Carla Kriwet, CEO of Connected Care and Health Informatics at Philips, is more than familiar with the opportunities and challenges hospitals face when leveraging health IT across the enterprise.
Virtual health is an enterprise-wide initiative for health systems today versus a department-specific undertaking. This means the cast of virtual health champions now spans beyond the clinical realm, and the traits of what distinguishes a great virtual health program from an average one differ.
Becker’s Hospital Review caught up with Ms. Kriwet to gain insights on these aforementioned points, and to learn how a longstanding partner is leveraging tele-ICU technology in its emergency departments, what lessons health systems can expect to learn in their first 1-2 years with virtual health capabilities and where the use of smart equipment is growing.
The following interview was lightly edited for clarity and brevity.
Question: Who is most often the champion for virtual health in health systems?
Carla Kriwet: In the past, telehealth was mostly advocated by the CMIO and departmental clinical leaders, who would solve specific questions and specific disease topics. As there is consolidation in the industry, we see more and more enterprise challenges, such as value-based healthcare and achieving the Quadruple Aim. You have to impact the entire patient journey, end to end, to reach the targets of the Quadruple Aim. That concerns the CMIO and CNO from clinical side, who still play a role, but increasingly so do CIOs and COOs. We talk to a lot of CIOs and COOs. Telehealth is shifting from being a department initiative to an enterprise initiative, and these leaders are really stepping up.
In an enterprise-wide initiative, it doesn't help if we say, 'We can solve the problem in ICU only.' Organizations are more interested in an integrated approach. We have department-specific solutions, but we are more and more integrating them into a meaningful layer of useful data and optimization above the EMR. The EMR is a data repository, and caregivers often struggle to get meaningful information out of it in time. Now the question is what value do we get out of it? How does it compare to the aims we have around care improvement, cost savings, and patient and caregiver satisfaction?
In the past we used to pitch technology to the university professors at big institutions. If they used our solutions, they would promote them with students, and their students ended up in hospitals and that's how solutions were scaled. That is less the case today. Investment in advanced technology are not made by whether an individual likes or dislikes a piece of technology.
Q: What distinguishes great telehealth programs from average ones?
CK: I believe average programs are built with technology concepts only. They're connecting things that weren't connected; they are improving the reach and visibility. But the great programs really go for clinical and operational transformation. Clinical transformation is seamless workflow integration, optimization of the standards of care and really reducing variation. Operational transformation has a lot to do with costs and workflow. Great programs measure both types of transformation in a performance-based way.
For example, our e-ICU program has customers who have signed up to share their data in an anonymized way with each other. Every month they get a dashboard that shows how they are comparing to other clients using the same technology. The names they don't see, but they see their organization's spot, and they have a tool to engage with one another and share best practices. Sometimes when they fall behind, they reach out and say, 'Can you let us know who the best ones are?' We have to double check with those high-performing organizations. It's not all automatic — there are privacy concerns we uphold — but they love the exchange and they love the learning. Some clients use the dashboard internally, because some have five, six telehealth programs in their system. They go back and say, 'How come Program A performs like that and B doesn't?'
The last thing I would like to mention is the great programs see telehealth as an opportunity for culture change to work toward an outcome. To get people excited at outcome is good. These outcomes affect customers and caregivers, and they are measurable and improve accountability in the system.
Q: Can you explain how Downers Grove, Ill.-based Advocate Health Care deployed e-ICU technology in its emergency department with eCareMobile carts? How do those work?
CK: Advocate has been a leader for providing innovative solutions to patients. They are really at the forefront, and they have one of the largest e-ICUs in the country. Advocate is a longstanding, 15-year-old partner of ours, and their drive is to extend telehealth technology far beyond its original application in the ICU. Advocate considers e-ICU as a patient safety initiative, and it leveraged the e-ICU solution for other areas in the hospital, such as eCareMobile carts in the emergency room.
Advocate is taking the e-ICU technology as an enterprise-wide telehealth platform with mobile solutions in areas where you need 24/7 virtual care. The carts are in the ED and allow intensivists to monitor patients and provide intervention and clinical decision support in the right time. This is not just great for access and cost, it is also great for patient satisfaction because patients don't have to travel anymore. If you can get the same advice and care and support at home, it's great.
And lastly, the program is great for the fourth element of the Quadruple Aim, which is caregiver satisfaction. I've been talking to nurses who say, 'Hey I'm 60, I love my profession, but I cannot lift patients anymore. My back just couldn't do it, but I'd still love to share my experience.' They're extremely happy. That's a new kind of job opportunity.
Q: What lessons can organizations expect to learn in the first 1-2 years of deploying a virtual health solution?
CK: One of the key learnings is that you cannot do virtual health on the side. It doesn't make sense to do a tiny pilot somewhere just to do something cool with telemedicine and market around it. It has to be an integral part of your hospital operations. You have to adjust workflows with it, you have to train people, you need a culture change from it. You have to be serious about it.
And virtual health is also a software game, so you have to think about platforms, workflows and capabilities. So it's good to pilot, but don't use it as a Band-Aid that you put on a system in one area to fix a little problem.
You really have to start from the beginning and say, 'What are the objectives I want to achieve?What is my target? What is my dashboard? Where do I stand?' Then you have to go over baseline data and pinpoint what you want to improve upon. Then you go to the patient floor because workflows have to be adjusted. Only then you talk about the technology part.
It's good to have small impactful wins — celebrate them and socialize their success. You can start in a small area, but you have to keep the big plan in mind. You cannot just use virtual health as a patchwork system; that doesn't work.
Q: In which specialties/departments are you seeing the greatest adoption of smart equipment (i.e. biosensors)?
CK: Wearable technologies are most beneficial in an environment where rounding and staff constraints are big topics. If you look at the general ward, the caregiver to patient ratio is 1:10 or 1:12. The reason why you don't need wearables in the ICU, besides having higher requirements for the vital signs detection, is because you have a caregiver ratio of 1:1 or 1:2. When you don't have that type of staffing, it gets interesting — you have a lot of fluctuation of staff and information, and information gets lost.
Areas with staff constraints are those where algorithms can inform care providers on patient conditions and send alarms or notification once intervention is needed or to predict when it is needed. Smart equipment is one of the few technologies where you don't look at the issues after the fact, but you predict. By combining a patient's respiratory rate and temperature, you can predict a heart issue six to eight hours before it happens.
Also, with these technologies, you know when a patient gets worse and has to go to the ICU — but you also know when they get better. So often patients are kept against their will or against medical need in the hospital just to be on the safe side. But if you have intuitive data that you didn't have in the past that is analyzed in a smart way, you can manage the patient flow in your hospital far more efficiently.
The goal of the Quadruple Aim is to have the right care at the right time for the right person. There is no need for a person to come into a hospital, get infections and become sicker than they were before to receive care. This advanced technology is not just to alarm for patients who are getting sicker, but also to get healthy people home or if they are home, to keep them from getting admitted to the hospital. The dream of first-time diagnostics and right care at right time is not yet a reality, but these technologies help us get there.