Got Rural? Go Virtual. St. Luke's Did.

Virtual Care Center models next generation telehealth services.

There's a lot of talk these days about how health systems, particularly those serving rural populations, need to think beyond the walls of their facilities to provide care.

St. Luke's Healthcare System did something about it.

This summer the Boise, Idaho–based health system opened a 24-hour 35,000-square-foot Virtual Care Center, providing telehealth services to patients, clinics, and hospitals every day of the year throughout Idaho and Eastern Oregon, including five critical access hospitals.

Serving remote locations presents numerous challenges. "Rural healthcare providers serve populations which are not only socioeconomically disadvantaged, but also suffer from numerous health disparities and poorer outcomes than non-rural communities," according to Rural Relevance 2017: Assessing the State of Rural Healthcare in America, produced by The Chartis Center for Rural Health.

Compounding the problem, rural America has lost 83 hospitals since 2010.

Given these circumstances, how do health systems increase access and improve outcomes for rural residents? Telemedicine is one solution. As more health systems explore better ways to cost effectively and efficiently serve these populations, St. Luke's approach offers some compelling concepts to explore.

A Strategy That Meets Rural Needs

"Idaho is a very rural state, so access to healthcare is an extreme challenge here," says Krista Stadler, RN, senior director of telehealth services for St. Luke’s Health System. For example, St. Luke's has the only children's hospital in Idaho.

St. Luke's decision to build the Virtual Care Center can be traced back to its 2020 strategy initiative. Objectives included:

1. Evolve and transform population health delivery to improve outcomes and lower costs
    
2. Build trust by becoming a preferred partner within communities served due to the ability to deliver coordinated, affordable, and accessible healthcare
    
3. Build consumer engagement by changing the perspective from what the system thinks is right to what the consumer wants
    

"When we looked at those three things, telehealth and virtual care became a clear and obvious endeavor that we wanted to embark on to meet our patients' needs, as well as organizational needs," Stadler says.

Combining Functions Fosters Innovation

Telehealth, which some now refer to as "virtual care," is a growing area of service. Health systems across the country have opened facilities to house eICU monitoring—sometimes in foreign locations, to manage remote patient monitoring at home, to provide direct-to-consumer services, or to offer telehealth services and consultation to clinics, emergency departments, and providers. Others have built centralized command centers to handle capacity, patient transport, transitions, and bed management.

While a few other comprehensive standalone facilities exist in the nation, St. Luke's may be one of the first to combine all of these services under one roof, with the exception of a direct-to-consumer application, which they do not offer.

Besides having a single location for all telehealth services, the unusual aspects of their approach include combining virtual care with a transfer center/bed management, IT services, data analytics, and an innovation lab. The idea: To bring together all the elements and people needed to inspire further healthcare transformation.

"From my standpoint," says Stadler, "what makes us a little bit unique is that we have taken a variety of services—not just the clinical teams—and put them in one location to foster innovation and think about how we deliver care based on what the consumer is asking for. It's a different mindset, and we like to think of it as care transformation."

"All of those folks in one center help us think through many different aspects of the challenges of healthcare today," says Stadler. Currently she oversees 90 team members, with the capacity to expand to 350.

Stadler says David Pate, MD, JD, president and CEO of St. Luke's, "refers to the Virtual Care Center as 'a laboratory for change that benefits the patient.' That is really our culture. We want people to come up here and think about the possibilities, and not be afraid of trying new things."

Anatomy of the Virtual Care Center

St. Luke's center handles 80,000 virtual visits annually and the transfer center manages another 23,000 calls each month. There are 63 virtual care work stations, including semi-enclosed "pods" to ensure private consultations, and eight transfer center work stations.

The facility encompasses six distinct functions:

1. Remote Patient Management offers a platform for monitoring and delivering care to patients at home. This offers tremendous advantage to those located in rural areas, increasing access to care, and reducing their need to travel.
    
2. Virtual Clinic Consultation Rooms that enable providers to care for multiple patients in numerous locations simultaneously, greatly increasing access to care for people in the communities St. Luke's serves. Specialty care services are growing rapidly, providing service to critical access hospitals and clinics in remote locations.
    
3. TeleICU provides specialty care and decision support to critically ill patients and their bedside care teams at hospitals across Idaho, including four tertiary care centers and five critical access hospitals or freestanding EDs, plus one external partner. 
    
4. Technology Build Room, occupied by a dedicated team of IT professionals who deploy custom-built solutions throughout the health system.
    
5. Transfer Center and Bed Placement, a team that coordinates internal and external provider connections and consultations, and directs patient transfers throughout the health system.
    
6. Innovation Lab to support and deploy innovative technologies to transform the way the system provides services to patients across the region.

Changing Outcomes Through Chronic Care Management

One of the highlights of its virtual care success is the Remote Patient Management (RPM) program, launched in 2017. RPM offers home monitoring for patients with one of five chronic conditions: COPD, diabetes, hypertension, congestive heart failure, and coronary artery disease. Providers refer patients into the program who have a new diagnosis, multiple conditions, failure to respond to treatment, or a recent hospitalization that requires close follow-up care.

Participants receive a home kit with a mini iPad and Bluetooth peripheral devices such as a blood pressure cuff, a pulse oximeter, and a scale. Each day patients participate in a daily video health session, responding to questions about their physical and emotional health, along with a reading of their vital signs using the devices. Information from those sessions feeds into a software program that identifies responses and data that fall outside of expected limits.

"That information helps the nurses and social workers focus on who they need to reach out to that day," says Stadler. The team contacts patients to provide further support via video chat and secure texting to the tablet or phone.

 A 12-month pilot resulted in:

• 38% reduction in emergency department visits
• 54% reduction in hospital visits
• 65% reduction in hospital stays

The decrease in hospital stays is "the one that really gets me excited," says Stadler. "I believe that is attributed to the fact that we are monitoring these patients and getting information from them daily, which allows us to recognize that they're starting to have challenges with their illness early. Sometimes they need to go to the hospital. When they get there, their stay is much shorter because their [acuity] is much less, [because they don't go] straight to the ICU. Patients are embracing it and doing well with it."

Improving Access and the Patient Experience

In addition to improving outcomes, virtual care is improving accessibility and convenience for St. Luke's rural population, changing the dynamics of the patient and family experience. Stadler points to services provided through its children's hospital in Boise as one example. Preoperative visits and post-surgical follow-up care presented a huge inconvenience to families in the past.

"Traditionally parents had to take time off work and drive into Boise," Stadler says, a trip that can be complicated by severe weather conditions. "We've now installed telehealth equipment in local multidisciplinary clinics in the rural areas and, assuming that it's safe, depending on the magnitude of the surgery, the pediatric surgeon now sees these patients in their local clinic for these visits. It's really wonderful for the patient and their family because they're allowed to stay in their community. A kid who just had an operation may not be up to a four- to five-hour car drive to come back for a 15-minute follow-up visit."

“Patients heal best at home, surrounded by people who love and care for them,” Stadler says. And, she points to another advantage: virtual care keeps providers off the road and more productive. "Put that together, and we’re able to provide healthcare when and where it’s convenient for everyone involved. This is the future of healthcare, and we’re proud to be leading the way in Idaho.”