On a recent weekday, Jess Rowell squared off in front of five computer monitors in an office cubicle at St. Elizabeth Regional Medical Center in Lincoln, her navy scrubs the only hint that she wasn’t a Wall Street trader.
On one screen, the registered nurse pulled up records and reviewed medications against the results of lab tests to make sure all were in line. Another color-coded screen showed seven patients scheduled for discharge that day.
As each patient’s turn came, the system would allow Rowell to call into his room, asking first whether it was a good time to talk, and then appear on a screen to walk him through his discharge orders. If a patient was going home with a dressing that would require changing, for instance, she could go over written instructions or demonstrate the steps. If a doctor wanted to show a patient an x-ray, she could ring Rowell via the stethoscope icon on a touch screen and Rowell could put it on the display.
Part of a system known as a virtual integrated care team, the setup that CHI Health is testing at hospitals in Lincoln and Kearney is one of a number of ways health care systems are tapping technology in-house to help monitor and care for patients, just as they continue to expand their ability to reach patients electronically outside their walls.
CHI Health also has set up cameras in an Omaha hospital to help staff remotely keep an eye on patients at risk of falls, a task that otherwise would require placing someone in the room.
And the Bryan West Campus has been working with a Lincoln software startup that’s developing a fall-prevention system that uses 3-D cameras and an algorithm to predict patient movement and alert nurses before a fall can occur. Lincoln-based firm Ocuvera, working with five other facilities, next month will launch a study of the system with a fall expert from the University of Nebraska Medical Center.
Audio and visual technology for some time has been used to bring doctors and patients together for consultations, sending specialists where they’re needed over so-called telehealth networks and allowing patients to avoid long trips or check in 24/7 for minor illnesses.
Remote technology, too, has been used to help monitor intensive care patients. CHI Health’s electronic intensive care unit service allows nurses and doctors to monitor patients in a number of area hospitals from one west Omaha location. Nebraska Medicine and Bryan Telemedicine have opted for a different solution, deploying mobile cart-based systems in ICUs.
But health care providers say they continue to look at new areas and new models as they seek to improve care and deliver it at an affordable price.
“We’re thinking, ‘How else can we use this technology outside the traditional realm,’” said Mandi Constantine, division director for CHI Health’s virtual services and enterprise access center.
The virtual integrated care team system that CHI Health is using at St. Elizabeth and Good Samaritan in Kearney centers on virtual nurses like Rowell who work remotely to help a team of doctors, nurses and other staff on the floor with admissions, rounds, discharges, patient education and other tasks, said Sue Schuelke, virtual nurse coordinator at St. Elizabeth.
CHI Health currently is testing the concept through a $1.4 million grant, awarded in July 2015, from the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services. St. Elizabeth began piloting the program in 2012.
Schuelke said virtual nurses also mentor other staff — all have master’s degrees or are working to complete them — and monitor measures of quality care such as fall rates, length of stay and readmission rates, which are getting increasing attention in health care.
So far, Schuelke said, the two hospitals have found that the program allows floor nurses to spend more time in patient rooms and decreases the amount of time it takes to respond to call lights. Discharge times have improved, as have other measures.
“We’re trending in the right direction,” Schuelke said.
Virtual hospital rooms — 20 beds at St. Elizabeth, 24 at Good Samaritan — are equipped with two monitors and two cameras, one with good daytime vision and the other for use at night.
Kyle Ainsworth of Columbus recently spent time in a virtual room at St. Elizabeth after pain medication from a recent surgery exacerbated a pre-existing stomach condition. The floor nurses handled hands-on, day-to-day tasks; a virtual nurse checked in with him several times a day.
While he knew certain foods could be triggers, he said, the virtual nurse gave him some additional guidance about things he might want to avoid and even sent up literature he could take home. The virtual nurse also walked him through his discharge, displaying paperwork on the screen while she talked. “To me, it streamlined a lot of things,” he said.
Schuelke said the program isn’t intended to replace a direct care nurse. “It really is about communication and coordination of care and being that extra team member to those nurses upstairs,” she said.
CHI Health also has been using what’s known as a virtual sitter program at Immanuel Medical Center’s rehabilitation unit in Omaha. Patients undergoing rehabilitation are particularly susceptible to falls.
Denise Hall, director of nursing in the unit, said sitters watch monitors for movement indicating a patient might try to get out of bed, often catching them before they trigger alarm systems on beds. A sitter can call in and remind the patient that he’s not supposed to get up by himself. If the patient doesn’t respond, the sitter can call a floor nurse to the room or put out an emergency call.
During a three-month pilot project last year, the unit saw a 22 percent reduction in falls, Hall said. The unit also saw some cost savings due to the fact that it required fewer sitter hours. The system is less intrusive than placing a person in the room. Virtual sitters can only hear conversations when they call in.
The hospital also has begun using virtual sitters to monitor some pediatric and behavioral health patients.
Bryan Acute Inpatient Rehabilitation at Bryan West Campus has been testing a somewhat different approach to fall prevention. The system Ocuvera has developed relies on software, 3-D images and an algorithm to predict when patients are about to get up and sends an alert, complete with images, to dedicated cellphones carried by nurses assigned to specific patients. If a nurse doesn’t respond, the alert appears on a screen at a nurse’s station.
Christie Bartelt, nurse manager, said none of the nine patients with whom they’ve tested the system over the past two months have experienced falls. And nurses are running less. Based on the images they see on the phone, nurses can decide whether the movements are normal for the patient or require a quick response.
Paul Bauer, product manager for Lincoln-based Ocuvera, said the company also has been collecting data at a rural hospital and a long-term care facility. The company hopes to start a new study in January, tapping five different sites, under a $100,000 research and development grant from the Nebraska Department of Economic Development.
Researcher Katherine J. Jones, an associate professor of physical therapy education at UNMC, said her previous work found that a team approach was important in effective fall reduction programs. “We want to know if we layer this automated video monitoring on to what’s being done already, does it make a difference,” she said.