By Bill Siwicki

Healthcare provider organizations and clinicians are fortunate that telehealth has gone mainstream as a result of the COVID-19 pandemic. Telehealth opens up many new avenues to expand access to care, streamline the delivery of care, create new workflows and improve patient outcomes.

Hopefully the Congress and state legislatures will act soon to ensure the temporary reimbursement expansions for telemedicine will continue after the public health emergency ends.

But what can provider organizations do to accelerate virtual care adoption? How can telehealth be used as a patient engagement tool in inpatient settings? What are workflows that showcase the potential of hybrid care delivery – in-person encounters and virtual sessions – in the future of healthcare? And how will telehealth evolve beyond today’s uses?

Healthcare IT News sat down with Mike Brandofino, CEO of Caregility, a vendor of telehealth technology and services, to get the answers to these important questions.


Q: Now that telehealth has gone mainstream because of the pandemic, how do you believe provider organizations can accelerate virtual care adoption?

There has been a public perception that telehealth and virtual care consist solely of having a virtual doctor’s visit when you feel ill or following up on a routine treatment. And while that is a part of it, it is not the complete telehealth story.

In many ways, virtual care helped define the pandemic. We witnessed a spectrum of solutions take place during this time, from switching to Zoom for doctor appointments to healthcare professionals putting baby monitors in rooms to monitor patients, thus minimizing the use of dwindling PPE supplies while reducing the number of times a caregiver had to enter a COVID unit.

Although these were creative approaches, they were not sustainable solutions – and we can learn from what worked over the past few years to make better, more informed decisions moving forward.

Telehealth – when adopted as an enterprise-wide strategy – elicits many creative uses. We have heard from doctors who say that, thanks to virtual rounding, they get more done and see more patients by not having to walk miles through hospital hallways.

Other examples include virtual care in patients’ homes and assisted living communities. Regardless of “how,” there has been a growing interest in enhancing the entire care experience through the adoption of hybrid care models that include both in-person visits and virtual encounters.


Q: You suggest telehealth can be used as a patient engagement tool in inpatient settings. Please explain.

To be able to deliver quality care to patients and support the caregivers along the way, whether they’re specialists or part of a remote call center, you need to have virtual access to every room that would potentially host a patient.

With this in mind, many hospitals are moving to a centralized hub-and-spoke model where clinicians and other clinical staff are in a central hub and remotely assist the floor staff in supporting their patients. Utilizing telehealth technology helps alleviate overburdened and short-staffed clinicians as much as it helps them care for their patients.

Telehealth solutions also can be used to share knowledge from experienced nurses. For example, an experienced nurse who has an injury or condition that prevents them from physically being on the patient floor still can provide their expertise by virtually assessing low-acuity patients, freeing up floor staff to care for patients that require in-person assistance.

Telehealth can be used as a learning tool where veteran nurses virtually coach newer nurses through a situation or procedure they are not yet comfortable with doing on their own. Telehealth also can be used for routine activities like giving a patient their discharge instructions. The goal of these tools is not to replace nurses, but to free up their time to focus on more acute circumstances and tasks.

Virtual rounding is another great application to augment the patient experience and make a patient feel comfortable. It provides the ability to easily include members of the patient’s family, an interpreter, behavioral health specialist and other specialists, such as a pharmacist, to discuss their medications.

There are so many use cases within inpatient environments that can be addressed to augment the patient and clinician experience.

In outpatient settings, there has been significant positive feedback from patients regarding virtual physicians’ appointments, where patients reported feeling they are receiving more attentive care from their doctor.


What are some workflows that showcase the potential of hybrid care delivery – in-person encounters and virtual sessions – in the future of healthcare?

There are a plethora of ways to use this technology in hybrid care environments. Hybrid care is about combining personal encounters with virtual engagements.

One of the biggest ways that we’re seeing demand is in centralized models, where a pool of nurses, physicians or clinicians in a central call center remotely connect to almost any admitted patient in the health system. The advantage to this approach is that the clinicians don’t have to be physically in the same location, since you deploy the platform in the cloud. However, virtual workflows must include strong communication with the floor nurses.

Another example is a health system struggling with the shortage of experienced nurses. These teams used a similar approach, but rather than passive tele-sitting, the virtual nurses check in on patients periodically, or the floor nurses virtually call more experienced nurses when they need assistance. Nursing teams also utilize hybrid care for routine activities like looking in on a patient 30 minutes after they have taken their medications to make sure they are doing well.

A more abstract workflow we have heard about is with an ambulance service. The clinical team wanted to leverage hybrid care to pre-triage patients in the field and potentially bypass the emergency room by pre-admitting them to the hospital or other most appropriate facility.

The goal, in this case, was to connect the EMT with the emergency medicine physician to pre-determine what the issue is and potentially prevent the patient from having to go through the ER entirely.

Although the promise of hybrid care is bright, there are many things we must continue to consider for it to realize its full potential. First, it is important the nursing teams understand this technology is intended to alleviate pressure by taking on some of the lower priority tasks, thus allowing the teams to use their in-person time to focus on the more critical components of delivering patient care.

Next, we’ve seen that patient trust in technology remains hesitant. There certainly is an opportunity to educate patients on how inpatient virtual engagement is meant to help and not intrude. We’ve heard stories where some clinical teams are empowering patients to decline video calls from their rooms and instead accept an audio-only connection.

It is important to make sure the patients have a good understanding of the value of virtual care in their environment – in the hospital and at home – so they can trust that the technology in their rooms is to help enhance their care and their health outcomes.

Also, the industry continues to see telehealth reimbursement as a challenge. Initially, there weren’t reimbursement models in place for virtual care in the ICU. However, when the hospitals went to the centralized hub-and-spoke model because of patient/nurse ratio challenges the case could be made clearer to justify the investment.

For home care scenarios, it appears there is substantial funding available for telehealth sessions delivered in that environment. But the middle ground, like being able to bill and codify ad hoc virtual sessions, is something we need to work on and advocate for.

Looking to the future, I believe there are some opportunities to use virtual workflows to justify the technological investment in services like remote observation. As an example, inside the hospital, there is a huge advantage to having one sitter monitor twelve rooms simultaneously.

There also is ample opportunity for creative use cases for aging in place by using hybrid care models in the home, but we need to also ensure providers will be fairly compensated for that innovation through reimbursements.


How do you think telehealth might evolve beyond its current use today?

There’s so much creativity and innovation happening right now. For example, we’ll soon be able to use camera technology to assess vitals such as body temperature and pulse rate.

We also can use technology to augment the information caregivers are getting by integrating those data points with hospital room sensors and other peripherals such as digital stethoscopes and blood pressure cuffs. We’re going to see an increase in this combination of the ability to remotely access and interact in the room with sensors and other smart devices.

All this data integration leads to what is possible and accessible for patients in their homes. For example, we will see a continued increase in routinely sending post-acute patients home to recover instead of requiring them to stay as inpatients for a longer period.

This will be done by equipping them with devices that capture data on their vitals and checking in with them daily through virtual visits. This combination of technology and hybrid care is going to fundamentally change the way we provide healthcare, and hopefully improve outcomes along the way.

Virtual care uniquely allows the opportunity to bridge health equity gaps as well. In addition to the technical challenges that impact rural areas, there are substantial cultural and trust challenges with health equity.

Armed with the right resources, this is an opportunity to discuss with community leaders how virtual care can be a tool for improved engagement. I’ve heard about examples like creating a kiosk for that initial care session, so people don’t have to travel to a clinic or health center.

When it comes to health equity, our focus should be on things we can do to build trust with clinical teams and the patient communities they serve – and telehealth can be a useful tool in the toolbox to build that trust.

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