Virtual care: A model for the future?

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What is the best way to provide better patient outcomes, shorter hospital stays, fewer complications – all at a lower cost?

One innovative route to achieving this points to the future of healthcare: a virtual clinic staffed by specialists, overseeing the treatment of people both in hospital and at home, often large distances away.

While it sounds far-fetched, it’s a reality. The world's first virtual care centre was launched in late 2015 by Mercy, one of the United States' largest health providers. Since then it has helped cut emergency room visits and hospitalisations in Mercy's home state Missouri by more than 33 percent, while also reducing readmissions.

“These virtual systems help you do a better job of improving the quality, decreasing complications and increasing survival, and decreasing cost of care by getting people out of hospital quicker,” says Mercy's Executive Vice-President and Chief Clinical Officer Dr Fred McQueary, who will be the keynote speaker for the APHA 39th National Congress in Adelaide on Sunday 15- Tuesday 17 March 2020.

The Mercy Virtual Care Centre's 300-plus staff care for patients at the group's 40-plus hospitals and more than 900 practices across the Midwest, monitoring them using integrated telemedicine programs while liaising with on-site colleagues.

It took over 15 years to develop from concept to reality, having started with Mercy's first virtual intensive care unit program in 2004.

“To a certain extent, a lot of the programs we developed out of necessity because of how geographically dispersed our healthcare system is,” Dr McQueary said.

“We are spread over four states, and trying to provide care in all those states, and that distance, can be difficult when a lot of our facilities are small rural facilities, and you're trying to provide specialised care in a place where you don't have enough volume to justify parking a specialist in that location.”

One of the major challenges was convincing medical staff that the technology was there to help them, not replace them, and building relationships was critical to success.

“It's like eyes in the sky looking over the shoulder of the local treatment team, and early on a lot of people resent that. They feel that, 'What, you don't think I'm doing a good enough job already?' And they have a sense that they're not being trusted.”

For patients, there are significant advantages. Being monitored at home is a major benefit, Dr McQueary said, especially for those who have to travel long distances to be treated.

“The problem in many situations is the disconnect between the patient and the provider, between the chronically-ill pulmonary disease patients who live 50 miles from their physician and can't get in on a day-to-day basis, and the physician who doesn't have room to see them every day, doesn't necessarily have to see them  every day.

“But if you're able to check in with that patient and make sure that if there's any of the early signs that they're starting to take a step downhill, you can adjust the medications and  reverse that,” he said.

It also translates to immediate care in the hospitals, such as that provided by Mercy's virtual sepsis unit.

“The first sign of sepsis, we're on it right away, rather than waiting till maybe it's the next shift or for another nurse. It's that early reaction that really makes a difference, and providing those early warning systems, allowing you to intervene before things get worse,” he said.

So how would he advise an Australian healthcare provider hoping to enter the virtual realm?

“The technology is the first thing. And then you get the people that are ready to do it, then you get the systems that are ready to do it, and the last thing that comes along is the system to pay for it.

“If you want to get in this early and be somebody who's known for having better outcomes and who's very patient friendly, you're going to have to take somewhat of a leap and start doing this before the payment system catches up,” he said.

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