Inpatient telemedicine at health system Providence provides critical access to care to more than 100 hospitals across nine service lines. And it has been improving quality and access across the health system.

Inpatient telehealth services at Providence include tele-stroke, tele-EEG, tele-neurohospitalist, telepsychiatry, a telehospitalist program, Hospital at Home, and tele-ICU. Recently, the large health system launched a tele-infectious disease program and a virtual nursing program called CoCaring. These programs are critical due to the shortage of physicians and the difficulty in recruiting specialists to rural areas.

Dr. Eve Cunningham is group vice president and chief of virtual care and digital health at Providence and founder of the AI-enhanced clinical intelligence engine MedPearl. She reports that her inpatient telemedicine programs are "growing like gangbusters." So we sat down with her for a first-hand tour.

Q. First, in broad terms, please talk a bit about inpatient telemedicine at Providence.

A. Historically, medical specialist access was confined to the four walls of a hospital or clinic, often requiring transfer of patients from community hospitals to specialists not embedded in a community. With telemedicine, we can now "beam in" these specialists to remote, underserved and rural communities to evaluate and consult with patients and empower the local medical community with specialist consultations and support.

Through telehealth, we not only save time by eliminating the need for travel, we ensure that specialists are used efficiently across the care network. Using technologies such as tele-carts and cameras, specialists can conduct evaluations and work alongside boots-on-the-ground healthcare teams to provide necessary care and formulate appropriate treatment plans.

This setup also helps in managing the limitations of physical hospital space. As some regions face regulatory and financial challenges in expanding hospital bed capacity, optimizing the use of existing beds becomes essential. Inpatient telemedicine supports this by ensuring that patients receive the right level of care in the most appropriate settings without the need for physical relocation.

Overall, inpatient telemedicine at Providence enhances care delivery by making specialist knowledge more accessible, supporting clinical staff, optimizing the use of hospital beds, and improving patient flow and management across facilities.

Q. You report that inpatient telemedicine is "growing like gangbusters" at Providence. Why? What are the driving factors?

A. The growth of inpatient telemedicine at Providence is driven by three key factors, each essential in addressing the changing landscape of healthcare.

First is the ongoing shortage of physicians. Several factors contribute to this shortage, including aging physician demographics and an increasing number of retirements, burnout that is causing many practitioners to reduce their FTE or leave the profession entirely, and challenges in filling residency and fellowship programs.

This shortage is notably severe in neurology, a concern raised by a 2019 call to action from the American Association of Neurologists. Also, the difficulty in recruiting specialists to serve in rural communities exacerbates this issue, as these areas traditionally have fewer physicians per capita compared with urban centers.

Another driving force behind the adoption of telemedicine is the need for bed optimization and improved patient flow within hospitals. In states where certificate-of-need regulations limit the expansion of hospital beds, maximizing the use of existing beds is crucial.

Telehealth programs help achieve this by ensuring beds are used to their highest capacity, reducing unnecessary patient transfers and admissions. This capability is particularly beneficial to smaller community hospitals, enabling them to handle more complex cases that might otherwise be transferred to already overcrowded tertiary hospitals.

Finally, the shift toward hybrid work models among physicians also is catalyzing the expansion of telemedicine. Many healthcare professionals now prefer a balance between onsite duties and the flexibility of remote work.

This not only boosts job satisfaction and retention but also increases the overall efficiency of healthcare delivery. Because our providers can provide care remotely, it minimizes travel time between facilities and enables faster patient care.

The convergence of these factors – physician shortages, the need for efficient use of hospital beds, and the preference for hybrid working models – contributes to the growth of inpatient telemedicine at Providence. Our programs support more effective healthcare delivery, address critical staffing and resource constraints, and lead to better patient outcomes.

Q. What kinds of patient outcomes are you getting through the technology? How is it helping outcomes?

A. Our telehealth programs have notably reduced unnecessary patient transfers between facilities. Our clinicians can offer specialized consultations remotely, enabling patients to obtain appropriate care where they are. Telehealth allows patients and clinicians to avoid the need for physical relocation unless it is absolutely essential.

We also have observed a reduction in unnecessary hospital admissions, particularly evident through the telepsychiatry program. This program provides efficient evaluation of patients directly from the emergency department, enabling safe discharges without the need for hospital admission in approximately 30% of our consultations.

At the same time, the telepsychiatry program helps ensure that patients are placed in the most suitable care environments based on their specific needs.

The implementation of telehealth services, managed by hospitalists and virtual nursing programs, has decreased the overall length of hospital stays. This efficiency not only improves patient throughput but also enhances bed availability for incoming patients requiring inpatient care.

In critical care settings, the tele-ICU program has played a crucial role in reducing the time patients need mechanical ventilation. By optimizing treatment plans and enabling more timely interventions, patient recovery times have improved, thereby enhancing the management of ICU resources.

Our newly launched tele-infectious disease program focuses on enhancing antimicrobial stewardship and ensuring compliance with guideline-directed therapies, aiming to decrease the incidence of antibiotic-resistant infections through more appropriate antibiotic usage.

Finally, our tele-stroke program has made significant strides in reducing treatment times. The faster administration of thrombolytics and interventions for clot reduction are essential in improving outcomes in stroke care, which potentially reduces long-term disabilities.

We also are able to keep 70% of our tele-stroke consult patients in their community hospitals, thereby reducing unnecessary transfers of care to overtaxed tertiary facilities.

Q. What kinds of problems or challenges is inpatient telemedicine solving, or at least helping minimize? For example, does it help with staff shortages or burnout?

A. One of the most critical issues our programs addresses is staff shortages and burnout, particularly in rural and underserved areas. The strain on our current clinicians is already immense. Telemedicine helps mitigate this challenge by allowing clinicians to provide care remotely, reducing the need for physical presence at multiple locations and thus decreasing travel stress and burnout.

This also helps to maximize the use of the limited number of available physicians by extending their reach across more facilities without the additional physical and time burdens.

Another area where telemedicine makes an impact is in the optimization of hospital beds and patient flow. Given the strict regulations and financial constraints that often hinder the expansion of hospital bed capacity, telemedicine is crucial in making the most of existing resources.

It supports more effective patient triage and treatment, ensuring patients receive care in the most suitable setting without needing to transfer. This is particularly important in regions where increasing the number of hospital beds is not feasible due to regulatory or financial limitations.

Telemedicine also improves access to specialist care. Through the use of telehealth technology, specialists can evaluate, diagnose and plan treatment for patients remotely. This is especially beneficial in areas that suffer from a scarcity of specialists, allowing patients in these regions to receive high-level care that might otherwise be out of reach, effectively democratizing access to specialized medical services.

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