The health system is putting 'Telehealth for Nursing' to the test in one hospital, and getting results that will aid in scaling and sustaining the program
Intermountain Health's new Telehealth for Nursing program may be checking all the boxes for a virtual nursing pilot, with KPIs that focus on improving patient outcomes and cutting down on wasted time. But executives are also keeping an eye on the intangibles.
Becky Fox, chief clinical information officer for the Salt Lake City-based health system, and HealthLeaders Mastermind participant, says an innovative program has to include an "other" box, especially when it deals with front-ling clinical work. That's because nurses can take a new idea developed by health system executives and make it better.
"We kind of leave it as an 'other' field because we know that nurses are the best entrepreneurial, innovative folks, and if anyone's going to figure out another way that anyone can use telehealth and these technologies, then our nursing staff are going to do it," she says. "We always have a KPI that's other things we have learned or other benefits that we have seen along the way."
Intermountain is one of a handful of health systems across the country that are taking part in the HealthLeaders Virtual Nursing Masterminds program, a series of virtual meetings capped off by an in-person event in June. The program is taking a deep dive into virtual nursing strategies with perspectives from some of the top health systems and executives in the country.
Like so many other health systems, Intermountain is just getting started on the journey, with a small pilot program in one hospital. Fox says the concept was launched to address not only the ongoing nursing shortage, but to improve the patient experience. The pilot program uses a virtual nursing station within the hospital and shifts nurses on the unit between in-person and virtual care.
Fox says the program will evolve as Intermountain learn more about the nuances of virtual nursing, but she has been surprised so far in how the nurses are responding. While visiting the hospital a few weeks ago, Fox says she talked with a nurse involved in the pilot.
"She said 'I really wanted to do follow-up,'" Fox recalls. "'This patient told me this amazing story of his life. I really connected with him.' And so she wanted to do a follow-up. So that goes in the 'other' category."
"So now we're looking at, as other healthcare organizations have done, do we have a follow-up telehealth visit with that patient with that nurse, [maybe] two days later, to say 'Hey, Mr. Smith, I just wanted to see how you were doing. You were telling me the other day that you were concerned about this. Have you had your needs met? And having that [extra] touchpoint."
"What I also heard was the value that the nurse felt with [the program]," Fox adds. "That's one of the things that has [resonated], the gratitude. When we see that and hear that and feel that from patients, that's one of the things that we oftentimes hear in [nurse] burnout stories. That they didn't feel that they got to be their best."
Fox says Intermountain executives are learning a lot from this pilot program, and that both nurses and patients are seeing the value.
"They do feel connected regardless of the fact that the nurse is on a laptop, a mobile cart, or whether they are connecting with the clinician on a big monitor in the room," she says. "They feel like they're being supported, educated, and know how to care for themselves when they go home."
Those feelings, Fox says, will help executives as they move from a pilot in one hospital to a program in several hospitals. And that's why the 'other' box is just as important as any of the KPIs.
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With an aggressive innovation strategy, the New Jersey health system wants to be a force of change rather than a passive participant
Healthcare innovation is a popular topic these days as healthcare organizations strive to redefine care delivery in a time of tight margins and increasing competition. But for all the talk of AI, virtual services, and value-based care, how do executives identify what needs to be changed?
Health systems looking for an innovation model could check out the Atlantic Health System. The New Jersey-based organization, comprising six hospitals and more than 400 care sites, is fostering new ideas through the Atlantic Health Venture Studio, which not only offers capital investments but also provides mentorship, forges strategic partnerships with new and emerging companies and offers product and service c-development for in-house partners.
"We wanted to take a more proactive and intentional approach," says Doug Hayes, the studio's executive director. "We don't want to just passively receive the innovations that are coming out of the market. We want to actually help play a role."
Hayes, who ran his own New York City-based venture studio for eight years and was a partner and executive director of Blueprint Health, launching close to 50 VC-backed digital health startups, joined Atlantic Health roughly three years ago, when the health system had decided to develop its own venture studio.
The timing was right. Coming out of the pandemic, many health systems were struggling with staff shortages and mandates to improve care, while the innovation landscape was filled with new ideas and technologies aimed to tackle those pain points. At the same time so-called disruptors, such as Amazon, Google, Walmart, and the large pharmacy chains, were jumping into the sandbox with new strategies aimed at addressing healthcare's problems and giving consumers an easier way to access care.
Hayes points out that the disruptors, coming in from more consumer-friendly industries, are "very good at what they do. [And] that's a type of thinking that … we're not accustomed to thinking in healthcare."
But healthcare is different—as proven by Walmart's decision to close its in-store health clinics and telehealth program, UnitedHealth's shuttering of Optum Virtual Care and the continuing problems faced by Teladoc and American Well. Hayes notes that healthcare organizations can embrace new ideas from outside the industry and perhaps even partner with disruptors, but they have to own their innovation strategies.
In other words, they want to be the disruptor.
"We're not going to be looking to them to think about what we've got to do," he says. "We have a growing internal competency and fluency around innovation."
In other words, healthcare organizations like Atlantic Health aren't necessarily interested in the next shiny object. They're focused on creating a comprehensive strategy that identifies new ideas and tools and fosters growth and integration into the enterprise.
Hayes says the venture studio has developed a few key guidelines along the way:
Don't mix innovation with the operating budget. Atlantic Health separates its investment funds from the operations budget, instead using long-term capital to support innovation. Hayes says it's important to make clear that innovation isn't taking money that would otherwise be used for salaries, new hires, or other operational expenses.
Innovation and technology are also separate. The key to enacting any meaningful change, says Hayes, is change management. Oftentimes the most meaningful changes come in workflow redesign or operational adjustments. New tech is a tool that can be used to achieve better or new results, but there's a lot of groundwork that has to be done first.
"Goals are for people who want to accomplish something once, and systems are for people who want to accomplish something repeatedly," he points out. "We're trying to set up a system."
Good ideas can come from anywhere. Ditch the thinking that the only good ideas come from the management level. Clinicians and nurses have the front-line knowledge to come up with the most effective workarounds, or new ideas to address pain points. Likewise, a small start-up might see things differently than a tech giant and come up with a better solution. Hayes says the key is to create an atmosphere that welcomes ideas from any and all sources and gives them the right support and resources to develop.
An example of this, he says, is Atlantic Health Advancements (AHA), a $500,000 fund set up to catalyze ideas from within the health system. The program targets small projects, often process innovations typically generated from front-line staff like nurses. A program like this, Hayes says, instills an interest in employees to be creative and come up with new ways of doing things, while giving management a forum for letting those ideas gain traction.
Be nimble, and ready to act quickly. "Anyone or any health system that thinks they can predict where the future of technology is going to lie in 18 months is lying to you or themselves or both," says Hayes. Healthcare organizations have to diversify their approach to innovation, pivoting when something doesn't work out and being willing to "look under the hood" just to see where a new idea or tech might go.
And at a time when healthcare organizations are struggling to make ends meet, an important benchmark for any innovation is ROI. Hayes says Atlantic Health treats this business line as any venture studio would.
"We want outsized and uncorrelated returns," he says. "And we don't just want the return. We want these partners to make us smarter."
That's what health systems across the country are pursuing. And while the so-called disruptors are taking a hit at present, it's imperative that healthcare executives understand the need for change, and the value of affecting that change rather than waiting for change to happen.
"The things that got us here won't get us there," says Hayes of the push to redefine care. "Our patients don't ow us a lifetime of committed usage … so we need to earn their business over time."
The changes are aimed to close gaps around HIPAA and help healthcare organizations and consumers control the use of personal health information
Federal officials are making sweeping changes to regulations around digital health apps and platforms in an effort to combat data breaches and fill in the gaps around the Health Insurance Portability and Accountability Act (HIPAA).
The U.S. Federal Trade Commission (FTC) last week announced final changes to the Health Breach Notification Rule (HBNR), which requires vendors of personal health records (PHR) and related entities that are not covered by HIPAA to notify individuals, the FTC and, in some cases, the media of a breach of unsecured personally identifiable health data. The rule also requires third-party service providers to vendors of PHRs and PHR-related entities to notify such vendors and PHR related entities following the discovery of a breach.
The changes aim to close loopholes caused by the proliferation of third-party apps and platforms in the digital health ecosystem and give both healthcare providers and consumers more control over the use and reliability of healthcare data.
“Protecting consumers’ sensitive health data is a high priority for the FTC,” Samuel Levine, director of the FTC’s Bureau of Consumer Protection, said in a press release. “With the increasing use of health apps and connected devices, the updated HBNR will ensure it keeps pace with changes in the health marketplace.”
The changes include:
Revised definitions. Several definitions were rewritten to include health apps and similar technologies not covered by HIPAA. This includes redefining “PHR identifiable health information” and adding new definitions for “covered healthcare provider” and “healthcare services or supplies.”
Clarifying ‘breach of security.’ A “breach of security” will now include any unauthorized acquisition of identifiable health information that occurs as a result of a data security breach or an unauthorized disclosure.
Revised definition of PHR related entity. The definition of a “PHR related entity” will now cover entities that offer products and services through the online services, including mobile applications, of vendors of personal health records. It also makes clear that only entities that access or send unsecured PHR identifiable health information to a personal health record — rather than entities that access or send any information to a personal health record — qualify as PHR related entities.
Clarifying multiple sources of PHR identifiable health information: The final rule clarifies what it means for a personal health record to draw PHR identifiable health information from multiple sources.
Expanded use of electronic notification: The final rule authorizes the expanded use of e-mail and other electronic means of providing clear and effective notice to consumers of a breach.
Expanded consumer notice content: The required content that must be provided in the notice to consumers has been expanded to include the name or identity (or, where providing the full name or identity would pose a risk to individuals or the entity providing notice, a description) of any third parties that acquired unsecured PHR identifiable health information as a result of a breach of security.
New timing requirements. For breaches involving 500 or more individuals, covered entities must notify the FTC at the same time they send notices to affected individuals, which must occur without unreasonable delay and in no case later than 60 calendar days after the discovery of a breach of security.
Improved readability. The final rule also includes changes to improve the rule’s readability and promote compliance.
A new FDA program aims to develop strategies and guidelines for health systems delivering care in the patient’s home
Health systems are getting more help planning new remote patient monitoring (RPM) and acute care and hospital at home programs.
The U.S. Food and Drug Administration (FDA) has announced the launch of the Home as a Health Care Hub, a resource designed to help healthcare executives understand how to design programs that deliver care in the home setting. As part of this program, the FDA’s Center for Devices and Radiological Health (CDRH) is contracting with an architectural firm to explore how healthcare and health equity can be included in home design.
“While many care options are currently attempting to use the home as a virtual clinical site, very few have considered the structural and critical elements of the home that will be required to absorb this transference of care,” Jeff Shuren, MD, JD, director of the CDRH, and Michelle Tarver, MD, PhD, the CDRH’s deputy director for transformation, said in a press release.” Moreover, devices intended for use in the home tend to be designed to operate in isolation rather than as part of an integrated, holistic environment. As a result, patients may have to use several disparate medical devices, some never intended for the home environment, rather than interact with medical-grade, consumer-designed, customizable technologies that seamlessly integrate into an individual person's lifestyle.”
The program builds on an intriguing trend in healthcare, in which health systems and hospitals are looking to shift more services out of the hospital, clinic, and doctor’s office and into the patient’s home. This includes RPM programs that enable care teams to monitor patients at home, either by gathering patient data at selected times or with continuous monitoring, and acute care and hospital at home programs that combine RPM, virtual care, and in-person care.
That transition isn’t so easy. While the consumer technology industry is seeing huge growth in wearables and smart devices that include healthcare uses, clinicians are wary of the reliability of data coming from these devices and don’t know how to use them. As well, while the home offers a new setting for healthcare delivery, clinicians need to better understand the both the challenges and the advantages of delivering healthcare in that setting.
“We have an untapped resource in the home,” Hon Pak, vice president and head of the digital health team at Samsung Electronics and a former Kaiser Permanente executive, said during a CES 2024 panel on this topic this past January in Las Vegas. “Fundamentally, we have to change the model” of how care is delivered.
The new program will also take aim at another key strategy in healthcare innovation: Addressing health inequity, or challenges to healthcare access and treatment caused by social drivers of health.
“This partnership includes collaboration with patient groups, healthcare providers, and the medical device industry to build the Home as a Health Care Hub,” Shuren and Tarver said in the press release. “This prototype will serve as an idea lab, not only to connect with populations most affected by health inequity, but also for medical device developers, policy makers, and providers to begin developing home-based solutions that advance health equity.”
“Existing models that have examined care delivery at home have found great patient satisfaction, good adherence, and potential cost savings to healthcare systems,” they added. “By beginning with dwellings in rural locations and lower-income communities, the planned prototype will be intentionally designed with the goal of advancing health equity.”
The two executives said the program is part of a redesign of healthcare to focus on the patient, with care plans that meet a patient’s needs and desired rather than a plan that forces the patient to adjust to new roles or routines. As such, care providers need to understand the environment around the patient.
“The Home as a Health Care Hub prototype is the beginning of the conversation—helping device developers consider novel design approaches, aiding providers to consider opportunities to educate patients and extend care options, generating discussions on value-based care paradigms, and opening opportunities to bring clinical trials and other evidence generation processes to underrepresented communities through the home,” they said.
The new will be unveiled sometime this year as an AR/VR prototype.
A study launched in 82 HCA Healthcare hospitals found that an AI tool could help staff identify and react to an infection and help contain an outbreak
Healthcare organizations are training an AI tool to rapidly identify outbreaks within a health system, giving clinicians more time to contain the infection and treat patients.
A four-year study in 82 hospitals across the US, recently posted in The New England Journal of Medicine, found that the automated tool reduced potential outbreaks by 64% compared to traditional methods of identifying an outbreak. The tool identified potential outbreaks, on average, three times per year per hospital.
“Outbreaks in hospitals are often missed or detected late, after preventable infections have occurred,” Meghan A. Baker, MD, ScD, a Harvard Medical School assistant professor of population medicine at the Harvard Pilgrim Health Care Institute and lead investigator of the study, said in a press release. “This study provides a practical and standardized approach to identify early transmission and halt events that could become an outbreak in hospitals.”
Funded by the U.S. Centers for Disease Control and Prevention (CDC), the CLUSTER study was conducted in 2019-22 at hospitals within the HCA Healthcare system by a team of investigators from HCA, the Harvard Pilgrim Health Care Institute, and the University of California, Irvine (UCI) Health.
The research aims to help a healthcare industry still reeling from the effects of the COVID-19 pandemic (which, coincidentally, interrupted this study) and looking for better methods of tracking outbreaks before they cripple hospitals and harm more people. Researchers are turning to AI tools to sort through data and more quickly and accurately identify trends.
“Despite significant progress in reducing healthcare-associated infection outbreaks, including of antimicrobial-resistant pathogens, they remain an industry challenge and can present as clusters that signal potential for transmission to patients,” Joseph Perz, DrPH, MA, senior advisor for public health programs in the CDC’s Division of Healthcare Quality Promotion and a committee member for the CDC’s Council for Outbreak Response: Healthcare-Associated Infections, said in the release. “The CLUSTER trial provides evidence that early detection powered by automation tools and quick action can prevent outbreaks from growing.”
In this trial, researchers created an “algorithm-driven statistical detection tool” that combed through laboratory data for signs of more than 100 bacterial and fungal infections, then posted real-time alerts to infection control programs. The process included both an automated review of patients’ clinical cultures and a statistical assessment of whether patients with these specific infections were increasing in number.
The results of the study were affected by the COVID-19 pandemic. According to researchers, automated alerts weren’t as effective during the pandemic because hospital staff were so busy that they weren’t able to respond to the alerts in time. Researchers decided instead to focus on the results gained prior to the pandemic.
The research team said the underlying software will be available to all health systems, but it must be integrated into their EHR and other clinical workflow platforms.
The ONC and The Sequoia Project have added new enhancements for FHIR adoption in version 2.0 of the Common Agreement, which sets thew stage for nationwide interoperability through the TEFCA framework
Federal officials are showing further support for FHIR with the release of version 2.0 of the Common Agreement, which established the foundation for the Trusted Exchange Framework and Common Agreement (TEFCA) data exchange framework.
HL7’s Fast Healthcare Interoperability Resources (FHIR) Application Programming Interface (API) exchange has long been seen as a key element to nationwide interoperability, but many are worried that healthcare organizations are ready to embrace the standards just yet. Version 2.0, released by the U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) and The Sequoia Projects, ONC’s Recognized Coordinating Entity (RCE) for TEFCA, includes enhancements and updates for FHIR support.
“Today’s release includes framework enhancements, including greater use of FHIR, better support for use cases beyond treatment, and simplified onboarding for participants like clinicians, digital health apps, public health agencies, and other end users of health data,” Mariann Yeager, The Sequoia Project CEO and RCE lead, said in a press release.
“We have long intended for TEFCA to have the capacity to enable FHIR API exchange,” ONC chief Mickey Tripathi, PhD, added in the release. “This is in direct response to the health IT industry’s move toward standardized APIs with modern privacy and security safeguards, and allows TEFCA to keep pace with the advanced, secure data services approaches used by the tech industry.
"What makes us different is we're offering [patients] immediacy."
A new disruptor is taking aim at the healthcare industry’s busiest site: The Emergency Department.
Concierge care programs designed specifically for urgent and emergency care are finding support from consumers who don’t want to wait several hours in an ED, along with primary care providers who don’t want to send their patients there. The service offers a cash-only alternative to the ED and could pull more patients away from hospitals and health systems.
“The experience [of an ED] is so challenging,” says Brad Olson, CEO of Sollis Health, which operates 11 clinics in New York City and the nearby Hamptons, as well as California and South Florida, and serves some 18,000 members. “What makes us different is we’re offering [patients] immediacy.”
Launched in 2016 in New York as Priority Private Care, Sollis is building a business model through partnerships with consumers, primary care providers, and businesses who want to avoid the traffic and time spent in an ED, which sees more than 130 million visits a year. The company offers a concierge care model that bypasses payers, and also offers a range of services that include diagnostics, labs and vaccines, virtual care, specialty care, even house calls.
The model adds another wrinkle to the crowded urgent care market, where hospitals and health systems are already competing with retail and stand-alone urgent care clinics that not only pull patients out of the ED, but offer additional resources and connections that pull a patient further outside the health system’s orbit of care.
Olson is quick to point out that Sollis Health is a disruptor, but not necessarily a competitor to health systems and hospitals—he notes the company has partnerships in place with more than 30 health systems for everything from ED services to specialty consults. He notes one clinic is located not far from Cedars-Sinai in Los Angeles and is partnering with the hospital even while giving consumers an alternative to Cedars-Sinai’s ED.
The ’disruptor’ moniker is important. Olson, a former executive with Peloton and Starwood Hotels & Resorts, brings a retail mentality to healthcare that is propelling companies like Amazon, Walmart, and Walgreens in the healthcare space. He notes that consumers are turning away from hospitals and health systems because of the complexity and cost of healthcare, and they certainly don’t want to wait several hours in a crowded hospital waiting room for fragmented care that leads to more scheduled visits in other locations.
The University of Rochester Medical Center is banking (literally) on a new strategy for extending its telehealth network into rural areas of New York.
In a partnership with Five Star Bank, Verizon, and digital health companies Higi Health and Dexcare, URMC is co-locating telehealth stations in Five Star branches across the western part of the state. The model aims to improve access to care for rural residents, especially those on Medicaid and Medicare, who face geographical and technological barriers.
Michael Hasselberg, PhD, URMC's chief digital health officer, says the health system came out of the pandemic seeing measurable benefits in a telehealth platform for rural residents, but most were using a phone to access care. In order to include Medicare and Medicaid reimbursements, URMC needed to establish an audio-visual telemedicine link.
Tackling social determinants of health (SDOH)
There will be many benefits to this new model, and tackling SDOH is one. Co-locating a telehealth station in a bank gives URMC an opportunity to address several SDOH.
"Financial health is so closely tied to physical health," noted Hasselberg, who said a patient could be referred to the bank right after the telehealth visit for help understanding, planning for, and paying medical bills. "We might be able to affect healthcare access and financial instability at the same time."
Hasselberg sees plenty of opportunities to expand the program, not only to other bank branches and potentially other banks, but to assisted living and skilled care facilities, which struggle to connect their patients to the care they need. In addition, he sees more services being available through the kiosks, including chronic care management and follow-up care. They could even be used as access points for resident sot connect with local primary care physicians.
"We all went into this going, 'This may be a nothing-burger,'" he said. "And patients [may] go, 'I don't know about getting healthcare in a bank.' But what if it does work? That's the really exciting part. Because if this does work, it could be transformative. It could be replicated across other health systems and across other banks across the country."
The Mayo Clinic is working on an AI tool that will integrate with the EHR, prompting clinicians to identify and address both SDOH and clinical bias.
Researchers at The Mayo Clinic in Arizona are developing an AI tool within the EHR that will help clinicians identify and address social determinants of health—including when their own actions contribute to clinical bias.
The health system is partnering with TruLite Health to create a platform that will enable both clinicians to identify SDOH and take steps to address access and care gaps. The AI tool, called Truity, mines patient data for signs of health inequity and develops patient-specific recommendations for care management.
“It incorporates so many factors, including social determinants of health, in a real-time, easily accessible platform that is available to the clinical team [and] to the patient,” says Nathan Delafield, MD, FACP, an internal medicine physician at the Mayo Clinic who’s working on the technology.
Delafield, who’s working with two other researchers to get the tool ready for implementation later this year, says health system leaders are anxious to take on some of healthcare’s biggest access challenges but not at the expense of adding more task to already overworked providers.
“For decades, our healthcare system has been challenged by the gradual acknowledgement of healthcare disparities, without meaningful, tangible solutions to address them,” he says. “But evidence would suggest that most physicians are ill-equipped to meaningfully address them.”
Research by Deloitte indicates that health inequities cost the U.S. healthcare industry about $320 billion a year, and that price tag could top $1 trillion by 2040 if the industry doesn’t take action. That would include understanding why health systems spend thousands of dollars more per year to treat minorities for a variety of chronic conditions than to treat white patients with the same health concerns.
Healthcare organizations are making it a priority to address SDOH, but many have struggled to find the right strategy. Some are developing tools that address specific challenges like food insecurity, while others create separate platforms to address SDOH from outside the EHR, requiring providers to take extra steps to include that in care management.
Delafield says the Mayo Clinic is taking its time with this technology to make sure it’s integrated into a provider’s regular workflow.
“We want to be really diligent” about taking the time to study workflows and make this interoperable with minimal disruption, he says, rather than developing a tool that “becomes another source of excessive clicks.”
The technology, he says, will be designed to analyze patient data from a wide variety of sources to not only identify the barriers to care but also common clinical practices that may lead to health inequity. This would give clinicians an opportunity to learn how health inequity may be created or sustained by a doctor’s actions.
And it will also be made available to patients, he says, “so that patients will understand that these things are being considered as we’re evaluating their overall healthcare.”
Aside from giving providers patient-specific care management recommendations, the platform will also be designed to connect patients with health coaches employed by TruLite Health. Over time, Delafield says, as Mayo Clinic providers learn how to identify and address SDOH and clinical bias, they’ll likely develop the skills to become health coaches themselves.
“I think we will see some clinical change [and] some behavioral change that will improve clinical outcomes,” he says.
The California-based cancer care center is launching two mobile health units this year to bring screening services and other resources to underserved communities.
One of the nation’s largest cancer care providers is launching a mobile health program to boost access to screening services for underserved populations.
City of Hope, based in California, is rolling out a fully staffed mobile health clinic to neighborhoods in Antelope Valley and greater Los Angeles, and plans to launch a second vehicle later this year. The two clinics will offer mammograms and screening capabilities for as many as 15 different types of cancer, as well as resources for further care coordination and treatment.
"Our comprehensive mobile cancer prevention and screening program is the next step in our mission to expand access to optimal cancer care, bringing our expertise outside the walls of our campus and into the communities we serve,” Harlan Levine, MD, president of health innovation and policy at City of Hope, said in a press release. “We know that identifying and addressing cancers early saves lives, and we want to do our part to ensure every person has access to these services and help create a healthier, more equitable future for all.”
City’s of Hope’s mobile health strategy is a growing trend in the US, as more and more healthcare organizations look to address healthcare access issues and bring more services to consumers in their homes, businesses, and communities. Mobile health programs can reach people who might not be able to or want to visit a doctor, and who might be ignoring or postponing a health issue that, left unchecked, could become serious, even fatal.
The program is supported by a Health Resources and Services Administration (HRSA) grant secured with the help of California Rep. Mike Garcia; it will be sustained, officials say, through charitable donations.
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