Can physicians and nurses provide quality care through a computer connection?

Mercy Virtual has been called a hospital without patients, and the description is both true and false. There are neither beds nor patients in the gleaming four-story medical facility, which opened in late 2015 in Chesterfield, Missouri, a St. Louis suburb. But the facility is a hub of very real care for very real patients, in hospital beds and at home.

Part of the Mercy health care system, which spans 44 hospitals in the Midwest, Mercy Virtual is the incarnation in bricks and mortar of what has generally been consigned to the ether: virtual care.

Virtual Care

Also referred to as telemedicine or telehealth, virtual care involves the remote diagnosis and treatment of patients by medical experts who are miles or even continents away. Heralded as a way to save money while providing quality care for patients who might not otherwise have access to specialists, telemedicine has exploded in growth during the past decade. One report claims that, globally, telemedicine will be a $36.2 billion industry by 2020, up from $14.3 billion in 2014. This new approach to health care is of particular importance to older Americans, because it creates the potential of putting a virtual doctor or nurse right into the homes of patients, as frequently as needed, monitoring their health and making real-time diagnoses and treatment adjustments.

While many health care providers are developing elaborate virtual-care operations, no other single initiative to date reaches the grand scale exemplified by Mercy Virtual, the first built-from-scratch virtual-care center in America. With a team of more than 700 physicians, nurses and support staff serving 750,000-plus patients last year, Mercy Virtual is an experiment in telemedicine writ large.

But does it work?

The Patient’s Point of View 

Bob Garbs, 83, participates in Mercy Virtual’s Engagement@Home program, in which patients get care at home or another location besides a hospital. I looked on, with his permission, while a “care navigator,” Emily Roper, a young woman just out of college and trained by Mercy Virtual, talked to Bob and a great-nephew who was visiting. Bob’s smile on the computer screen brightened the room, and the conversation with Roper was so warm and friendly that I got the vague impression he might be trying to set up his care navigator with his great-nephew.

When it was time to review Bob’s clinical status, the video connection was passed to nurse Lori Tasche. While obviously focused on Bob’s health status, this part of the “visit” also looked and sounded like an interaction between people who knew each other well and cared about each other a lot. Looking for the impersonal liabilities of care across miles, I saw no real evidence of it from the delivery side.

The next day, I sat with Bob in his home, 40 miles from Mercy Virtual, in Washington, Missouri. For Bob, these daily visits as part of Mercy’s Engagement@Home program have been nothing less than a life changer. A former smoker with advanced pulmonary disease, he had been struggling to get enough breath just to make it through another day when he first entered the program. Now, set up at home with an iPad video camera and a nebulizer, and with continuous monitoring and virtual encounters at whatever frequency is warranted, he reports that every day is better than the one before. “I don’t think I’d be here anymore if it weren’t for the virtual-care program,” Bob told me. “I call them my Mercy angels.”

His wife, once constrained by her husband’s condition, now has what Bob notes is one of the program’s many benefits: peace of mind. When we visited, she was out shopping — because she could.

Much the same story played out at either side of the other virtual-care situations I encountered. I first met Gloria Gill, 72, via a video screen, about 40 miles from where she lay in a hospital bed in Mercy Hospital Washington’s intensive care unit, also in Washington, Missouri. Gloria had far more clinical details to discuss because she was acutely ill, but aside from that, her interactions with the care team at Mercy Virtual were nearly a replay of Bob’s: warm and intimate.

The next day, I visited Gloria at her bedside and, as with Bob, saw the video conversation from the other side. The video camera was fixed to the wall of the hospital room and could pick up and transmit very high-resolution images of Gloria, who, in turn, saw her care team projected right onto her television. Of course, all this discourse was subject to the federal government’s stringent health information privacy rules; when not serving as a video connection, that camera in Gloria’s hospital room was angled against the wall to show it was inactive.

Gloria was receiving treatment for pneumonia that had come on several days earlier, heralded by severe chest pain. Naturally chatty and, I think, enjoying all the attention, she talked about the many advantages of virtual care in the hospital. But Gloria was in the virtual Engagement@Home program, too, and spoke as much about that.

“There’s always somebody, and they’re just a call away—it gives me such peace of mind,” she told me.

Enrollment in Engagement@Home in no way displaces a primary care provider; it’s an add-on, and one often recommended by the primary care doctor in the first place. As soon as her pneumonia symptoms emerged, Gloria used her iPad to contact the virtual-care team at Mercy, and they took care of the rest, arranging for her transfer to the hospital, alerting her primary care provider and overseeing her initial treatment.

Contrast that to hours spent at home wondering what to do, followed by hours in a crowded emergency room before anyone looks in on you, and you start to see the powerful benefits of virtual care.

The Diagnosis

Whether other hospital systems can, or want to, replicate Mercy’s specific model is still to be determined. And more data need to be collected and analyzed in areas such as patient-usage patterns and the barriers of entry for health care providers. But Mercy has already shown that as a business model, virtual care can be a winner—that it can reduce health care costs, improve efficiency and lead to improved patient outcomes.

“We resuscitated a patient at night with the tele-ICU physician in charge via video, and the patient had a phenomenal recovery.”

 

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(Excerpted from AARP Magazine: www.aarp.org/)