Providence’s patient telemedicine programs are having a powerful impact

Telemedicine for Patients Across the Health System Providence provides critical access to care at more than 100 hospitals across nine service lines. And it has improved quality and access across the health system.

Telehealth services for patients in Providence include tele-stroke, tele-EEG, tele-neurohospitalist, telepsychiatry, a telehospitalist program, Hospital at Home, and tele-ICU. The large health system recently launched a tele-infectious disease program and a virtual nursing program called CoCaring. These programs are critical because of the physician shortage and the difficulty of recruiting specialists to rural areas.

Dr. Eve Cunningham is group vice president and chief of virtual care and digital health at Providence and founder of the AI-enhanced clinical intelligence engine MedPearl. She reports that her inpatient telemedicine programs are “growing like crazy.” So we caught up with her for a firsthand tour.

Q. Can you first talk in general terms about telemedicine for patients in Providence?

A. Historically, access to medical specialists was limited to the four walls of a hospital or clinic, often requiring patients to be transferred from community hospitals to specialists who were not embedded in a community. With telemedicine, we can now “beam” these specialists into remote, underserved, and rural communities to evaluate and consult with patients and provide the local medical community with specialist consultations and support.

With telehealth, we not only save time by eliminating the need for travel, we also ensure that specialists are deployed efficiently across the care network. Using technologies such as tele-carts and cameras, specialists can perform assessments and collaborate with care teams on the ground to provide the necessary care and formulate appropriate treatment plans.

This setup also helps manage the limitations of physical hospital space. As some regions face regulatory and financial challenges in expanding hospital bed capacity, optimizing the use of existing beds becomes essential. Inpatient telemedicine supports this by ensuring that patients receive the right level of care in the most appropriate environments without the need to physically move.

Overall, inpatient telemedicine at Providence is improving care delivery by making specialty knowledge more accessible, supporting clinical staff, optimizing hospital bed utilization, and improving patient flow and management across facilities.

Q. You report that telemedicine for patients is “exploding like a rocket” in Providence. Why? What are the drivers?

A. The growth of clinical telemedicine at Providence is driven by three key factors, each of which is essential to address the changing healthcare landscape.

First, there is the ongoing shortage of physicians. Several factors contribute to this shortage, including an aging physician demographic and increasing retirement rates, burnout that is causing many physicians to reduce their FTEs or leave the profession altogether, and challenges in filling residency and fellowship programs.

This shortage is particularly severe in neurology, a concern raised in a 2019 report. call to action from the American Association of NeurologistsThe difficulty of recruiting specialists to rural communities also exacerbates this problem, as these areas traditionally have fewer doctors per capita compared to urban centres.

Another driver of telemedicine adoption is the need for bed optimization and improved patient flow within hospitals. In states where certificate-of-need regulations limit the expansion of hospital beds, maximizing the use of existing beds is critical.

Telehealth programs help achieve this by ensuring that beds are maximized, thereby reducing unnecessary patient transfers and admissions. This capability is particularly beneficial for smaller community hospitals, as it allows them to treat more complex cases that would otherwise be transferred to already overcrowded tertiary hospitals.

Finally, the shift to hybrid work models among physicians is also a catalyst for the expansion of telemedicine. Many healthcare professionals now prefer a balance between on-site tasks and the flexibility of remote work.

This not only increases job satisfaction and retention, but also increases the overall efficiency of healthcare. Because our providers can provide care remotely, it minimizes travel time between facilities and enables faster patient care.

The convergence of these factors—physician shortages, the need for efficient use of hospital beds, and the preference for hybrid work models—is contributing to the growth of inpatient telemedicine at Providence. Our programs support more effective care delivery, address critical staffing and resource constraints, and lead to better patient outcomes.

Q. What types of patient outcomes are you getting from the technology? How does it help the outcomes?

A. Our telehealth programs have significantly reduced unnecessary patient transfers between facilities. Our clinicians can provide specialized consultations remotely, allowing patients to receive the right care where they are. Telehealth allows patients and clinicians to avoid the need for physical travel unless absolutely necessary.

We have also seen a reduction in unnecessary hospitalizations, which is particularly evident through the telepsychiatry program. This program provides efficient evaluation of patients directly from the emergency department, allowing safe discharges without the need for hospitalization in approximately 30% of our consultations.

At the same time, the telepsychiatry program ensures that patients are placed in the most appropriate care environment, based on their specific needs.

The implementation of telehealth services, managed by hospitalists and virtual nursing programs, has reduced the overall length of hospital stays. This efficiency not only improves patient flow, but also increases the availability of beds for incoming patients requiring clinical care.

In intensive care settings, the tele-ICU program has played a crucial role in reducing the time patients require mechanical ventilation. By optimizing treatment plans and enabling more timely interventions, patient recovery times have improved, thereby improving the management of ICU resources.

Our recently launched tele-infectious disease program focuses on improving antimicrobial stewardship and ensuring adherence to guidelines-based therapies. The goal is to reduce the incidence of antibiotic-resistant infections through more effective use of antibiotics.

Finally, our tele-stroke program has made significant strides in reducing treatment times. Faster delivery of thrombolytics and clot busting interventions are essential to improving outcomes in stroke care, potentially reducing long-term disability.

In addition, we can keep 70% of patients who receive a telestroke consultation in their local hospitals, thus limiting unnecessary transfer of care to overburdened tertiary institutions.

Q. What types of problems or challenges does inpatient telemedicine solve, or at least help minimize? For example, does it help with staff shortages or burnout?

A. One of the most critical issues our programs address is staffing shortages and burnout, particularly in rural and underserved areas. The strain on our existing clinicians is already immense. Telemedicine helps alleviate this challenge by enabling clinicians to provide care remotely, reducing the need for physical presence in multiple locations and reducing travel stress and burnout.

This also helps to ensure that the limited number of available physicians can be optimally utilized, as they can expand their working area to more institutions without incurring additional physical and time-consuming burdens.

Another area where telemedicine is making an impact is the optimization of hospital beds and patient flows. Given the strict regulations and financial constraints that often hamper the expansion of hospital bed capacity, telemedicine is crucial to maximizing existing resources.

It supports more effective triage and treatment of patients, ensuring patients receive care in the most appropriate setting without the need for transfer. This is particularly important in regions where increasing the number of hospital beds is not feasible due to regulatory or financial constraints.

Telemedicine also improves access to specialist care. Through the use of telehealth technology, specialists can evaluate, diagnose, and plan treatment for patients remotely. This is especially beneficial in areas that are experiencing a shortage of specialists, allowing patients in these regions to receive high-quality care that would otherwise be out of reach, effectively democratizing access to specialized medical services.

Follow Bill’s HIT reporting on LinkedIn: Bill Siwicki
Send him an email: bsiwicki@himss.org
Healthcare IT News is a publication of HIMSS Media.