Roundtable sessions at this week's CMO Exchange include discussions on use of artificial intelligence tools, integrating advanced practice providers into clinical care teams, medical director accountability, and addressing workplace violence.
More than two dozen CMOs and chief clinical officers are attending this week’s HealthLeaders CMO Exchange in Utah.
The CMO Exchange features a series of roundtable discussions on issues that are top of mind for clinical leaders. Roundtable topics at this week's CMO Exchange include use of artificial intelligence tools, integrating advanced practice providers (APPs) into clinical care teams, medical director accountability, and addressing workplace violence.
CMO Exchange participant Thomas Balcezak, MD, MPH, executive vice president and chief clinical officer at Yale New Haven Health, provided a preview of these topics in a recent interview with HealthLeaders.
Thomas Balcezak, MD, MPH, is executive vice president and chief clinical officer at Yale New Haven Health. Photo courtesy of Yale New Haven Health.
Use of AI tools
In healthcare, it is important to view AI tools broadly, according to Balcezak.
"As a physician administrator, I like to look holistically at how the organization operates," Balcezak says. "I don't make a distinction between the sharp end of clinical care with the physicians, nurses, and pharmacists, and the support end of clinical care with the back-office work such as preauthorization. I think broadly about AI applications in terms of how to make the whole care experience better."
Yale New Haven Health has deployed several AI tools that have a direct impact on clinical care. For example, one of those tools conducts ambient listening and transcription for patient encounters with clinicians.
"We have an AI tool to assess deterioration of patients in the inpatient setting, which lets clinicians know patients may be deteriorating before they are in crisis." Balcezak says. "We have an AI tool that performs pre-evaluation of radiologic exams to help radiologists to quickly and completely evaluate radiograms."
An example where Yale New Haven Health uses AI tools to improve back-office work that impacts the care experience is specialty pharmacy prescription preauthorization.
"We use an AI tool to summarize the patient's clinical information in order to provide that information to the payer," Balcezak says.
There is not widespread concern among clinicians and other clinical care team members that AI will replace clinical staff, according to Balcezak. Instead, the technology will be assistive.
"It's similar to automotive technology such as power steering and lane change warnings," Balcezak says. "People have not thought that these technologies would eliminate the need to drive. It helps people drive more safely and helps people drive with a better degree of precision. In the world of clinical care, this is what AI is helping us do as well."
For example, AI tools can help clinicians manage the barrage of data that is being generated in healthcare such as data points that need to be evaluated and new clinical knowledge that needs to be integrated into patient care processes, Balcezak explains.
"AI is going to make clinicians more effective and hopefully reduce some of our burdens," Balcezak says.
Deploying APPs
APPs have become essential members of care teams at health systems, hospitals, and medical groups, according to Balcezak.
"Almost every day, we are adding more and different kinds of advanced practice providers to our care teams," Balcezak says. "As care becomes more complicated and as the physician shortage continues to grow, we are increasingly looking to advanced practice providers to help extend physicians and help physicians to take care of patients better and more efficiently."
At Yale New Haven Health, APPs have been deployed in every care setting.
"APPs help in the operating rooms. They help on the inpatient floors. They help in our outpatient clinics," Balcezak says. "I can't think of any clinical care space where we haven't seen APPs make inroads in helping physicians take better care of patients."
Specific examples of APPs working in care settings at the health system include advanced practice registered nurses and physician assistants in ICUs helping critical care physicians take care of patients and APPs helping cardiothoracic surgeons to do procedures such as vein harvesting and closing the chest after surgery.
"APPs are playing critical roles in helping physicians," Balcezak says.
Medical director accountability
Medical director accountability is a top priority at Yale New Haven Health, according to Balcezak.
"We are conducting a large review of all our medical directors at health system sites to ensure that their jobs are appropriately structured," Balcezak says. "We are making sure that medical director job descriptions are appropriately scoped so that the lines of accountability are made clear."
Ensuring medical director accountability mirrors efforts to promote quality care, Balcezak explains.
"You need to ensure that the right structures are in place," Balcezak says. "You need to make sure that the right processes are in place to drive the outcomes that you want to achieve."
Depending on what medical director you are talking about, desirable outcomes can be more efficient flow of patients at an inpatient or ambulatory location, better quality outcomes, or better patient experience, according to Balcezak.
"It comes down to structures and processes to drive the outcomes you are seeking," Balcezak says. "If you can't define what outcomes you are looking for, then it can be hard to determine what structures and processes to put in place."
Addressing workplace violence
Limiting workplace violence is a focal point at Yale New Haven Health, with Bridgeport Hospital President Anne Diamond, JD, leading the effort across the health system, according to Balcezak.
Efforts to address workplace violence at Yale New Haven Health include installing weapons detection technology at the health system's facilities and crafting patient codes of conduct, Balcezak explains.
When patients commit acts of workplace violence, healthcare facility leaders must act immediately, according to Balcezak.
"You need to address an episode of workplace violence in the moment," Balcezak says. "You need to make sure that the patient and the staff are made safe."
Steps also must be taken to address the aftermath of a workplace violence incident, Balcezak explains.
"You need to support all of the staff members who were involved in an event," Balcezak says. "You need to support staff physically and emotionally."
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
To find out more about the HealthLeaders Exchange program, visit the program’s webpage or the program’s LinkedIn page. To inquire about attending a HealthLeaders Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
In the latest installment of HealthLeaders' The Winning Edge series, a three-member panel of experts explore successful strategies for handling the advanced practice provider boom.
With a growing shortage of physicians in many specialties, advanced practice providers (APPs) such as nurse practitioners and physician assistants have become essential members of clinical care teams. APPs are being deployed in every care setting, including inpatient units, outpatient clinics, specialty practices, and urgent care centers.
The video below features a three-member panel of experts discussing successful strategies for managing and deploying APPs. The panelists are Teresa Caulin-Glaser, MD, executive vice president and chief clinical officer at OhioHealth; Debra Fournier, DNP, APRN, chief advanced practice provider officer at Dartmouth Health; and Read Pierce, MD, CMO at Denver Health.
The panelists cover a wide range of topics, including the importance of APP onboarding programs, leadership roles for APPs, deploying APPs in primary care, and offering professional development opportunities for APPs.
The Winning Edge series is an extension of theHealthLeaders Exchange program. The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
To find out more about the HealthLeaders Exchange program, visit the program’s webpage or the program’s LinkedIn page. To inquire about attending a HealthLeaders Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
For health systems and hospitals, one of the most effective strategies for retention of advanced practice providers is to offer professional development opportunities.
This week, HealthLeaders held the latest webinar in The Winning Edge series. The webinar was titled "The Winning Edge for Handling the APP Boom."
A three-member panel of experts discussed a range of topics, including the importance of APP onboarding programs, leadership roles for APPs, and deploying APPs in primary care. The panelists were Teresa Caulin-Glaser, MD, executive vice president and chief clinical officer at OhioHealth; Debra Fournier, DNP, APRN, chief advanced practice provider officer at Dartmouth Health; and Read Pierce, MD, CMO at Denver Health.
The infographic below features the panelists' four tips for offering professional development opportunities for APPs.
The Winning Edge series is an extension of theHealthLeaders Exchange program. The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
To find out more about the HealthLeaders Exchange program, visit the program’s webpage or the program’s LinkedIn page. To inquire about attending a HealthLeaders Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
Discussion points in this week's Winning Edge webinar included the importance of APP onboarding programs, leadership roles for APPs, and deploying APPs in primary care.
The latest webinar as part of HealthLeaders' The Winning Edge series held yesterday focused on effective strategies for managing and deploying advanced practice providers (APPs).
With growing shortages of physicians in many specialties, APPs have become essential members of care teams in the inpatient and outpatient settings. Yesterday's webinar focused on a range of APP issues, including the importance of APP onboarding programs, leadership roles for APPs at health systems and hospitals, and deploying APPs in primary care.
All three of the webinar's panelists stressed the importance of robust onboarding programs to position APPs for success.
Fournier said onboarding for APPs at Dartmouth Health includes three elements: setting expectations for APPs as an organization, filling education gaps, and establishing mentorship relationships so there is a point person to work with each APP.
Pierce said onboarding for APPs at Denver Health includes establishing specific milestones for APPs in the onboarding process.
A related consideration for APPs at Denver Health is providing orientation for physician assistants and nurse practitioners who move laterally between specialties, Pierce said. In those instances, the health system makes sure it provides physician assistants and nurse practitioners with foundational and core knowledge in their new specialty.
At OhioHealth, the health system provides a unified approach to onboarding for physicians and APPs in the first week of employment, Caulin-Glaser said. This approach includes a focus on OhioHealth's values and mission as well as training on the health system’s approach to team-based care.
Leadership roles for APPs
APPs play leadership roles at OhioHealth, Dartmouth Health, and Denver Health.
At OhioHealth, APPs play a leadership role in care coordination, including areas such as nursing and pharmacy, Caulin-Glaser said.
At Dartmouth Health, APPs often serve in consulting roles, and some APPs are involved in training clinicians at the health system's academic medical center, Fournier said.
At Denver Health, APPs are active in clinical staff governance such as serving as members of the medical executive committee and APP Council, Pierce said.
There are several kinds of qualities that APPs should possess when they serve in leadership roles, according to the webinar's panelists.
An APP who serves in a leadership role should have an excellent performance record in their area of clinical practice as well as the ability to communicate well and bring staff members together, the panelists said.
At OhioHealth, APPs who function in leadership roles are consistent high performers, demonstrate versatility, and have a desire to lead care teams, Caulin-Glaser said.
At Dartmouth Health, APPs who work in leadership roles show an aptitude for collaboration and demonstrate curiosity, Fournier said, adding that mentorship of APPs is crucial in their development as leaders.
APPs in primary care
Part of the original concept of APPs decades ago was for them to work in the primary care setting, Pierce said, adding that Denver Health has expanded the APPs role in primary care clinics to serve as specialists such as providing behavioral health services.
APPs can manage their own patient panels in primary care clinics, the panelists said.
At OhioHealth, APPs in primary care clinics are often leading efforts in care coordination and continuity of care, Caulin-Glaser said, adding APPs have been involved in ambulatory quality care initiatives.
At Dartmouth Health, the health system has taken steps to support APPs who function as independent providers in primary care clinics, including pairing new APPs with more experienced APPs or physicians as well as recognizing and filling knowledge gaps, Fournier said.
The Winning Edge series is an extension of theHealthLeaders Exchange program. The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
To find out more about the HealthLeaders Exchange program, visit the program's webpage or the program’s LinkedIn page. To inquire about attending a HealthLeaders Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
APP onboarding, ideal roles for APPs in team-based care, and circumstances where APPs can lead care teams are top of mind for CMOs.
The next webinar in the HealthLeaders Winning Edge series, which will be held on Tuesday, Sept. 16, from 1 to 2 PM ET, will tackle managing the growing number of advanced practice providers (APPs) head-on.
With physician shortages in many specialties, APPs have emerged as a vital workforce resource for health systems, hospitals, and medical groups. For example, deploying APPs has become a solution for providing clinician coverage of emergency departments that lack 24/7 physician coverage.
In conversations with HealthLeaders earlier this year, a pair of CMOs gave different takes on whether care teams should always be led by physicians or whether it is appropriate for care teams to be led by APPs in some circumstances.
"Multidisciplinary care teams should be collaborative, with flexibility to adapt based on the patient's needs and setting," Kalman says. "Whether in the hospital or outpatient clinic, well-structured teams ensure the best outcomes."
While the growing role of APPs helps address physician shortages, physician-led teams provide the optimal structure for delivering high-quality, patient-centered care, according to Kalman.
In a well-designed care model at Northwell, different team members contribute their expertise, with physicians providing oversight and team decision-making for complex cases. Kalman highlights the importance of flexibility.
"An advanced practice provider may manage a patient’s diabetes and hypertension, but if that patient presents with rapid atrial fibrillation and a fever, physician consultation is essential to determine next steps," Kalman says.
APPs such as nurse practitioners and physician assistants are going to play leading roles on care teams more often, according to Suzanne Wenderoth, MD, executive vice president and CMO of Tower Health as well as a HealthLeaders CMO Exchange member. Historically, CMOs and other healthcare leaders have thought that physicians should lead care teams under all circumstances, but that view is changing.
"Now, we recognize with both changes to laws in the states, which allow for full practice authority for advanced practice providers, and the physician shortage in the post-COVID era, there has been an evolution in our thinking," Wenderoth says.
At Tower Health, APPs and nurses are under consideration for leadership roles on care teams, Wenderoth explains.
"At Tower Health, we do believe that every care team should have access to a physician," Wenderoth says. "But whether care teams need to be led by a physician is up for discussion."
There are circumstances where a care team can be led by an APP or a nurse, according to Wenderoth.
"When we talk about leading care teams, we are really talking about making sure the leader has leadership skills such as maintaining accountability, demonstrating professionalism, and having good facilitation skills," Wenderoth says. "That can be done by a physician, advanced practice provider, or nurse."
The Winning Edge for managing APPs
This week’s Winning Edge webinar on managing APPs features a panel of three experts.
Teresa Caulin-Glaser, MD, executive vice president and chief clinical officer, OhioHealth
Debra Fournier, MSN, APRN, chief advanced practice provider officer, Dartmouth Health
The panel will focus on more than a half-dozen discussion topics.
What is the optimal role for APPs in providing team-based care?
Are there circumstances where APPs can lead care teams?
What is the optimal role for APPs on inpatient care teams?
What is the optimal role for APPs in outpatient and specialty clinics?
How do you balance support versus supervision in the APP-physician relationship?
What are successful models for APP onboarding and orientation?
What professional development opportunities have you considered for APPs?
When it comes to deploying APPs, what is the biggest challenge you have faced?
Register here to attend the webinar. An OnDemand version of the webinar will be available at the same link used to register for the webinar.
The Winning Edge series is an extension of theHealthLeaders Exchange program. The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
To find out more about the HealthLeaders Exchange program, visit the program’s webpage or the program’s LinkedIn page. To inquire about attending a HealthLeaders Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
The first step in integrating clinical care is figuring out how to provide value for patients, this chief physician executive says.
One of the top priorities of University of Iowa Health Care's inaugural chief physician executive is integrating clinical care across the health system.
Bevan Yueh, MD, MPH, began his new role as chief physician executive of University of Iowa Health Care on July 31. He previously worked as CEO of University of Minnesota Physicians and vice dean of clinical affairs at University of Minnesota Medical School.
"What I must figure out first is how to provide value to patients in the state," Yueh says. "This is a state institution. We have got to be able to show everyone in the state that we are valuable to them. When we integrate clinical care, we want to make sure it is what people in the state want."
The number of patients that want to seek care at University of Iowa Health Care is growing, and integrating clinical care is imperative, according to Yueh.
"We know that we do not have enough resources here to take care of every patient who wants to see us," Yueh says. "In the past, we knew that we were comfortable only being in Iowa City and that patients had been willing to travel a long distance to see us. But healthcare is changing, and we must evolve."
A key to success in integrating clinical care is for leaders of the health system and clinical staff to view patients as if they were family members, Yueh explains.
"I would not want my mom driving four hours to Iowa City if care could be provided closer to home," Yueh says. "We need to figure out how we can work with partners throughout the state, so that we can give care to patients conveniently."
Bevan Yueh, MD, MPH, is the inaugural chief physician executive of University of Iowa Health Care. Photo courtesy of University of Iowa Health Care.
Driving quality improvement
Culture and measuring results are essential in quality improvement efforts, according to Yueh. Clinical staff must understand that the organization is committed to doing things better.
"Then you must be able to measure what you are doing wrong and where you are not doing a great job," Yueh says. "Measurement must be accurate—you need to have one source of truth, so people agree on how you are doing in terms of quality."
A chief physician executive, CMO, and other clinical leaders can play a pivotal role in establishing a culture that supports quality improvement, Yueh explains.
"Most doctors, advanced practice providers, and nurses want to do things better," Yueh says. "A clinical leader has to unleash that spirit and to make doing things better easy. A clinical leader must identify barriers to make it easier for their staff to do things better. A clinical leader must listen to their staff members to understand their frustrations."
In addition to culture and measurement, a health system or hospital must be able to prioritize to improve quality, according to Yueh.
"You cannot improve every quality measure at the same time," Yueh says. "At a former institution where I worked, we decided to prioritize sepsis care response time. Our care teams were just not getting to sepsis patients quickly enough. We decided this was a priority because if we could get to sepsis patients within the first hour of symptoms, their mortality rate decreased significantly."
Achieving a coordinated care experience
Clinical leaders and staff members must appreciate the patient perspective to achieve a coordinated care experience, Yueh explains.
"Leaders and staff members need to think about a coordinated care experience as if they were caring for their mom, their kid, or their spouse," Yueh says. "Staff members need to focus on how they would want those family members to have a care experience."
Listening to patients and recognizing any struggles they have in receiving care is essential in providing a coordinated care experience, according to Yueh.
"For example, you need to acknowledge if you required a patient to travel 200 miles three times to see a surgical oncologist, medical oncologist, and radiation oncologist," Yueh says.
High-risk pregnancies are increasing, and CMOs need to put resources in place to address them.
Hospitals in Florida are forecasting a 14.5% increase in high-risk pregnancies over the next decade, and the trend is expected to be nationwide. According to Cleveland Clinic, the causes of high-risk pregnancies include pre-existing conditions in women such as diabetes, high blood pressure, and obesity, as well as pregnancy-related health conditions such as gestational diabetes, low birth weight, and preeclampsia.
There is no doubt that high-risk pregnancies are increasing, according to Mert Bahtiyar, MD, director of the Fetal Care Center at Yale New Haven Children's Hospital. On the maternal side, there are patients with increased high-risk factors such as high body mass index, chronic hypertension, previous surgeries, and malignancies. From the babies' perspective, there are more high-risk factors, including genetic and structural abnormalities.
View the HL Shorts video below to see what kind of services Yale New Haven Children's Hospital is providing to address high-risk pregnancies. Click here to read the accompanying HealthLeaders story.
At Cedars-Sinai Health System, community health workers are addressing patients' social drivers of health and impacting key metrics such as readmissions.
The primary role of community health workers is helping health systems and hospitals address their patients' social drivers of health. Unmet social needs such as food insecurity, housing instability, and transportation barriers impact clinical outcomes and key healthcare organization metrics such as hospital readmissions.
At Cedars-Sinai, community health workers are fully integrated and embedded in clinical care teams across several service lines, including emergency medicine, primary care, inpatient care teams, and outpatient clinics.
"Our community health workers are full-time staff, so they are not volunteers or contracted with community-based providers. This helps ensure accountability and the sustainability of our workforce," says Kathryn Hren, LCSW, MPH, director of the Community Connect Program at Cedars-Sinai. "They are not an adjunct service—they are directly part of our care teams."
Data indicates that community health workers at Cedars-Sinai are having a positive impact.
In the past year, the community health workers have served more than 2,000 patients, and 62% of those patients were successfully connected to services or resources for their unmet social needs. The national benchmark is about 57%.
Survey data shows patients have a high satisfaction rate in their engagement with community health workers, with 90% of patients who respond to the surveys saying they have strong satisfaction with their community health workers.
The community health workers are also moving the needle on key health system metrics, according to Hren.
"We look at data for appropriate utilization of healthcare services as well as engagement with primary care services," Hren says. "We see a promising pattern that patients who engage with our community health workers have a decrease in avoidable healthcare service utilization."
From the CMO perspective, Cedars-Sinai's community health workers help patients who are overwhelmed by navigating their healthcare and provide patients with support for issues that their clinical team cannot provide, according to Richard Riggs, MD, senior vice president of medical affairs and CMO of Cedars-Sinai Medical Center.
"Community health workers add value by connecting patients to social services for food, housing, and transportation while also helping them follow through on appointments and care plans," Riggs says. "By addressing these broader needs, they reduce unnecessary hospital visits, improve long-term outcomes, and ensure health systems are delivering care that truly meets patients where they are."
At Cedars-Sinai, community health workers are particularly helpful for serving the Medicare fee-for-service population, which has 35% of patients above the age of 80 and 40% of patients who are dual eligible for Medicare and Medicaid, Riggs explains. Community health workers can help ease common frustrations such as scheduling confusion, insurance, or how to access follow-up care. They also address practical barriers such as trouble managing medications.
"With their hands-on guidance, patients feel less overwhelmed and more supported in navigating both the health system and the everyday challenges that affect their health," Riggs says.
Community health workers at Cedars-Sinai are generating value for patients by addressing social needs and helping patients stabilize their lives after a hospital stay, according to Riggs.
"When social barriers are reduced, patients are better able to attend follow-up visits, fill prescriptions, and engage in ongoing care," Riggs says. "That stability translates into fewer avoidable readmissions and better long-term health outcomes, demonstrating how meeting social needs directly supports recovery."
Richard Riggs, MD, is senior vice president of medical affairs and CMO of Cedars-Sinai Medical Center and Cedars-Sinai Marina del Rey Hospital. Photo courtesy of Cedars-Sinai Health System.
How community health workers can address social needs
Although Cedars-Sinai social workers and clinical staff conduct routine social drivers of health assessments of patients, community health workers conduct a second round of assessments, Hren says.
"Sometimes, patients do not feel comfortable disclosing their needs to their clinical care team," Hren says. "So, once a patient is referred to a community health worker, they will do their own assessment of social drivers of health to make sure that we are not missing anything."
The next step is for community health workers to engage with patients to make sure they understand how they can address the identified needs.
"This includes insurance benefits, connecting to a community-based partner, and applying for public benefits," Hren says. "Community health workers provide education to help patients understand their options."
Cedars-Sinai's community health workers spend a lot of time hand holding patients to make sure they get connected to the social services they require, according to Hren.
For example, if a patient is at home and does not have access to a computer or Internet access to complete an application for Medi-Cal enrollment, a community health worker will go to the patient's home with a computer and hot-spot Wi-Fi to complete the enrollment application.
At Cedars-Sinai, the key differentiator between the community health worker role and a nurse or other roles is that community health workers can build a high degree of trust with patients because they can spend more time with patients than most clinical team members can spend, Hren explains.
"The interaction between community health workers and patients is not limited to one encounter—community health workers continue to work with patients in an environment that is comfortable for the patients such as home visits or meeting at a coffee shop," Hren says. "There are continuous phone calls and check-ins to encourage patients to engage in services and understand the resources that are available."
Kathryn Hren, LCSW, MPH, is director of the Community Connect Program at Cedars-Sinai Health System. Photo courtesy of Cedars-Sinai Health System.
Advice for other health systems
Health systems and hospitals that are interested in launching community health worker programs should start small and scale a program intentionally, according to Hren.
"For example, you can start a community health worker pilot in one service line, get data from the service line that shows the impact and value of community health workers, then expand intentionally to specific patient demographic groups or to patients with chronic illnesses," Hren says.
If funding is a barrier to starting a community health worker program, there are philanthropy dollars and grants that can support these programs, Hren says.
Finally, a health system or hospital must make sure that there is buy-in for a community health worker program among senior leadership and frontline clinical staff, Hren explains.
"You should avoid siloing community health workers and make sure they are part of the care team," Hren says.
At Ochsner Health, about 70% of the patients who have engaged with the health system's virtual emergency department have avoided emergency room visits.
Emergency room crowding is a challenge for health systems and hospitals across the country. Creating a virtual emergency department is a relatively new concept to address the problem, and it's a concept that Ochsner Health is turning into strategy.
Ochsner started its virtual emergency department in October 2024. The virtual emergency department is staffed by a board-certified emergency medicine physician and nurse navigator from 8 a.m. to 8 p.m. seven days a week.
So far, the virtual emergency department has worked with 13,000 patients. In 70% of these cases, patients have been able to receive care without visiting a brick-and-mortar emergency room.
"Originally, the concept came out of our overall journey to try to get patients to the right care in the right place," says Lisa Birdsall Fort, MD, system medical director of quality for emergency services at Ochsner. "We found that we had disproportionate ED utilization, so we needed a solution to help to make sure that we were able to connect patients to the right care."
From a CMO's perspective, the virtual emergency department program generates strategic, clinical, and financial value, according to Sidney "Beau" Raymond, MD, CMO of Ochsner Health Network. It improves access and convenience by allowing patients, particularly those with low-acuity conditions or living in rural areas, to receive timely care from emergency physicians without needing to physically visit the emergency department.
"This model enhances cost efficiency by reducing unnecessary ED visits and redirecting patients to more appropriate ambulatory or virtual care settings, which ultimately lowers overall healthcare spending," Raymond says. "Additionally, the program helps optimize resources by preserving high-acuity ED capacity for true emergencies, thereby improving throughput and reducing burnout among emergency staff."
The virtual emergency department addresses several pain points for CMOs, including alleviating ED crowding by offering patients more appropriate access points for care, Raymond explains.
"Many patients choose the ED for convenience or payment flexibility, but the virtual emergency department provides a viable alternative that maintains accessibility while improving care flow," Raymond says. "The program functions as a centralized hub, guiding patients to the right care setting, whether that be virtual, urgent care, primary care, or even specialty follow-up."
For patients, the virtual emergency department elevates patient satisfaction and outcomes by reducing wait times, improving care navigation, and offering personalized treatment plans, Raymond says.
Sidney "Beau" Raymond, MD, is CMO of Ochsner Health Network. Photo courtesy of Ochsner Health.
How Ochsner's virtual emergency department works
Patients are referred to Ochsner's virtual emergency department from primary care offices, specialist offices, urgent care centers, or the health system's nurse-on-call line, according to Noah Pores, MD, medical director of the virtual emergency department.
"If patients are triaged in such a manner that emergency care is felt to be needed, the virtual emergency department will be consulted through the Epic secure chat platform," Pores says. "From there, we engage with providers in a brief conversation about the case and review medical records such as images and laboratory results."
The virtual emergency department makes a care recommendation for patients based on the conversation with their providers, Pores explains.
"We ask questions of physicians or nurses, depending on which staff member is consulting with us," Pores says. "Then we make care recommendations about whether emergency care is appropriate."
If it is determined that emergency care is not appropriate, the virtual emergency department has several options to provide care. The patient can be offered a virtual visit such the video teleconferencing platform via Epic. The patient can be offered an e-visit, which is an asynchronous type of virtual visit that involves a survey submission by the patient. In an e-visit, the virtual emergency department physician can review the survey responses and provide services such as prescriptions, ancillary tests, or referrals.
The virtual emergency department also redirects patients to care settings that avoid an emergency room visit.
"We answer questions for patients, and many times the needs that they have can be resolved in the outpatient setting, which they can find difficult to navigate," Pores says. "The nurse navigator is the unsung hero in our virtual emergency department model. Their ability to schedule patients quickly for primary care and specialty clinics has been a game changer for us as a health system."
Noah Pores, MD, is medical director of the virtual emergency department at Ochsner Health. Photo courtesy of Ochsner Health.
The future of virtual emergency departments
Virtual emergency department programs are poised to become a national trend, according to Raymond, who adds that Ochsner's virtual emergency department program uses existing technology to address EDs that are filled with non-emergent patients
"It enables patients to be seen at the most appropriate site of care," Raymond says. "Traditional nurse triage lines, which most health systems use, are limited by protocol. By incorporating experienced ED physicians into the triage process, our virtual emergency department ensures that patients who would otherwise be sent to the ED due to protocol limitations can instead receive the necessary evaluation and management in a more suitable setting."
Health systems and hospitals that are interested in starting a virtual emergency department program should be prepared to apply a significant level of effort, according to Birdsall Fort.
"A virtual emergency department is not something that comes out of a box from an electronic health record vendor—it is a relatively new concept," Birdsall Fort says. "You need to be creative. You need to start the program, then refine what you offer."
It is important for a healthcare organization to establish buy-in for a virtual emergency department program, Pores explains.
"A virtual emergency department requires a lot of coordination across multiple stakeholders, including primary care, executive teams, quality departments, and population health programs," Pores says. "You also need a strong group of physicians who are willing to be engaged in the process."
Lisa Birdsall Fort, MD, is system medical director of quality for emergency services at Ochsner Health. Photo courtesy of Ochsner Health.
A recent study found 7.4% of emergency departments lack 24/7 coverage by attending physicians.
Hundreds of emergency departments do not provide 24/7 coverage by attending physicians, particularly at rural hospitals, according to a recent study.
The study, which was published by the Journal of the American College of Emergency Physicians Open, examined 2022 data from 4,621 emergency departments. The researchers found that 344 (7.4%) of the EDs did not have 24/7 attending physician coverage. The states with the highest percentages of hospitals where there was not 24/7 attending physician coverage of emergency departments were North Dakota, South Dakota, and Montana.
Sioux Falls, South Dakota-based Sanford Health struggles to have 24/7 attending physician coverage at its emergency departments in rural communities.
"We cover about 55 medical centers throughout the Upper Midwest. Some of those facilities are Level 1 trauma centers and are well-equipped to handle most emergencies," says Jeremy Cauwels, MD, CMO of Sanford Health. "Some of those facilities are in towns of about 800 people, and they have either a low volume of patients or low condition acuity to support a physician in their emergency departments on a regular basis."
The CMO of Sioux Falls, South Dakota-based Avera Health says it is difficult to find emergency medicine physicians to work at rural hospitals.
"It is challenging for us to have full-time physician coverage at our emergency departments, especially at our rural communities and settings, where recruitment for physicians is difficult," says Kevin Post, DO, CMO of Avera Health. "When you think about recruiting physicians for a small, rural community, when the physicians are not from that area it can be difficult."
Recruitment of emergency medicine physicians to work at rural hospitals is also a predicament for Sanford Health.
"The biggest challenge is finding a physician who wants to live in a town of 800 people," Cauwels says.
The absence of attending physician coverage at many emergency departments is a trend that will continue in the future, according to Post.
"We are facing an increasing physician shortage that will not lift for at least the next five to 10 years," Post says. "We need to acknowledge the physician shortage is the reality, then be proactive about what we can do about the shortage."
Jeremy Cauwels, MD, is CMO of Sanford Health. Photo courtesy of Sanford Health.
Rising to the staffing challenge
To provide adequate full-time clinician coverage of emergency rooms in the absence of an attending physician, Sanford Health and Avera Health rely on advanced practice providers (APPs).
"If we have a scenario where a physician is unable to cover an emergency department, we will have the staff at a rural hospital covered by an advanced practice provider such as a certified nurse practitioner or physician assistant," Post says. "It is important for these APPs to have the adequate training to serve in this role and adequate staff to support them."
With the right experience and training, an APP is equipped to provide care for 90% of the patients who seek care at an emergency room, according to Cauwels.
"Many of the patients who come into emergency departments are already managed in small towns and big cities by APPs," Cauwels says. "If you walk into a large hospital emergency department in Minneapolis, you will be seen by an APP in many situations, particularly for triage."
Avera Health and Sanford Health provide training for APPs who are overseeing emergency rooms.
"At Avera, we are exploring additional emergency medicine certification for our rural nurse practitioners and physician assistants, so they can have additional training specifically for rural emergency medicine," Post says. "This will help address the challenges of having limited resources at a rural facility."
Sanford Health provides simulation training for APPs who are leading emergency rooms.
"We have a motor home full of manikins that goes to hospitals throughout our footprint to train APPs on care such as how to deliver a baby precipitously, how to insert a chest tube, and how to manage an emergent airway," Cauwels says. "We actively engage with our teams to make sure they have those skills."
Kevin Post, DO, is CMO of Avera Health. Photo courtesy of Avera Health.
Leveraging telehealth
Avera Health and Sanford Health provide APPs who are overseeing EDs with access to emergency medicine physicians and specialists through telehealth. At Avera Health, Post explains that the health system has embedded telehealth technology into its rural emergency departments.
"With the push of a button, an emergency medicine physician and nurse can be available in an exam room," Post says. "These professionals can interact with the APP and the entire care team. It can be as simple as assisting with documentation or as complicated as helping with care guidelines."
Sanford Health supports APPs with telehealth at 31 of the health system's rural hospitals.
"APPs can get a virtual consult in real-time while they are treating a patient," Cauwels says. "These virtual consults include neurology, psychiatry, and board-certified emergency medicine physicians."
Using telehealth to support an APP at an emergency department ensures that patients receive quality care despite the absence of an attending physician on-site, Cauwels says.
"A physician does not have to live in a rural town to digitally appear in an exam room at a hospital and do the right thing for the patient," Cauwels says. "With digital technology, we can have physicians work with patients in real-time in small town emergency rooms."
Thomas Balcezak, MD, MPH, is executive vice president and chief clinical officer at Yale New Haven Health. Photo courtesy of Yale New Haven Health.
Bevan Yueh, MD, MPH, is the inaugural chief physician executive of University of Iowa Health Care. Photo courtesy of University of Iowa Health Care.
Richard Riggs, MD, is senior vice president of medical affairs and CMO of Cedars-Sinai Medical Center and Cedars-Sinai Marina del Rey Hospital. Photo courtesy of Cedars-Sinai Health System.
Kathryn Hren, LCSW, MPH, is director of the Community Connect Program at Cedars-Sinai Health System. Photo courtesy of Cedars-Sinai Health System.
Sidney "Beau" Raymond, MD, is CMO of Ochsner Health Network. Photo courtesy of Ochsner Health.
Noah Pores, MD, is medical director of the virtual emergency department at Ochsner Health. Photo courtesy of Ochsner Health.
Lisa Birdsall Fort, MD, is system medical director of quality for emergency services at Ochsner Health. Photo courtesy of Ochsner Health.
