This article is part of Jmore’s “Innovation in Health Care” special section.
LifeBridge Health is paving the way for a new, innovative method of practicing medicine. The Baltimore-based hospital system recently launched LifeBridge Health’s Virtual Hospital, a unique model to enhance care coordination and efficiency within the system.
“The point of the virtual hospital is to provide more access to patients,” says Dr. Jonathan Thierman, medical director and chief medical information officer of the virtual hospital. “Because there isn’t always great follow-up, coordination or resources for patients after leaving the hospital, we see a high volume of patients return to the ER or stay home and get sicker. We want to be able to better care for our patients, provide them with more access to medicine and avoid urgent ER visits.”
Located on the Sinai Hospital campus, the virtual hospital combines telemedicine services, a clinical command center, and international call centers located in Israel and the Philippines to provide patients with timely, coordinated care.
“What makes us different is that we tie telemedicine into our command center,” says Dr. Thierman. “Most institutions have clinical command centers that monitor the flow of patients in and out of the hospital, but what makes us a virtual hospital is the idea we can do tele-triage and other telemedicine visits virtually from different locations both at Sinai and Northwest hospitals.”
The tele-triage function works like this: When patients check into the emergency room, they are set up with a nurse and a computer screen, where they can video-conference with a physician assistant who can view their vitals, listen to their symptoms and read nurses’ notes. The PA can then order tests to be done while patients are waiting for an ER room to open up. Once a room opens, patients are taken back to see a doctor, who will most likely already have lab results.
“These services help patients get through more quickly and improves quality of care,” says Dr. Thierman. “It makes the patient’s visit more efficient, and we can catch problems sooner.”
The PA working tele-triage is located in a private, secure room, and the patient can choose to use a USB telephone handset to communicate with the provider on the screen.
“The physician assistant will begin the conversation by explaining that the hospital is getting the patient’s room ready, but they will get the ball rolling with lab orders while he/she waits,” says Dr. Thierman. “Once a patient hears that, they are appreciative of the additional service.”
With the focus of health care shifting to value-based care, the telemedicine providers are able to interact with patients at the same time that nurses are doing triage, a move that reduces waiting times and increases swiftness of care. And because the service is a part of the ER visit, currently there is no added cost for the patient.
“There is a lot of emphasis and investment on the idea of ‘right care, right place, right time,’” says Dr. Jonathan Ringo, Sinai’s senior vice president and president/chief operating officer. “The funding opportunities that are in place to help prevent hospital readmissions have allowed us to put this model of care in place, and this trend will only continue to grow.”
Since implementing the virtual hospital in January, more than 4,000 patients have used tele-triage. The average ER waiting times for those who used the service decreased from 86 to 26 minutes.
“These are all added services,” says Dr. Thierman. “We aren’t replacing face-to-face doctor visits. We are supplementing them.”
In addition to the virtual hospital, international call centers in Israel and the Philippines allow for highly trained professionals to work with patients getting ready to be discharged and make follow-up calls to patients cleared to leave the hospital. Currently, there are more than 30 employees working out of the call center in Jerusalem.
“There are a lot of U.S.-educated and U.S.-trained health care providers who have made aliyah,” Dr. Ringo says. “The call center allows us to use sources internationally to enhance our local services.”
Last February, Reisterstown resident Wayne Webb, 58, went to Northwest Hospital after suffering from breathing problems. He was given medication and sent home. But over the following weekend, Webb’s condition worsened and he couldn’t get out of bed. Forty-eight hours after he left the hospital, he received a call from the hospital checking in on his condition. He said he couldn’t get out of bed, was having a hard time talking and hung up.
Two hours later, an ambulance showed up at his house.
“I wasn’t expecting anyone to come, but it was a relief when I saw paramedics at my door,” Webb says. “They came in, set up a laptop and next thing I know, I was talking to a doctor. After telling him my symptoms and getting my vitals taken, the doctor told the paramedics to give me some medication in my home. But eventually, I was taken to the hospital and admitted with a lung infection.
“I think this saved my life,” he says. “No one should be skeptical of the virtual hospital because if it weren’t for that, I can’t tell you where I would be.”
While in-home tele-triage isn’t the norm and patients must be in the ER to benefit from the tele-triage for now, Dr. Thierman says the goal is to make this model accessible to anyone, regardless of their location.
“I’m amazed with how receptive everyone has been,” says Dr. Thierman. “We hope to remove all barriers so this become natural and a service patients grow to expect.”