignment, provides safety and quality controls to ensure appropriate licensing and credentialing, as well as manages scheduling using Providence Epic instances and service-line standards.”
And finally, the Telemedicine Resource Center. “Last, we provide shared services that support our hospitals as they transition toward a virtual care augmented hospital,” she said. “We provide learning and education opportunities for every level and function, helping the organizations we serve to manage the differences and complexities of telehealth operations.”
RESULTS
Virtual care at Providence is proving to be an important component of the health system’s care delivery. Today, the health system has more than 250 virtually enabled acute care clinicians delivering service in more than 100 sites in eight states, and delivers more than a million patient encounters every year.
The Providence Virtual Acute Care services has evolved from tele-stroke alone to eight offerings including:
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The tele-stroke service line, live in more than 80 sites, serving more than 16,000 patients every year with an average response time of 2.4 minutes.
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The emergent tele-neurology offering, serving more than 1,000 patients every year at 28 sites, providing 24/7 neurology coverage to hard-to-recruit service areas.
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The tele-neurohospitalist service line, offering 24/7 access to board-certified neurologists at eight sites, reducing transfers and improving patient outcomes.
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The tele-EEG service line, live at 12 sites, enabling EEGs at sites without machines to be conducted and reach within 24 hours and stat requests to be read within two hours.
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The telepsychiatry service line, live at more than 40 sites, with an average response time of less than seven minutes. One in three patients are rapidly triaged and sent to lower acuity care.
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The tele-critical-care service line, which has decreased risk-adjusted mortality, decreased length of stay and reduced transfer rates.
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The tele-hospitalist service line, which has demonstrated reduced ED wait times of more than 6-times at partner hospitals, contributed to decreased length of stay, and offers cross-cover resolution times of less than 10 minutes.
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The recently launched tele-infectious-disease service line, offering same-day consults 365 days per year; early infectious disease consultation can reduce length of stay by up to 29% and reduce 30-day readmissions by 8%.
ADVICE FOR OTHERS
“I would emphasize the critical role virtual care plays in mitigating clinician shortages and allowing patients to have access to care regardless of their geographic location,” Schlegel said. “Virtual care not only alleviates staffing constraints but also enhances patient outcomes by providing timely access to expert care – and is incredibly meaningful to families who are able to keep their loved ones close to home.
“I don’t believe flexibility is a trend – I think it’s the new currency of hospital employment,” she continued. “When done right it’s good for patients, good for hospitals, good for administrators and good for our clinicians. That said, embracing flexibility should not mean a compromise to care quality. It’s important to figure out a way to both have scalability and deliver quality care. Through many years of learning, we’ve figured out a model to do both.”
Follow Bill’s HIT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
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