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Out of the Box Healthcare

Mercy Virtual’s Advances in Telehealth: A Case Study.

Thomas H. Hale, MD PhD


Telemedicine, or the treatment and diagnosis of patients via telecommunications technology, is gaining a bigger spotlight in healthcare, as more organizations seek to provide patients with the around-the-clock support they need from the comfort of their own homes. Mercy Virtual has taken the concept of telemedicine and run with it, using telehealth innovations to reach beyond the walls of its hospitals and physician offices. It is connecting patients and providers, regardless of the distance between them, monitoring and caring for patients in both hospitals and in their homes. The Mercy Virtual team is using a combination of people and technology to make healthcare continuous, convenient and complete while addressing the challenges facing an overburdened system.


Telemedicine by Number


7 million is the estimated number of telemedicine patients in 2018, a significant increase from the 350,000 telemedicine patients in 2013 (Cisco Customer Experience Report).


29 states already required health insurers to pay for telemedicine services in 2015 (How Telemedicine Became Mainstream).


One-fourth of the health IT market is dedicated to telemedicine, with an estimated worth of $20 billion by 2019 (IHS Press Release).


Mercy began its telehealth journey in 2006 with the creation of Mercy SafeWatch, a teleICU program. By watching over patients with an extra set of expert eyes – provided 24/7 by both clinicians and technology – Mercy is on pace to eliminate ICU complications, such as ventilator-associated pneumonia and central line blood stream infections, and reduce ICU length of stay and mortality rates by up to 40 percent compared to national averages.


Today, we operate the world’s largest single-hub electronic intensive care unit serving both Mercy patients and those of other health care organizations. From Mercy’s Virtual Care Center in Chesterfield, experienced critical care physicians and nurses monitor more than 470 ICU beds in five states.


This same teleICU monitoring technology, coupled with an early warning system, is helping identify, triage and manage hospital patients most susceptible to sepsis. In doing so, we have been able to reduce the mortality rate for severe sepsis by 68 percent and for those who have progressed to septic shock by 44 percent.


For stroke victims, Mercy’s telestroke program uses two-way video to connect stroke patients with a neurologist the moment they arrive at one of our emergency departments. Currently, we provide 24/7 telestroke care at 33 hospitals both small and large.


Once a telestroke connection is initiated, the neurologist can talk with the patient and see scans to determine if the patient should receive the clot-bursting drug tPA. As result of the program, Mercy is able to administer tPA to three times more patients than the national average.


Keeping Patients Healthy and at Home


Mercy is currently piloting a program through our hospital in Washington, Missouri, targeting the sickest chronically ill patients. It is estimated that the sickest 5 percent of the population account for nearly 50 percent of the healthcare spend, often through recurring emergency room visits and preventable hospital remissions.


Patients in this program are sent home with an iPad and wirelessly connected biometric devices to monitor blood pressure, weight, blood sugar and other vital signs. This allows the Mercy Virtual team to continuously monitor patients with COPD, heart failure and diabetes, for example, and quickly respond before symptoms escalate.


Using the iPad, Mercy Virtual team members can have secure video conversations with patients, similar to using FaceTime or Skype. Patients also use the iPad and triage software to respond to questions about their health and symptoms.


The results are very encouraging, showing that people can remain at home while experiencing an improved quality of care and reducing readmissions and costs. For example, we have a heart failure patient who lives in a rural area more than 100 miles from the Mercy hospital in Washington. Over the span of several months, he had to be transported numerous times to the hospital by helicopter when his symptoms flared out of control. Now, using these home monitoring tools, he has not been back to the hospital for more than five months.


A Win-Win Situation


While there are obvious benefits for patients, a telehealth model also offers significant benefits for providers. Our home monitoring programs give primary care physicians and specialists peace of mind knowing that their patients are being carefully monitored and cared for once they leave the hospital or office – care that is documented and easily at hand when they next see the patient.


Telehealth is an answer to the growing shortage of physicians, particularly in rural areas where it can be challenging to recruit an experienced specialist. Through telehealth, Mercy provides specialty care where it is currently unavailable and needed support to the limited number of specialists serving smaller communities. This allows local providers to maintain balance in their lives, increasing both satisfaction and retention.


But good healthcare is still about people serving people. Telehealth is not a replacement for the relationship patients have with their physicians or their care teams. Telehealth is a tool that supports the effectiveness of the caregiver and extends the accessibility of the physician so patients can receive the right care at the right time in the right place. This usually means patients remain in their communities with their families.


Mercy Virtual Care Center and Beyond


Mercy has cemented its commitment to telehealth by building the world’s first Virtual Care Center in west St. Louis County. This four-story, 120,000-square-foot center accommodates nearly 300 physicians, nurses, specialists, researchers and support staff. Care is delivered 24/7 via audio, video and data connections to locations across Mercy, as well as outside the Mercy system through partnerships with large employers and other healthcare providers.

In addition to enabling care to more than three million patients over the next five years, the Mercy Virtual Care Center serves as a hub for advancing telehealth through research and training.


As we rapidly move to accountable care and contracted care models, telehealth will be a key component to help meet the “triple aim” of improving the patient experience, improving the overall health of our population and reducing the per capita cost of healthcare. We have learned that our caregivers and technology teams can work together to identify care needs earlier, allowing us to deliver simpler, less costly and higher impact care


Thomas H. Hale, MD, PhD, executive medical director at Mercy Virtual, maintained a patient practice for 23 years and was president of Mercy Medical Group for 15 years prior to his current position with Mercy Virtual in 2009. Hale served as the physician leader for Mercy's implementation of a fully integrated electronic health record system covering more than 30 hospitals and 700 ambulatory sites.

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