The virtual hospital

The last year has seen a rapid increase in virtual healthcare technology adoption, with virtual hospitals overcoming the challenges of COVID-19 to provide care to patients remotely. But what exactly is a virtual hospital? Hospital + Healthcare spoke with Philips ANZ General Manager Matt Moran to learn more.

How would you define virtual care?

Virtual care is a proven model of care that brings together a centralised, senior team of clinicians and leverages technology to support patients both in and out of the hospital. The solution delivers need-to-know information to caregivers, empowering them to care for the patients who need it most, preventing deterioration before it happens. This care model challenges the current paradigm by allowing a small group of clinicians to support hundreds of bedside clinicians and their patients, leading to better health and economic outcomes.

In Australia, virtual healthcare technologies are on the rise. A change in the Medical Benefits Scheme (MBS) for telehealth arrangements has enabled widespread telehealth adoption. Until 2020, Australians overwhelmingly preferred face-to-face settings with healthcare providers, with only 0.1% being MBS virtual care attendances. During COVID-19, a survey found that 62% of respondents found their telehealth experience was as good as or better than traditional in-person medical appointments.

Philips ANZ General Manager Matt Moran says now is the time to ensure we maintain momentum and maximise the opportunity of virtual health care.

What scope is there for virtual care to improve patient outcomes?

Virtual care works on multiple fronts to improve patient outcomes. Apart from the clinical benefits associated with early clinical intervention, the ability to deliver virtual acute care unhindered by the challenges of distance in a country like Australia creates an enormous opportunity. For patients requiring longer-term continuous care, such as for those with chronic conditions, these solutions allow for treatment in the comfort and safety of their homes.

Specific health and economic outcomes include:

• Lower mortality risk overall — patients were 26% more likely to survive the ICU; 16% more likely to survive the hospital stay;
• In-patient care teams can reduce falls and assist with monitoring patient wellbeing and mobility.
• Altogether faster discharge from both ICU and the hospital.
• Greater patient satisfaction from both telehealth services and virtual hospitals.
• The ability to provide care across the healthcare continuum from healthy living to prevention to diagnosis, treatment and home care — rather than siloed intervention in a crisis.
   

What are other key benefits of the technology?

Beyond improved patient outcomes, virtual care enhances patients’ experience by enabling health systems to deliver person-centred care, improved safety and quality through process standardisation, improved efficiency and enhanced integrated care multidisciplinary team coordination.

The platforms underpinning these models of care are designed to allow for rapid, efficient scale-up allowing for health systems to support multiple hospital systems and patients across vast geographies.

For healthcare providers, this technology creates capacity by focusing teams on the patients who need them most to reduce mortality, maximise adherence to clinical best practices and shorten the length of stay. It also optimises existing capacity by having the right resources in the right place at the right time to remove bottlenecks within and across facilities.

Philips has successfully rolled out a remote ICU for US-based Emory Healthcare based at the Royal Perth Hospital in Western Australia. This program sees critical care physicians (intensivists) and acute care nurse experts provide medical care to patients in the US from their base at Royal Perth Hospital using Philips’ remote ICU monitoring technology.

What are the barriers to uptake of virtual care solutions?

There are a number of internal and external barriers that are slowing the widespread adoption of virtual hospital technologies. The largest barrier is the availability of suitable re-imbursement models to justify investment and sustainability. The current hospital reimbursement models of activity-based funding tend to support funding for intervention rather than prevention, which inhibits rapid scale-up of these solutions.

Other contributing factors include:

• Limited access/reduced connection to the internet, which reduces facilities’ and patients’ abilities to access and maintain services. Poor internet can have a flow-on effect on audio and video quality, reducing virtual technologies’ effectiveness.
• Change management is one of the largest challenges in uptake. Hospitals wishing to adopt virtual care need to rethink their staffing ratios and retrain clinicians to practise medicine in a new way. Successful programs come with powerful partnerships, whether between the patient and the clinician in home-monitoring solutions, or the clinicians and the bedside teams in in-hospital models.
• Questions around security and privacy of personal information and records are not uncommon. Our latest Philips Future Health Index 2020 report found that 89% of younger healthcare professionals believe technology will provide better patient outcomes, and 70% of Australians believe AI will offer personalised care.
   

The 2019 edition of the Philips Future Health Index report explored the impact of digital health technology on healthcare professionals and patients and detailed key barriers and solutions to virtual care adoption locally. Key findings from the 2019 report include:

• Patient empowerment: enabling patients to be actively involved in managing their health improves patients’ and healthcare professionals’ experience.
• Breakdown of data silos: the research shows that Australians are more open to granting healthcare professionals access to their data when they access that data themselves. Healthcare professionals agree that patients having access to their health data improves their patients’ experience.
• Healthcare professional advocates: patients are more likely to track health indicators upon recommendations from healthcare professionals who actively advocate the use of virtual technologies.
• Training and awareness: exposure to digital health technology increases how proactive people are in managing their health. Creating strong education programs for healthcare professionals and patients will accelerate the willingness to adopt new technologies.

A closer look at a virtual hospital

Philips has delivered virtual hospital services to East Metropolitan Health Service (EMHS) to improve patient care and proactively detect the risk of patient deterioration.

The Clinical Command Centre is a cornerstone of EMHS’s Health in A Virtual Environment (HIVE) program, responsible for driving a hub-and-spoke model of care that utilises machine learning and predictive analytics to reduce length of stay as well as complications, avoidable transfers and mortality.

Based at Royal Perth Hospital, the Clinical Command Centre oversees inpatients in step-down units and higher acuity wards. The technology will provide a virtual safety net of specialist support for over 100 beds over the next five years.

The Clinical Command Centre is an example of how technology can be integrated within health care to deliver improved patient outcomes and staff support. In Clinical Command Centres across the world, Philips has leveraged its monitoring, machine learning and advanced analytics to drive reduced mortality, reduced complications and reduced length of stay. This technology has historically improved patient experience and reduced provider turnover on multiple fronts, including a 26% reduction in patient mortality;¹ a 30% reduction in length of stay² and helped 15% of patients be discharged home faster.³

Philips Managing Director Australia and New Zealand Matt Moran said, “In working with the East Metropolitan Health Service to develop the HIVE program, we have created a virtual hospital solution capable of predicting patient deterioration and to help identify and prioritise patients most at risk for earlier interventions.

“This Clinical Command Centre will help EMHS unlock gains and efficiencies and drive innovations that help deliver on the ‘quadruple aim’: enhancing the patient experience; improving health outcomes; lowering the cost of care; and improving the work life of care providers.”

At the launch of the HIVE project at EMHS, Western Australia Deputy Premier and Health Minister Hon Roger Cook said, “The McGowan government has a strong commitment to encouraging investment in innovation to improve the future health of all Western Australians. The Sustainable Health Review highlighted the need to invest in digital health care to transform and improve the quality of care for Western Australians, and the HIVE is a great example of that investment in action.

“The HIVE will revolutionise the way we deliver health care in WA and will also provide ongoing opportunities for research involving artificial intelligence and data analytics to ensure WA researchers are at the forefront. The HIVE also represents a major opportunity for WA researchers and innovators to become world leaders in the development of biotechnology and AI assisted healthcare delivery.”

Moran concluded, “The advanced technologies behind our Clinical Command Centre reference sites have a proven track record and are constantly improving. However, achieving value-based outcomes requires clinical transformation — and that is precisely what has driven the success of the Philips Clinical Command Centre globally over the last 20 years. Our program combines people, technology and process to provide measurable, predictable and sustainable outcomes.”

Virtual hospital extends to support COVID-19 patients

Queensland’s West Moreton Health has expanded its innovative virtual hospital program to support COVID-19 patients recovering at home.

Developed by Philips and introduced in 2016, MeCare — Mobile Enabled Care — allows chronically ill patients to track their daily health targets, manage symptoms and use videoconferencing to connect with a clinical team each day.

West Moreton Health and Philips expanded their partnership to safely care for more people in response to the COVID-19 pandemic and reduce demand for hospital services.

West Moreton Health’s Community and Rural Services Executive Director Melinda Parcell said the MeCare model was adapted for COVID-19 patients with milder symptoms.

“West Moreton Health has expanded its hospital capacity as part of its response to the COVID-19 outbreak, but we have also considered how we can use existing technology and innovation to provide safe care within the community setting. It means people can receive the care they need in the comfort of their own homes and we are also eliminating the risk of transmission in the hospital setting, where other vulnerable people may be receiving care.”

Depending on their acuity and care needs, COVID-19 patients can be cared for at home under either the moderate or ‘lite’ model. Moderate model patients are given tablets and health devices so they can measure their temperature, blood pressure and oxygen saturation levels and respond to regular health surveys to track their health progress. Others who require less supervision can use their own mobile device to receive remote support via Philips’ enterprise remote patient monitoring platform (eCareCoordinator).

The health information recorded on each of these devices is monitored by West Moreton Health’s virtual care team, which can provide timely intervention through phone calls, videoconferencing and in-home visits as needed.

Moran said well-designed virtual hospital programs enabled health systems to best leverage clinical resources to ensure patient care was not compromised.

“In partnership with West Moreton Health, we are proud of the virtual capability of MeCare now being leveraged to manage COVID-19 patients,” he said.

“Supported by Philips technology, a small group of highly trained West Moreton clinicians are able to deliver care to a large amount of people in the community.

“This is possible because these clinicians are able to provide timely intervention to only those participants needing care, while smart clinical decision support tools highlight those at greatest need. Using the right technology and the most appropriate ratio of clinicians to patients is a crucial success factor at a time when resources must be conserved.”

References

1. Lilly CM, et al. A Multi-center Study of ICU Telemedicine Reengineering of Adult Critical Care. CHEST. 2014; 145(3): 500-7.
2. Lilly CM, et al. Hospital Mortality, Length of Stay and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes. JAMA. June 2011; 305(21) 2175-83.
3. Impact of an Intensive Care Unit Telemedicine Program on a Rural Health Care System. Zawada, et al. Postgrad Med J, 2009; 121(3):160-170.

Images courtesy of Philips.