In today's episode, we're joined by John Zabrowski of VHC Health, to discuss the development of the system's 15-year RCM partnership, how the system and vendor plan to work together, and goals for the first year.
The New Jersey health system is partnering with care.ai to scale a pilot program in one med-surg unit to all of its hospitals
Virtua Health is partnering with an AI company to scale a new Virtual Nursing program across the enterprise.
The New Jersey-based health system is collaborating with care.ai to integrate its virtual care technology throughout Virtua Our Lady of Lourdes Hospital in Camden following a pilot program launched late last year in one med-surg unit. Virtua executives say the platform will eventually be scaled out to all hospitals in the health system.
"By embracing the transformative potential of artificial intelligence and ambient intelligence, Virtua is pioneering a new era in patient care," Tarun Kapoor, MD, MBA, Virtua Health’s senior vice president and chief digital transformation officer, said in a press release.
The partnership is part of a nationwide trend of health systems and hospitals adopting virtual nursing platforms for one or more of three primary reasons:
Many are using virtual care technology to address staffing shortages and reduce stress and burnout by assigning virtual nurses administrative tasks and allowing on-site nurses to focus on care management.
They can also target improved administrative and clinical outcomes through round-the-clock patient monitoring and data entry and analysis.
Some are also using the platform to mentor newer nurses and give older nurses a new opportunity to stay in the workforce.
Virtua executives say the platform aims to streamline patient care “from routine admit and discharge activities to documentation, fall prevention, and clinician safety.” It enables floor nurses to focus on patient interaction while the virtual nurse handles other tasks, while ambient AI sensors in the rooms keep an eye on patients at all times.
“Our focus is not just on integrating cutting-edge technologies, but on enhancing the human aspects of healthcare,” Michael Capriotti, Virtua Health’s senior vice president of integration and strategic operations, said in the press release. “By swiftly adopting optical cameras and ambient sensors, we’re poised to markedly enhance the patient and care team experience, ensuring a safer, more efficient, and empathically connected healthcare experience.”
CNOs must know how to define healthy work environments in order to build them.
On this week’s episode of HL Shorts, we hear from Deana Sievert, Chief Nursing Officer at Ohio State Wexner University and Ross Heart Hospitals, about the qualities of a healthy work environment. Tune in to hear her insights.
A recent OIG audit of evaluation and management (E/M) services provided by telemedicine during the pandemic found that providers generally followed the rules for Medicare reimbursement. But they did make some documenting errors
Healthcare providers who use telemedicine often rely on reimbursements to support the platform. And according to a recent audit, they did a pretty good job documenting those virtual encounters during the pandemic.
The report, prepared by the Health and Human Services Department’s Office of the Inspector General (OIG), analyzed $10.3 billion in E/M services billed to Medicare between March and November of 2020, of which $1.4 billion, or about 14%, were conducted by telemedicine. The OIG found that providers “generally complied with Medicare requirements” to a point that the agency made no recommendations for changing or improving the coding and reimbursement process.
That being said, the OIG audit identified five common errors in documenting for an E/M visit conducted via telemedicine. They are:
Documenting how a service was provided. Some providers didn’t document whether the service was done in person or through either an audio-only or audio-visual telemedicine visit.
Documenting the location of the telemedicine visit. Some providers did not document where the provider or patient were located during the encounter.
Identifying the telemedicine product used. Some providers documented the use of audio-visual telemedicine for an E/M visit but didn’t identify the platform used (such as Zoom, Microsoft Teams, or a telemedicine vendor). The federal government relaxed both CMS and HIPAA guidelines during the pandemic to enable providers to use more telemedicine platforms, including public-facing products. Now that the pandemic and the public health emergency have passed, the government is again cracking down on telemedicine products that don’t meet rigid privacy and security guidelines and pushing providers to use platforms that are secure.
Clarifying the telemedicine modality. Some providers documented that they used audio-only telemedicine for the E/M encounter but used an audio-visual telemedicine CPT code, which is different from the audio-only CPT code. The government expanded the use of audio-only telemedicine during the pandemic to expand access to healthcare services but has been pulling back since then to focus on more secure audio-visual telemedicine platforms.
Documenting problems with the technology. Some providers reported that there were problems with the technology during a telemedicine visit, such as an unreliable internet connection or issues using video. They therefore conducted the visit via audio-only telemedicine but documented the visit as an audio-visual visit.
According to the OIG report, the problems weren’t big enough to indicate the need to take action, but they point to areas of concern that could affect future telemedicine policy. For example, CMS may wish to issue guidance in the future on how providers should deal with technology issues and how they should document the encounter.
Creating a safe patient handling program can help reduce injuries and time lost due to injury.
Working in healthcare poses many safety concerns, including exposure to illness, physical injury, and workplace violence.
According to the Occupational Safety and Health Administration (OSHA), in 2020, hospitals recorded nearly three times more work-related injuries and illnesses for every 100 full-time employees than in all industries combined.
One concern for nurses is the use of equipment to handle patients who are less mobile and need assistance, says Deana Sievert, Chief Nursing Officer at Ohio State Wexner University and Ross Heart Hospitals.
“Nurses are utilizing many different pieces of equipment to complete patient care,” Sievert said. “Those pieces of equipment can be very heavy or difficult to move.”
“It is more common than it should be for nurses to sustain musculoskeletal injuries such as pulled or strained muscles, and damage to bones or joints,” Sievert added, “and these can range from small sprains to career ending injuries.”
CNOs must ensure that there are proper safe patient handling procedures in place so that nurses avoid sustaining injuries.
Policies and procedures
Sievert believes CNOs need to build a culture focused on safety, where nurses have the tools they need to be successful. The policies created for safe patient handling should promote the concepts of a no-lift environment, and treat the use of safe patient handling equipment as a non-negotiable.
“Creating a ‘no lift whenever possible’ culture is something each CNO should strive for,” Sievert said. “It is imperative to ensure that nurses have [the] appropriate pieces of equipment that assist with lifting, repositioning, increasing mobility, walking aides, and emergency equipment when lifting may be necessary.”
Sievert recalls one of the most successful no-lift cultures she worked in, where there was a safe patient handling coordinator who visited each department and made the no-lift expectations clear. The safe patient handling coordinator also evaluated each department and identified needs, providing the appropriate equipment for each kind of care.
“Safe patient handling equipment was in all areas of the hospital including ambulatory areas,” Sievert said, “and the hospital had overhead patient lifts in each patient room.”
Additionally, there were safe patient handling coaches on each unit, according to Sievert.
“These coaches were key to departmental culture,” Sievert said. “All of this body of work helped significantly drive down injury costs and days lost to injury.”
According to OSHA, having a written safe patient handling policy ensures implementation and continued success. Programs will work when there is consistent leadership making safe patient handling a visible priority, and when nurse managers and frontline staff members are involved during the development stage.
OSHA provides a safe patient handling checklist that health systems can use to evaluate their programs. The checklist is broken up into several sections:
Policy development
Management and staff involvement
Needs assessment
Equipment
Education and training
Program evaluation
CNOs can use this resource to see which areas in their safe patient handling programs are well developed and which components of the programs might need more attention.
Training
To make safe patient handling programs a success, CNOs need to make sure that nurses receive the proper training, and that they understand the equipment and procedures to the fullest extent.
Sievert recommends that training follow the resources the organization has in place to address physical hazards.
“Training should be crystal clear in regard to the culture the organization wants to create, the expectations, and resources available,” Sievert said. “Creating that culture is key to success, and training and retraining is critical.”
According to OSHA, all staff, including physicians, must be trained in safe patient handling, through onsite demonstrations of equipment use and maintenance and broader education programs. OSHA provides the following recommendations to create a safe patient handling training program.
Train all relevant workers on using mechanical lift equipment
Refresh, remind, and require ongoing training
Use mentors and peer education
Train caregivers to check each patient’s mobility every time
Engage patients and their families
For more information on OSHA’s recommendations for safe patient handling, click here.
Sharp HealthCare has launched the Spatial Computing Center of Excellence, a new research hub aimed at turning VR technology like the Apple Vision Pro into a clinical tool
While many health systems see the new Apple Vision Pro as a consumer device, executives at Sharp HealthCare are taking a close look at what it can do for clinicians.
The San Diego-based health system recently opened the Spatial Computing Center of Excellence, an innovation center aimed at studying the healthcare applications of AR and VR technology. The center, launched in a collaboration with Epic and Elsevier, is the latest initiative to come out of the year-old Sharp Prebys Innovation and Education Center.
“This is a completely different form factor that opens up a lot of opportunities in healthcare,” says Brian Lichtenstein, Sharp’s associate chief medical informatics officer. “In the spatial realm, we have a chance to move beyond the limitations of the EHR.”
While AR and VR technology has long been focused on gaming, other industries are starting to see the value. Healthcare is no different, as health systems like Cedars-Sinai and Boston Children’s have, for the last few years, developed AR and VR programs to address health concerns like pain management, childbirth, mental health issues, and pediatric care. Cedars-Sinai, which hosts a virtual medicine conference called vMed, recently debuted an AI-enhanced app for mental health treatment designed exclusively for the Apple Vision Pro headset.
At Sharp HealthCare, though, the interest for now is solely on the clinician ranks, which are dealing with stress and burnout associated with overflowing workflows and seeing their numbers decrease. This is where Lichtenstein and his colleagues hope the technology can ease workflow pressures and make life easier for doctors and nurses.
“We’re looking at a new way of enabling humans to interact with computers,” says Dan Exley, Sharp’s vice president of clinical systems.
The new research center is closely aligned with Apple and has purchased 30 Vision Pro headsets to get the ball rolling. The latest iteration of the VR technology was initially teased in a video last June and made available to the public at the beginning of February—at a price of $3,500.
Michael Reagin, MBA, CHCIO, Sharp’s SVP and chief information and innovation officer, says Apple has been a longtime partner of the health system, and that partnership gives Sharp clinicians and engineers an opportunity to work not only with top-line technology but a consumer-facing device that has made a considerable impact in the public space. That understanding of consumer needs will be important as the health system looks at how this technology can be used in healthcare.
“We have to be at the forefront of developing these resources,” he says.
Tommy Korn, MD, an ophthalmologist and digital health innovator with the Sharp Rees-Stealy Medical Group, says the timing is right because the health system is undertaking a major transition from four separate EHR platforms down to one Epic platform. This gives them the opportunity to develop projects that integrate better with the new platform.
He, Lichtenstein, and Exley all envision using the Apple Vision Pro to give doctors and nurses a new way of working with data, visualizing healthcare delivery, and interacting with their patients. Where clinicians now often labor to work with an EHR through a computer or laptop, a spatial computing app could create a 3D EHR, giving clinicians and patients a different look at healthcare conditions and how treatments affect the human body.
Exley, calling VR an “infinite canvas connected to infinite computing power,” says Epic has already developed an app for the Apple Vision Pro, and he envisions early uses for the technology in places like radiology and surgery. In addition, he says, the Spatial Computing Center of Excellence can draw on recent advances in AI technology and cloud computing to improve use cases.
“We want to see content that is driven by context,” Lichtenstein adds.
It's important that your health system stands out, says this CNO.
On this week’s episode of HL Shorts, we hear from Cassie Lewis, Chief Nursing Officer, Bon Secours Richmond Market, about how CNOs can distinguish their health systems to new nurses during the recruiting process. Tune in to hear her insights.
A collaboration between Rochester University Medical Center and Five Star Bank is putting telehealth kiosks in bank branches, offering new insights into how to improve access to care in rural regions
In a partnership with Five Star Bank, Verizon, and digital health companies Higi Health and Dexcare, URMC is co-locating telehealth stations in Five Star branches across the western part of the state. The model aims to improve access to care for rural residents, especially those on Medicaid and Medicare, who face geographical and technological barriers.
Michael Hasselberg, PhD, URMC’s chief digital health officer, says the health system came out of the pandemic seeing measurable benefits in a telehealth platform for rural residents, but most were using a phone to access care. In order to include Medicare and Medicaid reimbursements, URMC needed to establish an audio-visual telemedicine link.
“We thought, rural communities, what do you have?” he said. “You’ve got a traffic light, you’ve got a Dollar Store, and you’ve got a bank. What about banks?”
In singling out banks, Hasselberg identified a challenge facing health systems and hospitals looking to expand their telehealth networks. Many programs have focused on putting kiosks or telehealth stations in community centers, libraries, barber shops and hair salons, malls, and other retail locations. In most cases that means working with a different party at each location.
A patient uses a URMC telehealth kiosk at a Five Star Bank in New York. Photo courtesy URMC.
Banks, however “are in these branch distribution models, so they’re scalable,” Hasselberg noted. “I can’t scale a library, or a barber shop, or a community center because I, as a health system, have to negotiate with every single [site]. But if you negotiate with a bank, you have, potentially, access to all their branches across the region.”
In addition, and just as important, the costs of launching the program are reduced.
“The organizations partnering to make this pilot a success have all offered generous, in-kind support,” Hasselberg said. “Verizon Business is contributing the necessary telecommunications infrastructure. DexCare and Higi are providing leading-edge telehealth software and Smart Health Stations, respectively, to connect rural residents with UR Medicine physicians. And Five Star Bank is volunteering private space in its bank branches to create a healthcare access point for its neighbors in a familiar, trusted, community location. UR Medicine is not funding the Five Star Bank space.”
Addressing Key Gaps in Care Delivery
The program, which is currently in three branches, gives consumers and patients an opportunity to track key biometric markers, such as blood pressure, obesity, and blood sugar, through connected devices and an app managed by Higi. Through DexCare, visitors can connect for a virtual visit with a physician in the health system for treatment or to schedule an in-person visit.
“We already had an on-demand telemedicine service line that is staffed by our primary care doctors,” Hasselberg noted, “So we just kind of built off of that.”
The program addresses a number of care gaps that health systems face in serving rural regions. According to Hasselberg, roughly three-quarters of the health system’s rural patients live at least 10 miles from the nearest brick-and-mortar care site, but more than half live within three miles of a Five Star bank.
And studies have shown that consumers are often reluctant to visit a doctor’s office or clinic for a minor or nagging health concern unless or until they really need urgent medical care, often postponing care and running the risk of developing a more urgent health issue later. Co-locating a telehealth station in a bank, often located near other community services, gives the consumer an opportunity to combine a few errands in one trip, or to consider a virtual visit while out running other errands.
In a unique example, Hasselberg noted that one of the telehealth kiosks is located in a community with a sizable Amish and Mennonite population (the bank even has a drive-through for customers using a horse and buggy). Providing easy, convenient healthcare access for a population that traditionally keeps to itself and eschews most technology at home could go a long way toward improving care and outcomes for that group of people.
Unique Benefits to Telehealth
Hasselberg noted that many rural residents, particularly those with limited incomes, have higher rates of no-shows, cancellations, and ED visits and tend to skip or avoid filling prescriptions. All of those issues, he said, were improved significantly through the use of telehealth during the pandemic. And many don’t have or can’t afford broadband services in their homes, which a telehealth kiosk addresses.
The platform also gives URMC a visible presence in rural regions where brick-and-mortar sites are few and far between, at a time when disruptors like Walmart, Walgreens, Google and Apple are looking to stake a claim in the busy primary care space.
“What we have found is healthcare is local, especially in these small, rural communities,” Hasselberg said, adding the disruptors are doing more to improve healthcare than create competition. “Having a trusted health system to deliver care, and that understands these communities … is really, really important.”
“Our [goal] wasn’t to make money,” he added. “We needed to create access…. We’re not going to be looking at this through the lens of, are we generating enough volume to make a profit?”
Tackling Social Determinants of Health
In addition, co-locating a telehealth station in a bank gives URMC an opportunity to address several social determinants of health.
“Financial health is so closely tied to physical health,” noted Hasselberg, who said a patient could be referred to the bank right after the telehealth visit for help understanding, planning for, and paying medical bills. “We might be able to affect healthcare access and financial instability at the same time.”
Hasselberg sees plenty of opportunities to expand the program, not only to other bank branches and potentially other banks, but to assisted living and skilled care facilities, which struggle to connect their patients to the care they need. In addition, he sees more services being available through the kiosks, including chronic care management and follow-up care. They could even be used as access points for resident sot connect with local primary care physicians.
“We all went into this going, ’This may be a nothing-burger,’” he said. “And patients [may] go, ‘I don’t know about getting healthcare in a bank.’ But what if it does work? That’s the really exciting part. Because if this does work, it could be transformative. It could be replicated across other health systems and across other banks across the country.”
The CommonWell Alliance and Kno2 are the sixth and seventh organizations to qualify to exchange healthcare information under the federal TEFCA framework
The U.S. Department of Health and Human Services’ Office of the National Coordinator of Health IT (ONC) announced last week that the CommonWell Health Alliance—a nonprofit alliance of healthcare and technology associations—and healthcare connectivity company Kno2 are the sixth and seventh QHINS, joining the eHealth Exchange, Epic Nexus, Health Gorilla, KONZA, and MedAllies.
"These additional QHINs expand TEFCA's reach and provide additional connectivity choices for patients, health care providers, hospitals, public health agencies, health insurers, and other authorized healthcare professionals," ONC chief Micky Tripathi, PhD, said in a press release.
The Sequoia Project, the federally Recognized Coordinating Entity (RCE) for TEFCA management, is reviewing comments on a second version of TEFCA, which was unveiled last month. The group’s CEO and RCE lead, Mariann Yeager, said she expects the QHINs to begin implementing version 2 by the end of March.
“The most important thing for people to understand is that version 2.0 was revised to support FHIR-based exchange,” she told HealthLeaders in a recent interview. “There are new use cases to support healthcare operations and public health. The other thing is it does permit health systems that participate in TEFCA-based exchange to connect to multiple QHINS, to the extent that they support multiple data sources.”
TEFCA isn’t the only framework for health data exchange, but it does have the backing of the federal government and builds off of the expertise of the Sequoia Project. Each QHIN goes through a rigorous process to achieve the designation and must adhere to federal standards.
TEFCA actually become operational in December 2023, when the first five QHINS were announced.
Here are some best practices for recruiting, according to CNOs.
There are many strategies to help with recruiting, with varying degrees of success. CNOs need to focus on those solutions with proven positive outcomes to build their workforces.
Here are five tips for recruitment, by CNOs, for CNOs.
