James Hoevelmann of Sullivan, Missouri, used to work in hospital construction. But these days, even though he suffers from severe chronic obstructive pulmonary disease, the retired carpenter, 74, doesn’t want to go anywhere near a medical facility. And he doesn’t need to, even though his COPD has been bad enough in the past to regularly land him in the emergency room and the intensive care unit. The reason: Hoevelmann now gets his care from Mercy Virtual Care Center some 50 miles away in Chesterfield.
Equipped with an iPad and devices such as a blood pressure monitor and scale that stream his vital signs and other data from his home to the Mercy Virtual “command center,” he and his providers have been able to detect subtle health shifts in time to avert the cascade of deterioration that put him in the ICU. “We can trend the data on a daily basis and intervene in many cases even before patients experience symptoms,” says Gavin Helton, Mercy’s medical director. Says Hoevelmann: “I feel safer knowing I have those people behind me.”
Hoevelmann and his Mercy team are pioneers in the next big thing intelemedicine, the virtual care clinic, whose physicians, nurses and therapists provide the bulk of the care from miles away. Virtual care itself isn’t new: For a number of years, hospitals have contracted with remote critical care specialists to monitor their ICU patients and have relied on teleconsults with specialists at major academic centers to provide guidance or second opinions. But Mercy Virtual, which opened last fall, takes the concept to a whole other level.
The $54 million, 125,000-square-foot facility has no waiting rooms, hospital beds or patients on site. Instead it houses more than 300 medical professionals who sit in front of monitors and computer displays, watching over the care of patients at 38 hospitals in seven states. In addition to intensivists who observe patients and direct care at distant ICUs, neurologists provide guidance on stroke treatment to community hospitals. A team of virtual hospitalists orders and reads tests, and nurses field questions about everything from nosebleeds to sinus infections. Other clinicians, like Hoevelmann’s doctors, stay in near continuous touch with chronically ill patients at home – though these patients may venture to town occasionally for checkups at their doctor’s office nearby.
The concept is working. Mortality in the ICU “is trending 40 percent less than predicted,” says Randall Moore, Mercy Virtual’s president. “By virtually monitoring ICUs 24/7, we’re getting to problems earlier.” The result, he says, is that Mercy in the past year sent home 1,000 ICU patients who otherwise would have been expected to die and saved $40 million.ADVERTISING
While no other institution is demonstrating the promise of this type of care on a similar scale, patients in a growing number of health systems are getting a taste of the virtual clinic experience. Many hospitals, including CHI Health, which runs 14 hospitals serving Nebraska, southwest Iowa and northern Kansas, and Virginia Mason in Seattle, have partnered with the telehealth company Carena to create what the firm calls 24/7 private-label virtual clinics.
Web portals carrying the health system’s brand connect patients to primary care doctors in the system or to one of the board-certified family practice doctors or nurse practitioners (“virtualists”) on Carena’s payroll, who work at a patientless clinic near Seattle. When patients access the portal, they request a visit and can expect to interact with a physician in 30 minutes or less, day or night.
“The next thing you know, you’re in a virtual exam room on the screen. The doctor is there and the visit starts,” says Carena President and CEO Ralph C. Derrickson. Treatment recommendations rely on evidence-based guidelines, and because care is provided within the health system, the results are integrated into the patient’s electronic health record
. “It’s on demand, like streaming a movie,” says Frank Twiehaus, head of strategic business development for virtual care at CHI Health. “We are now bringing care to patients wherever they are.”
Thomas Jefferson University in Philadelphia has a similar arrangement with different companies, using only Jefferson physicians to deliver care. Besides primary care, the virtual clinic, called JeffConnect, allows consults in 18 different medical specialties from urology to psychiatry.
“People should be cared for in any way they want,” says Judd Hollander, associate dean for strategic health initiatives at Jefferson’s Sidney Kimmel Medical College and a professor in the department of emergency medicine. The virtual clinic enabled more than 3,000 doctor-patient interactions in the last year and now averages 20 to 30 a day. Jefferson is able to resolve the health problems for over 85 percent of the patients who connect; others are sent to their own doctors or to the ER.
Jefferson also offers “virtual rounds” to inpatients’ family members who can’t get to the hospital. Using an iPad equipped with video camera and telehealth software, patients and doctors connect from the hospital room to family members across town or the country.
A first-of-its-kind app being developed at the University of Southern California will add one more level of remoteness: Patients will meet with a lifelike avatar of their doctor. Using virtual reality technology and artificial intelligence, computer scientists at the university are working with Keck Medicine of USC to capture doctors’ faces and create avatars that can interact with people and guide them through complex medical decisions.
These “virtual doctors,” which will have the ability to recognize emotion and show empathy, will have the knowledge base to diagnose problems and provide information personalized to the patient: the best treatment path for someone diagnosed with prostate cancer, say, based on age, tumor characteristics, and levels of prostate specific antigen, or PSA. Eventually, sensors worn by the patient will also feed data back to the virtual (and actual) doctor to provide a fuller picture of the patient’s health.
The app will make it possible to access world-class medical expertise over a smartphone. And while it may sound like an impersonal way to serve patients, an avatar has advantages in that department, too. “Often people will disclose more to a virtual human than a doctor,” says Leslie Saxon, a professor of medicine at Keck and executive director of the USC Center for Body Computing. “They don’t feel judged.”