MU Health Care is one of only two health systems in the country to use the Xenon MRI, which could improve diagnosis and treatment for millions of people living with a variety of lung issues.
A new method for scanning lungs could improve diagnosis and care management for patients with a wide range of respiratory disorders.
Clinicians at University of Missouri Health Care are using xenon gas as a contrast agent in MRI lung scans. The process, called a Xenon MRI, gives care providers a better view of a patient’s lungs in action, and could improve treatments for patients living with cystic fibrosis, COPD, asthma, farmer’s lung, and other diseases.
“Advancing Xenon MRI from the research realm into clinical application represents a tremendous breakthrough for evaluating lung diseases such as cystic fibrosis, asthma or COPD,” Talissa Altes, MD, chair of radiology at the University of Missouri School of Medicine, told radio station KRMS in a recent interview. “Rather than imaging structures and tissue, we’re imaging function itself. In this case, producing a highly detailed image of how the lungs are doing their job.”
MU Health is one of only two health systems in the country using the inhaled contrast agent, called XENOVIEW. The health system launched a research program in 2018, and in 2022 the US Food and Drug Administration (FDA) approved its use with patients.
Patients inhale the gas contract agent, and an MRI is performed during a short breath hold, usually taking 10 to 20 seconds. The images produced by the scan are used by pulmonologists, surgeons and other respiratory specialists to get a better look at lung ventilation.
“Traditionally patients are diagnosed based on how they present compared to other patients with similar symptoms,” Robert Thomen, PhD, an associate professor of radiology and bioengineering at the UM School of Medicine, said in the radio interview. “Because we can now see the function of the lungs as air is inhaled, we have the opportunity to bring more precision to the diagnosis of respiratory disorders.”
The health system is seeking new ideas and technologies that can help improve cancer diagnosis and treatment in rural areas.
Tampa General Hospital is looking for innovative ideas to help improve cancer care in rural communities.
The hospital, through its TGH Innoventures venture capital and innovation arm, and its Cancer Institute are partnering with the non-profit Synapse Florida on the Innovation Challenge, which “encourages individuals and organizations to propose innovative solutions that address the significant need for cancer care where it otherwise may not exist.” Submissions are due by January 20, 2024.
Health systems and hospitals across the country have been turning to crowdsourcing in recent years to tackle vexing healthcare issues, with the idea that innovation doesn’t have to come from within the healthcare space. Some of the industry’s biggest disruptors, like Amazon, Apple, and Microsoft, are approaching healthcare with ideas and lessons learned from retail, hospitality, banking, and other industries.
Several health systems have launched their own innovation centers, often fueled by venture capital, to promote new ideas and technologies from within and in collaboration with the surrounding community. The health system can then test and fine-tune those products within the enterprise before marketing them through a new business line.
“Hosting an innovation challenge is a strategic move for any business seeking fresh, creative solutions,” Lauren Prager, CEO of Synapse Florida, said in a press release issued by TGH. “Through these challenges, organizations like Tampa General are establishing a direct channel for new ideas by engaging with innovators beyond their immediate sphere. This approach is particularly effective as it draws from a diverse pool of contributors, including those from outside the healthcare industry, such as patients, caregivers and businesses from varied sectors. Large organizations can significantly benefit from this open exchange, as it not only drives innovation but also strengthens community ties, fostering a culture of collaboration and inspiration.”
In this case, TGH officials say they want to target not only lack of access to cancer care services in Florida, but care for the estimated 46 million Americans living in rural areas, where lack of resources and higher risk factors are contributing to higher cancer and mortality rates.
“While we are working to increase access to world-class care across Florida, we recognize there are some challenges we face that require system disruption,” John Couris, president and CEO of Tampa General, said in the press release. “Through TGH Innoventures and in partnership with Synapse, we’re working to incentivize innovation so that we can transform care delivery. With this challenge, we invite experts, entrepreneurs and critical thinkers to offer up solutions that have the potential to have a real, meaningful impact.”
“The Innovation Challenge is illustrative of the work we do at TGH Innoventures, assisting Tampa General’s stakeholders in solving big problems in healthcare by looking outside the four walls of the organization,” added Rachel Feinman, the health system’s vice president of Innovation and managing director of TGH Innoventures. “By fostering partnerships and supporting projects, we can advance cancer care across Florida.”
Aurora Health Care has integrated the technology into new clinics, giving providers and patients a pathway to better care coordination
Real-time location system (RTLS) technology has long been used to keep track of objects, supplies, medicines, and even staff and patients within the healthcare space. Now some organizations are using the platform to map out provider workflows and patient journeys.
At Aurora Health Care, a Milwaukee-based health system encompassing 26 hospitals and more than 600 other care sites, leadership decided to incorporate an RTLS platform into new clinic construction. With that technology in place, the health system has been able to boost patient visits and streamline provider and staff workflows so that patients spend as little time as possible waiting around.
“We really appreciate it because it expedites the visit process,” says Elise Dieringer, BSN, RN, Aurora’s manager of clinic operations. “It really comes down to enhancing workflows. And we’re still learning every day how we can use it more, how we can use it better.”
With many health systems looking to maximize patient time and reduce workflow inefficiencies, RTLS technology offers an innovative platform for understanding the care pathway. Upon checking in to a clinic for an appointment, patients are given a badge and assigned an exam room, similar to a self check-in. The badge links to the clinic’s EHR and the patient’s record and alerts the patient’s care team, with the appropriate care team member sent to that room. If the patient is seeing multiple providers, the badge issues alerts when one provider is finished, when diagnostic tests are needed, or when it’s time to finish the visit. The patient can then be discharged from the room instead of the front desk.
Health system officials say the platform increased capacity at one clinic by about 15%, or an additional 86 visits per month, without reducing face-to-face time.
What it does reduce, Dieringer says, is time spent waiting to see a physician or nurse, or time spent by care team members waiting for a patient to be ready. Care team members know immediately when a patient is ready, and staff can use the data accumulated over time to better schedule patient visits and map out room utilization and care team workflows.
Dieringer says new clinics are designed so that the care team is based in a central area, rather than individual offices (one of the sticking points to provider buy-in, she adds, was getting physicians to see that they didn’t need to have their own offices). The floor plan is then mapped out to facilitate quick and efficient patient flow, with the idea that the entire care team, from nurses to doctors to specialists, goes to the patient rather than having the patient move around to meet each care team member.
“It really is a team-based approach” to healthcare delivery, she says.
Dieringer says the next step will be integrating the RTLS platform into an existing clinic, a bit of a challenge considering the technology will need to be designed around an existing floor plan. Beyond that, the health system will be looking at how it can use the data collected for other purposes, such as tracking the spread of viruses and infections within the clinic, monitoring supply chain efficiency and device use, even improving staff and patient safety.
A study led by Brigham and Women's Hospital found that a sensor-embedded pill can accurately track vital signs in patients being treated for sleep apnea and can be used to monitor fentanyl overdoses.
Researchers at Brigham and Women’s Hospital are reporting good results from a study that used a sensor-embedded ‘pill’ to monitor a patient’s vital signs.
The study, published in Device, gives new value to a digital health form factor that has seen its share of ups and downs, but could prove valuable in remote patient monitoring programs for a wide variety of health conditions.
“We have developed an ingestible electronic capsule that detects different movements associated with specific vital signs,” Giovanni Traverso, MB, BChir, PhD, a gastroenterologist in the hospital’s Division of Gastroenterology, Hepatology, and Endoscopy and co-corresponding author of the study, said in a press release. “We anticipate that there will be broad applications for this device, with the potential to improve monitoring for sleep apnea and other breathing conditions.”
In their research, Traverso and his colleagues tested the Vitals Monitoring Pill (VM Pill) on 10 patients living with sleep apnea. They found that the device, developed by Massachusetts-based Celero Systems, which was launched through the Mass General Brigham innovation network, captured respiratory and heart rate data that was comparable to other monitoring devices. It also captured moments when the patient stopped breathing, either intentionally (when a patient holds his or her breath) or during a sleep apnea event.
The device was also tested in a preclinical model for fentanyl overdose, and was able to detect respiratory depression caused within a minute of overdose in real-time. That capability is timely, given the nation’s opioid abuse epidemic and efforts to find new ways to monitor patients and reduce deadly overdoses.
The study was done by researchers at Brigham and Women’s, a member of the Mass General Brigham health system, the Massachusetts Institute of Technology, and West Virginia University, as well as members of Celero’s team. Some 57 hours of data was gathered from the patients at WVU Medicine’s Sleep Evaluation Center.
Healthcare organizations and pharmaceutical companies have been experimenting with ingestibles for years, but have struggled to find the right technology and use case. One of the first companies to develop “smart pills’ was Proteus Digital Health, which at one point was valued at $1.5 billion and had a partnership with Otsuka under its belt before filing for bankruptcy in 2020. Smaller, more recent studies have centered on monitoring GI issues and delivering and tracking the effectiveness of timed doses of medications.
Traverso, who launched Celero in 2017 and sits on its board of directors, says sensor-enhanced pills have great potential in RPM programs where providers need accurate data without worrying that the patient will affect the data-gathering. Data is transmitted from the pill to a receiver attached via USB interface to a laptop until the pill is discharged.
“Our study provides a tangible product with real commercial value,” he said. “Ingestible vital monitors can really transform our capacity to rapidly respond to life-threatening events.”
A new program at Bassett Healthcare monitors email inboxes and helps the health system react quickly to important patient emails.
With more and more healthcare being conducted online these days, health systems are struggling to get a handle on messaging between care teams and their patients.
Enter the Inbox Ninjas.
Launched in late 2022 by the Bassett Healthcare Network, the Ninjas are full-time advanced practice clinicians (APCs)–or staff with similar qualifications–hired by the health system to review email messages sent by patients to their care providers. The Ninjas separate the messages into different categories, giving high priority to messages that require action, such as answering an urgent medical question, scheduling an appointment, or filling a prescription.
The program addresses a vexing pain point for healthcare organizations, putting pressure on already stressed doctors to keep their inboxes up to date, even when they’re away. Missing those messages often leads to interrupted or delayed care, which affects care plans and clinical outcomes and boosts expenses.
Some health systems, including the Mayo Clinic, Cleveland Clinic, Vanderbilt Health, UCSF Health, Northwestern Medicine, BJC Healthcare, and even the Department of Veterans Affairs, are charging fees to answer emails, under the idea that a fee will cull out unnecessary messages and compensate care teams for their time.
Paul Uhrig, chief legal and digital health officer at New York-based Bassett and executive director of the Bassett Innovation Center, says leadership didn’t want to add that burden to their patients, many of whom live in rural areas and are concerned about the cost of healthcare.
“There’s a lot of messages coming into our providers now through the portal that need to be answered, and [those providers] were answering them during their pajama time,” he says, referencing the time spent by providers at home. “We wanted [a program] that takes the burden off them while not shifting that to their patients. We’re very conscious about not shifting cost to patients.”
Meeting a distinct need
Bassett launched the program to meet a very distinct problem. According to Halley Chiodo, the health system’s telemedicine specialist, a large primary care provider in Cooperstown, New York, had closed down, leaving thousands of patients without a PCP. Bassett stepped into the void to help but needed a means of sifting through the inboxes of the departed PCPs, tagging urgent messages to prevent lapses in any care plans, and shifting those patients to new providers.
They had little to work with at first.
“We built this program from the ground up,” she said during a presentation at the Northeast Telehealth Resource Center’s (NETRC) annual meeting this fall in Nashua, New Hampshire. “We had no model to work with.”
Chiodo said management didn’t want to pull in current staff and add to their workflows, so they created a new position, one that is all-virtual and requires APC-level qualifications so that they can answer questions and fill prescriptions on their own (the health system currently requires a New York license and three years of clinical experience). The role seems especially suited to clinicians at the late stages of their career or in retirement, who might enjoy a job that they can do from home.
With approval from leadership to hire five FTEs, the program launched in late 2022. Uhrig said that while the initial intent was to focus on the inboxes of doctors who were no longer with the health system or those on vacation or out of office for a period of time, leadership realized the program could benefit any and all care providers.
It also became apparent very quickly that addressing every single email message would be too much, even for the Inbox Ninjas. Chiodo said the health system adjusted the protocols to enable the Ninjas to sort through all emails but answer only the priority messages.
“Nobody needs a clean inbox,” she said.
With that model, Chiodo said, the health system found that the Ninjas could also be put to use supporting Bassett’s telehealth programs, providing an extra layer of clinical backup.
Calculating the ROI
Both Chiodo and Uhrig say the Inbox Ninjas have been successful in cleaning up inboxes and addressing care gaps for patients, but whether that makes the program sustainable is uncertain. Chiodo—who noted Bassett is hiring more Ninjas soon—said the program is all-virtual, so the workforce is unique and requires a different management style. She also noted that other departments have asked about having their own Ninjas.
As for cost, the program can be adjusted to fit the needs of the health system. The higher level of clinical proficiency, the more that a Ninja can do with regard to fielding and addressing requests for medical services, which also means the money spent on staffing will increase.
Chiodo said the health system is working on a formula that would establish the number of billable clinical encounters needed to support one Ninja—while adding that ROI shouldn’t be linked solely to billable encounters. Uhrig, who noted the program did receive some outside funding to get off the ground, also noted the challenge of determining value.
“How do we turn some of these activities into billable activities?” he asked. At the same time, he added, there are benefits that aren’t billable, including improved patient satisfaction and engagement and a less-stressed corps of doctors who aren’t worrying about their inboxes so much. Eventually, he added, the health system might be able to link those timely responses to e-mails to specific improvements in clinical outcomes and reduced healthcare expenses, along with less staff stress, a better workplace, and improved staff retention.
Chiodo says there’s no shortage of qualified people who are interested in the job.
“After all,” she said. “Who wouldn’t want to be called a Ninja?”
Research finds that patients are less likely to get follow-up diagnostic tests after a telehealth appointment than after an in-person visit. To address this, health systems need to provide better follow-up services.
Telehealth programs may be great for connecting patients to their doctors, but new research suggests it isn’t closing the gap on diagnostic tests and referrals.
A new study posted in the Journal of the American Medical Association (JAMA) by researchers from several notable health systems finds that diagnostic loop closures for colonoscopies, cardiac stress tests, and dermatology referrals were worse for patients after virtual visits than for those patients seeing their doctor in-person.
The research, conducted by affiliates of Harvard Medical School, Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Northeastern University, and Stanford, suggests that health systems aren’t providing the appropriate support after a telehealth visit to ensure follow-up tests are done. That would include sending messages to the patient after an initial visit to schedule and follow through on diagnostic tests.
Without that follow-up to close the loop, diagnostic tests aren’t taken and the care plan is interrupted. This could mean patients aren’t alerted to a serious health concern such as cancer or advanced cardiac disease and don’t take the necessary steps to seek treatment.
“When investigating notable differences in loop closure for orders placed during telehealth visits, our findings suggest that differences in loop closure may be inherent to telehealth as a modality,” the study team concluded. “One potential mechanism to explain this may be the lack of systems in place to help patients complete test and referral orders. During in-person visits, members of the support staff team sometimes help patients schedule their tests at checkout; however, this support is absent during telehealth visits. After the visit, patients do not receive any communication reminding them to schedule the test or referral, which may further limit loop closure.”
“Other potential explanations include the possibility that it may be more difficult to remember information provided during telehealth visits, that telehealth may present unique communication barriers, or that it may be more difficult to engage patients in shared decision-making during virtual visits, thus decreasing patient engagement with test and referral orders,” the team added.
In the study of more than 4,100 patient visits at a Boston-based primary care practice and affiliated health center between March of 2020 and January of 2021, researchers actually found low follow-up for each of the three tests, but lower after a telehealth visit. Overall, 58% of tests ordered during in-person visits were completed, while 43% of tests ordered after a virtual visit were completed.
Broken down further, colonoscopy referrals made up 78.7% of all orders. Of those, almost 57% were completed within a year by patients who’d seen a doctor in person, while about 39$ were completed by patients who’d used telehealth. For dermatology referrals, comprising 11% of all visits, 61.5% of those ordered after an in-person visit were completed within 90 days, and 63% were completed by those using virtual visits. For cardiac stress tests, comprising 10.3% of all orders, the numbers were 63% completed within 45 days of an in-person visit and 59% completed after a telehealth visit.
While identifying the challenges associated with virtual care, the researchers also emphasized that neither in-person nor virtual visits are performing well in closing the diagnostic testing loop.
“While the differences in loop closure between telehealth and in-person visits may be concerning, system-level changes are needed to improve test completion rates across all modalities,” they wrote. “These might include automated tracking for outstanding tests within electronic medical records and interventions such as telephone outreach to patients, automated text and email reminders, and the use of referral managers. These considerations may be particularly important for patients who rely heavily on telehealth, such as those in remote rural areas and disadvantaged patients with limited health access and literacy.”
The partnership with Talkspace addresses a surge in teenagers—both in the city and nationally--reporting severe behavioral health concerns and not receiving care.
New York City officials have launched a telehealth platform specifically designed to give teens access to behavioral health services.
The ‘TeenSpace’ platform, developed in a partnership with digital health company Talkspace, enables those between the ages of 13 and 17 to meet with a licensed therapist by phone, video, or text at no cost.
The program comes at a time when healthcare organizations across the country are struggling to find the resources to help a teenage population facing a surge of behavioral health issues. The National Institutes of Health (NIH) says depression in that age group has increased to the point that it’s a “major public health concern,” with some studies estimating one in every five is in need of care and more than half of those aren’t getting the care they need.
NYC officials say that percentage is even higher in the Big Apple. According to the city’s Department of Health and Mental Hygiene (DOHMH), some 38% of NYC high school students in 2021 reported feeling so sad or hopeless almost every day for at least two weeks during the past 12 months that they stopped doing their usual activities.
"Coming out of a once-in-a-century pandemic, we know that levels of anxiety and depression have increased particularly among our young people," Deputy Mayor for Health and Human Services Anne Williams-Isom said in a press release put out by the mayor’s office. The new telehealth portal "puts access to mental health support right in the hands of our young people. They can use their smart phone or other devices to connect with a practitioner in a time and space that works for them.”
Talkspace will manage the platform, which was designed by the company and city officials with input from teens. The service also enables a mental health professional treating a teen to refer that teen to additional resources, including in-person care.
A new partnership in Atlanta is helping church-goers monitor blood pressure and live healthier lives.
A new partnership in Atlanta is launching a remote patient monitoring program through area churches to address chronic care management in underserved communities.
Digital health company Rimidi is partnering with the Brighter Day Health Foundation to launch wellness clinics at Atlanta-area churches, beginning with Impact Church and World of Faith Family Worship. Brighter Day will locate weekend clinics within those churches and use RPM technology from Rimidi to help church-goers monitor their blood pressure and manage their health.
With underserved populations at a higher risk of developing chronic conditions and often facing barriers to accessing healthcare, healthcare organizations are looking for new ways to reach them and improve access to resources and care management. Some programs have located care teams and clinics in barber shops, beauty salons, community centers, fitness centers, libraries, and retail sites like malls and pharmacies.
Community health outreach is vital to health systems, both in improving clinical outcomes and reducing adverse health concerns that result in expensive trips to the doctor’s office, emergency care clinic, or hospital ER. Hospitals and health networks that collaborate with or support these programs can reduce acute care costs and ED traffic, while promoting healthier communities.
Some 350 church-goers are currently engaged in the Rimidi-Brighter Day program, in neighborhoods that are 80% African-American and the average age is 55. The participants have access to a nurse practitioner and dietitian at the weekend clinics and are given connected devices to track their blood pressure at home and send that date to their care teams. Staff at the clinics work with these patients to develop care management and healthy living plans at home.
“Chronic diseases are some of the most prevalent, yet challenging conditions to manage, especially when social determinants of health can create barriers to care,” Lucie Ide, MD, PhD, founder and CEO of Atlanta-based Rimidi, said in a news release. “It’s our responsibility as a clinical management platform to reduce those barriers through innovative technology, such as RPM. Our partnership with Brighter Day Health Foundation is aiming to meet patients where they are–literally–in their communities. Together, we will seek to provide individuals who currently may have limited access to healthcare within the Atlanta community with new tools and services to better manage their chronic conditions and improve their health overall.”
“Our goal at Brighter Day Health Foundation is not to take the place of the primary care provider, but to provide timely secondary interventions that help preclude ‘rising risk patients from becoming high risk patients,’” Eric Nixon, MPH, Brighter Day’s president and CEO, said in the press release. “Our faith-based model brings people into the healthcare system by creating new care access points and removing the non-clinical barriers to care that have historically plagued minority and underserved communities.”
The Washington-based health system, which spans more than 50 hospitals in seven states, tested the technology earlier this year with Premera Blue Cross, one of the largest health plans in the Pacific Northwest. Officials say it was vetted by internal teams as well as HEDIS (Healthcare Effectiveness Data and Information Set) auditors.
With the tool, Providence pushes to the head of the pack in the nationwide quest for interoperability through national FHIR standards, alongside federal efforts to develop TEFCA (Trusted Exchange Framework and Common Agreement). The goal is to create a national framework for the exchange of all data between healthcare organizations, health information exchanges, payers, consumers, and other stakeholders, eliminating silos, improving clinical and business operations, and moving the industry toward value-based care.
“Interoperability is critical within value-based care, and FHIR integration allows healthcare organizations to exchange comprehensive clinical data that enables more accurate risk assessments, enhances care coordination and captures outcomes more effectively,” Michael Westover, the health system’s vice president of population health informatics, said in a press release. “By using a national standard for contract gap closure and capturing the much-needed clinical data, we empower all stakeholders in their ecosystem to make more informed decisions, improve patient outcomes and enhance the overall quality of care to our patients – who are always at the center of all our efforts.”
The nation, as a whole, has been struggling to reach interoperability because of the lack of standards for data sets, particularly at a time when the industry is seeing a wealth of unstructured data from sources outside the health system. As a result, few organizations use the same rules to organize and share data, using everything from spreadsheets, fax machines, emails, and secure file transfer protocols (SFTP) to share information.
In an email to HealthLeaders, Westover said Providence is a “trailblazer” in developing data exchange standards that meet HEDIS quality measures.
“We had to wrestle with a new data standard, new technology, and a new data security model,” he said. “We tested for months with our health plan partners and frankly learned some hard lessons as we used a generic clinical exchange standard for a targeted business case. We are now using what we’ve learned to scale the platform with other health plans.”
At Providence, the health system’s data-as-a-service (DaaS) tool leverages the Member Attribution (ATR), Clinical Data exchange (CDex) and Bulk Implementation Guides as national data exchange standards developed through the HL7 Da Vinci Project, which is billed as an industry-led project to enhance data sharing between payers and providers to enable the industry’s transition to value-based care.
A key aspect of the project was securing participation from a payer.
“We initially targeted the clinical data elements for 15 or so clinical measures that have a big impact on patient care and payer finances,” Westover explained. “We were surprised at how excited our health plan partners were and how they immediately asked us to expand the number of included measures and the qualifying patient population in the dataset. Our partners quickly saw the impact this type of DaaS could make on their business during difficult financial times.”
“Payers currently get much of their clinical data from patient charts and from data manually keyed into clunky websites or spreadsheets,” he added. “This solution allows health plans to exchange curated patient data rapidly using a nationwide standard format. If health plans can get higher quality data faster and easier than they could before, they will outperform their competition on important HEDIS, 5-Star, value-based care metrics, and other government programs.”
According to Westover, more efficient data exchange with payers means that providers and payers will have a shared understanding of their patient populations, which in turn will help improve care management and coordination.
Providence executives plan on using the tool to partner with other payers and vendors on data exchange..
“The technological and regulatory environments are evolving so quickly that we expect to see a few different approaches to these types of healthcare interoperability challenges,” Westover said. “Some groups will ask their EMR vendors to take care of it for them. The most successful health organizations will be those that can exchange vital data more efficiently than the rest.”
Trinity Health uses virtual care, teamwork to address workforce, clinical care issues.
Trinity Health is taking a team approach in redesigning care delivery inside the hospital, using a three-person model that includes nurses, nursing assistants, and virtual care technology.
During a session in the HealthLeaders Virtual Nursing Mastermind series, Gay Landstrom, RN, PhD, NEA-BC, FAONL, FACHE, FAAN, CNO for the Michigan-based health system with 101 hospitals in 27 states, says the model, piloted in the summer of 2022 and is now live in roughly 40 sites, addresses not only the growing shortage of skilled nurses but a need to reduce complicated workflows that negatively affect patient care and staff morale.
“We realized that we needed to create teams,” she says. “This is a fundamental change to how we [deliver] patient care.”
Health systems across the country are turning to a variety of tools and strategies, many of them centered on virtual nursing. While the emphasis is on making the most of the shrinking nursing workforce by reducing stressful workflows, these programs are also increasingly targeting clinical outcomes, ranging from reduced length of stay to improved monitoring and patient engagement. And at a time when ROI for these programs hasn’t yet been proven, the more achievable benchmarks the better.
Landstrom says the driving force behind Trinity Health Together Team Virtual Connected Care is a shortage of nurses who want to work in acute care settings. To address this, the health system “tried a lot of things,” she says, from robots to scribes, before settling on a team-based approach.
Trinity’s three-person strategy is unique. The floor team consists of a nurse and either an LPN or CNA, with the former handling the nursing duties at the bedside and the latter doing tasks that don’t require an RN. The third team member, a veteran nurse, is in the telehealth center, monitoring patients and assisting the bedside team (as well as doctors) with documentation and consults.
Landstrom says leadership did a lot of research prior to launching the program and found that 40% of the tasks done by nurses on the floor can be done by someone other than an RN. Teaming a nurse with an LPN/CNA, she says, enables the nurse to work at the top of his or her license.
The virtual nurse, meanwhile, sits in the background, offering support when needed, answering calls from patients, and keeping watch over several rooms. Their tasks include documenting, monitoring, assisting with handoffs, rounding, working with doctors during examinations, and helping patients to understand doctors’ comments.
“There’s a great deal [of task] that a virtual nurse can do,” Landstrom says. “More than we thought they could. And they function here as a team.”
Landstrom says the virtual nursing role is typically filled by veteran nurses, and that some nurses “can picture having a longer career” by working as a virtual nurse. This could help Trinity and other health systems retain nurses who are considering leaving or retiring.
Indeed, one of the challenges to creating this model, says Murielle Beene, DNP, MBA, MPH, MS, RN-BC, PMP, FAAN, FAMIA, Trinity Health’s senior vice president and chief health informatics officer, is recruiting the LPNs and CNAs. As a result, Trinity has been working on updating its nurse assistant development program and has been in touch with nursing schools to determine how to bring more people into the workforce.
As for the technology, Beene said the health system “had to buy a lot of TVs” to establish the right platform for the virtual nursing component. While some health systems use tablets or telemedicine carts, an increasing number are using TVs built specifically for the healthcare setting and providing both entertainment and clinical services, ranging from audio-visual conferencing to access to resources and education.
“Technology assessments are vital” to establishing a good base for the program, Beene says. “It’s very important that we have seamless integration, and that was a challenge.”
Beyond the technology, both Beene and Landstrom say the biggest challenge to making this program work is change management. Redesigning inpatient care management is a drastic adjustment in how things are typically done inside a hospital, and it’s safe to say not everyone will be receptive to the changes from the outset. Executives need to map out these changes and lead staff through them, identifying the pain points and the benefits.
“We’re not just teaching people new workflows but coaching them,” says Landstrom.
Skepticism “was expected,” adds Beene, though management underestimated how much resistance they encountered.
“You don’t just drop this [new program] in and then leave,” she says. “This has to be part of the culture, and it involves a transformation of the mindset.”
Beene and Landstrom also found that coming into each hospital with a one-size-fits-all program was not working, and that each hospital not only had different strengths and needs, but different methods. That meant understanding the unique workflows and talents in each hospital and leaving enough room in the program model to adjust accordingly.
Likewise, Landstrom says, the three-person model “is not a model for all clinical areas.” She says it has shown value in med-surg, telemetry, and step-down care, but doesn’t quite fit on other wings of the hospital.
“We’ll be developing other models like this,” she says.
Landstrom also says it’s too early to determine ROI for this platform. While staff support and retention is an important goal, that alone probably won’t sustain the program. By charting clinical outcomes and aiming for pain points in monitoring, charting in the medical record, and patient discharge and room turnover times, she’s hoping the benefits will materialize in better patient outcomes, a shorter length of stay, and cost savings.
“It’s really a new way of thinking how we go about taking care of our patients,” says Beene.
The HealthLeaders Mastermind seriesis a months-long series of virtual panels and an in-person event featuring hand-selected healthcare executives. This Virtual NursingMastermind panel features ideas, solutions, and insights onexceling your virtual nursing program.Please join the community at our LinkedIn page.
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