Last year Mercy Virtual Care opened a first-of-its-kind facility that could redefine remote patient care.
Looking like it could have been designed by Frank Lloyd Wright, the four story, 125,000 square foot Mercy Virtual Care Center screams modern even before you enter it. A reflecting pool leads from the exterior façade into the spacious lobby. Accents of color compliment elegant white, wooden, and stone surfaces welcoming visitors, while prominent digital LED displays showcase cross-fading historical photos.
But it’s the second floor of the Center that most evokes the future of medicine. It’s like you’ve stepped into a massive, perpetually buzzing, super secret society, liberally dotted with seemingly futuristic technology and a knot of specially trained staff, diligently going about its business in tightly choreographed coordination.
Providing care to patients both nearby and far—but none in the $54 million first-of-its-kind facility itself—330 specialized medical professionals monitor 2,431 patient beds, of which 458 are occupied by the critically ill.
Physicians are seated at a console with six computer monitors filled with a wealth of data to enable them to better assist bedside providers, according to Ashok Palagiri, MD, an intensivist and medical director of TeleICU services at Mercy Virtual, located in St.Louis. Secure web cameras allow them not only to see what’s going on, but also be seen by those on the other side, whether in one of Mercy’s traditional hospitals, a physician’s office, or in some cases, the patient’s home.
“We have the medical team here, but with technology like highly-sensitive cameras and real-time vital signs, our providers can ‘see’ patients where they are,” explained Palagiri.
Dr. Ashok Palagiri, an intensivist and medical director of TeleICU services at Mercy Virtual (left), assists bedside medical teams virtually.
With its single hub electronic intensive care unit, doctors and nurses monitor patients’ vital signs and provide a second set of eyes to bedside caregivers in 30 ICUs across five states, while offering 24/7/365 operations. The facility’s also designed to be a workspace for innovations in patient care and product testing. With meeting spaces that boast multiple floor-to-ceiling whiteboards on tracks and giant computer monitors, the building, which opened in October 2015, invites collaboration and new ideas for getting care to patients when and where they need it with less expense.
A Brave New World
According to Deloitte’s 2016 Survey of US Consumers, patients of all demographics, including seniors, as well as caregiversare warming to technology-enabled care. In fact, 48% percent of consumers surveyed were very or somewhat interested in consulting with a doc or other provider using a video connection. Engaged consumers along with value-based care payment models, an aging population that prefers to age in place and an increasing prevalence of chronic disease, are largely driving growth in new technology development, reported Deloitte.
Along those lines, many providers are experimenting with delivering care outside the traditional setting, recognizing the potential efficiency and cost savings of keeping patients out of the hospital, lowering readmission rates, and promoting adherence to care plans. These technologies, often based on Internet of Things applications, will likely begin to transform how health care is delivered and alter hospital, health system, nursing home, and medical device company operating models.
The survey found patients are most interested in using technology for post-surgical care and chronic disease monitoring. Subgroups especially keen on these technologies include those with chronic diseases, millennials for telemedicine, and seniors for remote monitoring.
Meantime, an IBM white paper stated that more efficient, digital hospitals are emerging as critical hubs in these integrated healthcare networks, holding the potential to drive greater efficiency, improve quality of care, and provide access for more people than ever. Whether by newly built or retrofitted existing buildings, digital hospitals promise to boost efficiency and quality through better integration with all sources of care and enable deployment of eHealth systems to provide online information, disease management, remote monitoring, and telemedicine services that can extend the reach of scarce medical resources and expertise. Digital hospitals provide faster and safer throughput of patients, creating more capacity through process efficiencies, while containing costs, the paper continued.
The Human Factor
Of course, there are differences between practicing as an E-physician, as doctors do at a place like Mercy Virtual, and practicing at a typical facility. For example, E-physicians aren’t physically in a unit, alongside bedside nurses, patients and their families, said Palagiri. However, E- physicians can communicate with them on two-way videos. “It allows us to be visible and part of the team, ” he said.
“When you’re a beside physician and receive a call about a patient, often, the patient’s information isn’t at your fingertips. Conversely, a virtual clinician can immediately pull up the patient’s data, which can be vast, while on the phone with a bedside provider, and make better informed decisions about patient care,” added Palagiri.
Nevertheless, he acknowledged it takes E-physicians a while to acclimate themselves with the virtual world and not see patients face to face.
“We’re trained as physicians in the face-to-face arena with an emphasis on, for example, physical exams, conversations, and time spent with families and patients, said Palagiri. “In the virtual world, our job is to provide an extension of the bedside providers—not a replacement.”
The physical disconnect between an E-physician and a patient and his or her family also can be overcome—or at least minimized—with tools like Facebook, Twitter and Skype. “So speaking to a physician over a camera is no longer novel,” noted Palagiri.
Dr. Matthew Boland oversees patients in ICUs across the country through Mercy SafeWatch TeleICU.
But can that form of communication be slightly more daunting for relatively older physicians, who might not be as accustomed to applications like Facebook?
First, the daily routine of an E-hospital physician at Mercy tends to break down into years of experience, said Palagiri. “Newly graduated physicians from a critical care training program are usually just picking up a few shifts a month and spending the majority of their time at the bedside, as they need more experience and time at the bedside to improve their knowledge and skill base.”
Meanwhile, older physicians who have spent 20 or 30 years or more at the bedside are often looking to move into a virtual position to bridge over to retirement and often work full time in the virtual arena. The intermediate range physicians work anywhere from 25-50% in the virtual arena, and the rest at the bedside. “We encourage the younger physicians to spend as much time at the bedside as possible,” Palagiri said.
Palarigi believes that for any physician entering a virtual position, the best way to abet their adjustment is to work more shifts in the virtual arena, and feel at ease with the technology.
“The older physicians that apply for virtual positions are usually more adept at using newer technology,” Palagiri pointed out. “What an older physician may lack in technological prowess, they make up for with a greater comfort level in treating sicker patients and a multitude of presentations, all from having greater experience, than a newer physician that is familiar with newer technology.”
Mercy’s Virtual Care Center is a work space designed to spark collaboration and innovation.
Filling the Void
According to Palagiri, E-physicians often fill a void, such as lack of night time physicians or intensivists. “They’re actually bridging and improving the connectivity that the bedside physician and family currently have,” he said. In fact, Mercy staff members often hear that the families and patients feel “an added layer of comfort knowing a virtual team is available to assist the bedside staff during periods when they may be otherwise occupied and when bedside physicians aren’t available.”
During the virtual day shifts, the hospital focuses on providing consultation type notes for facilities that don’t include intensivists on staff, he explained. “These consultations assist the medical staff with patient care and also determining if patients can remain at their facility, or need to transfer to higher levels of care.”
Additionally, during night shifts, the facility assumes the role of the bedside intensivist (without procedures), Palagiri explained. “The E-physician not only takes calls from the bedside nurses and physicians, but also reviews data and alerts that many times can identify deteriorating patients sooner rather than later.”
“A large part of our clinical work is done at night, to allow the bedside physicians rest, and provide coverage that otherwise wouldn’t exist, creating a gap in communication outside of the handoffs between shifts,” he said.
Still, at least in some ways, practicing as an E-hospital physician can spark a different dynamic with colleagues, Palagiri said.
“It takes a longer time for bedside colleagues to become comfortable with their virtual partners—more so than if a new bedside partner was hired.” However, this process is eased when you sit with your colleagues at meetings, and walk by them in the halls of the hospital. “You become comfortable with them and are able to have spur of the moment conversations, which builds relationships,” he said.
Palagiri believes it’s only a matter of time before E-hospital physicians become a greater part of healthcare.
“I believe this isn’t a question of ‘What if?’ but when. As the virtual concept continues to grow and institutions become more comfortable with it, I think patient care will improve and we’ll finally overcome the day/night and weekday/weekend dichotomy that’s existed in medicine for years… Bedside physicians will accept their virtual counterparts as true medical partners and patients will receive true 24 hours a day, seven days a week, 365 days a year care.”
Mercy Virtual Care Center is a first-in-class facility for monitoring patients outside its walls 24/7/365.
Mercy Virtual’s first floor lobby
Balconies and terraces provide Mercy Virtual co-workers with places to rest.
Mercy SafeWatch, the largest single hub electronic ICU in the nation, provides 24-hour observation of critically ill patients.