The Future of Hospital Medicine: The Tools and Integrations that are Shaping the Specialty

Posted on Fri, Nov 20, 2015

Francisco Loya, MD
CEO, EmCare Hospital Medicine

 

The technologies we are using to improve the delivery of care in hospital medicine are showing great promise – if not outright success. At EmCare Hospital Medicine, we are deploying various innovations that improve operational efficiency, enhance quality of care, ease staffing challenges and upgrade billing/coding practices. As these tech tools become more prevalent, I would argue that the future of hospital medicine has arrived, and with it the promise of better care and lower costs.

 

Operational Efficiency

 

The value-based purchasing environment has increased pressure on hospital medicine. The onus is largely on us to try and prevent readmissions while still being expedient with inpatient care and discharge to help increase patient satisfaction. Through automation, we have been able to reduce wait times for patients, streamline the admissions process and improve rounding and charge capture.

Through technology, we have created a platform for emergency physicians and hospitalists to meet and confer virtually so that the hospitalist may admit patients without having to visit the emergency department. This platform has allowed for a decrease in boarding times by 2.5 hours, an eight percent reduction in “Left without Treatment” rates and overall improvement (to nearly 100 percent) in Centers for Medicare & Medicaid Services core measure compliance. A by-product of the reduced wait times for patients is an increase in E.D. volume of nearly 27 percent. This has meant more volume for the hospital without any additional strain on resources.

Another technology we use coordinates admissions between hospitals and primary care physicians. This direct admit system is enacted with a click of a button by the primary care physician, who can then fill out an online form to admit the patient to the hospital. The platform also generates a “boarding pass” for the patient to bypass the E.D. and go straight to the inpatient floor. Not only does this technology improve cohesion between hospitals and primary care physicians, it also improves patient satisfaction since wait times are reduced. That in turn leads to a decrease in E.D. crowding and an increase to the hospital’s referral base.

These tools certainly don’t substitute for human interaction and can’t guarantee improved quality of care, but they do allow for greater control and management over various administrative protocols. The results from these tools have been positive – both for hospitals and patients. Doctors are able to increase their focus on patient care, and most hospital medicine support staff and caregivers have their jobs made easier and more efficient.

 

Telemedicine

 

Telemedicine is another futuristic technology that’s growing in use and importance. Hospitalists are benefitting from virtual care and robotic caregivers that can help hospitals meet staffing and practice challenges.

“Five years ago, the technology wasn’t there,” said Angel Iscovich, M.D., a divisional CEO of staffing and innovation for EmCare. “The safeguards for patient privacy to protect encounters conducted over video just weren’t ready.”

Now we have cybersecurity that allows doctors to engage with patients via a video screen and webcam. The practice is easing staffing shortages for hospitals and putting patients at ease since they’re able to meet with highly-qualified specialists no matter where those physicians are.

Patients are also showing positive responses to robot doctors. Robots are slowly taking over rounding duties in some hospitals, acting as nocturnists that provide after-hours care. Companies that provide robodocs, such as InTouch Health, report that their robots can monitor heart sounds and connect to EMRs to improve care and efficiency. The robots are controlled with a tablet computer, so a caregiver can operate the robots on-site or the doctors can control the robots remotely for the virtual visits. The robots can easily round on the intensive care unit, interface with the equipment and provide more expedient and effective rounding than some of their human counterparts.

Cameras for the robodocs provide enough mobility and resolution to offer high-quality care. One doctor, through the use of video screens and robots, can cover multiple facilities while staying in one place. Hospitals can reduce costs by “sharing” the off-site physicians. And patient satisfaction scores have, so far, not suffered because of the technological intermediaries. If anything, early studies show that patients believe the robodocs and tele-visits allow them access to quality providers that otherwise would be unattainable.

 

Bundled Payment

 

The Bundled Payments for Care Improvement (BCPI) initiative is a federal government program designed to help manage costs for Medicare patients. BCPI allows disparate organizations to combine services and arrange for payment models that include financial and performance accountability for episodes of care. The program defines four broadly-defined models of care to include various combinations of pre-acute care, acute care and post-acute care.

With this recent inducement for organizations to work together, clinical integration is more important than ever – companies will need to attain certain levels of synergy outside of their own organizations. There are, however, some healthcare companies that are diversified enough to maximize the potential benefits of BCPI for themselves, their clients and patients. This type of self-integration tends to be more reliable because they have more control over more pieces of the BCPI integration – they are better able to manage quality of care across the care continuum. Through the integrated services – for example, a post-acute care company working with hospitalists – costs are reduced, which increases patient satisfaction since that patient is less likely to need readmitting and can receive care at home (where the patient generally prefers to be). With the cost offset, reimbursement from CMS can be more meaningful for the hospital as well.

 

Medical Command Center

 

Technology is allowing post-acute care companies greater control over the care offered in a patient’s home as webcams and video screens put caregivers face-to-face with patients. Our parent company, Envision Healthcare, has pioneered a new concept, the Medical Command Center that allows healthcare providers to check-in with patients to regulate prescriptions, check vitals and confirm operation of in-home medical devices. Medical Command Center staff use their high-tech control rooms to manage care for patients in a number of states and can quickly dispatch a caregiver such as a mobile integrated paramedic or physician assistant to a patient’s home when necessary.

These software advancements, tech tools and integrated services are becoming more pervasive as technology advances and providers find new ways to effectively integrate their services. By focusing on operational protocols such as admissions, rounding and discharge, along with streamlined billing practices and more seamless care, patients reap the benefits of high-quality personal care provided by caregivers while waiting less, paying less and visiting hospitals and doctors’ offices less.
 
By embracing the technologies that are available now and those that are on the horizon, hospitalists create more efficient practices for themselves and their patients, and are better able to focus on patient care, as opposed to the administrative processes that often keep us from the bedside - where many physicians prefer to be.

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