Cone Health, a Greensboro, North Carolina-based multi-hospital health system with 150 locations, had a telemedicine system in place for more than 12 years.
This technology did not update to meet the needs of Cone’s tele-ICU unit and there was not readily available technical support when issues occurred. The old technology also required staff to access two separate systems for their workflow. It was felt that this was too labor-intensive for staff.
Further, the audio/visual system was reaching the end of its life. There were two different systems in use. One of the systems continued to have multiple challenges and the equipment was not the best quality.
Additionally, there was a financial benefit to moving to a new telemedicine solution, said Dolly Walkup, application analyst at Cone Health.
All of this prompted a review of patient monitoring system from Epic. Prior to the formal review, the information about Epic Monitor detailed the ability to customize the system to the needs of the tele-ICU department. They were told Epic Monitor was customizable to meet the needs of the department.
Epic Monitor was an improvement for the staff workflow and patient safety, Walkup stated. Epic Monitor also was integrated with the Epic electronic health record, which was already in use by staff.
On the telemedicine front, Cone selected the Univago HE system from vendor Yorktel to replace the previous telemedicine system. This would give the department one universal system for audio/visual equipment. The technology and quality was greatly improved over the older system, Walkup stated.
There are many vendors on the market today offering telemedicine technology, including American Well, Avizia, GlobalMed, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services and Tellus.
MEETING THE CHALLENGE
The tele-ICU department is using the new technology for the remote monitoring of all the ICU departments over the Cone Health system. This includes more than 160 beds including 130 ICU and 30 step-down beds. The staff consists of three nurses and one physician. Wound care nursing staff also are using the audio/visual system to consult for patients across the multiple campuses.
“The new solution gives the end user three different views to meet their needs,” Walkup said. “The patient list gives them many different columns with data that will prompt them about the patient condition with colors and icons. The patient dashboard will give them more in-depth information about the patient.”
“The audio/visual solution gives the end user the ability to visually see the patient and the equipment that is in use by the patient such as ventilators and IV pumps.”
Dolly Walkup, Cone Health
This information is time-sensitive with the option to expand into a longer timeframe, she explained. There also is a watch-list featuring six patients on one screen for a closer look. This screen gives the user an abbreviated patient dashboard view. All of these views are customized to the tele-ICU staff needs. With the customized build, the end users have only the most important and the most recent data.
“The audio/visual solution gives the end user the ability to visually see the patient and the equipment that is in use by the patient such as ventilators and IV pumps,” she said. “The tele-ICU staff can also talk to the patient and/or staff when needed. With the integration within Epic hyperspace, the staff opens the chart and the audio/visual access is the first item to access.”
The system also provides an alert from the ICU side. If the staff in the room with the patient needs the attention of the tele-ICU staff, they are alerted with an icon and a sound. The staff is able to open the patient’s chart with one click and open the camera.
“One added benefit of the Univago HE system is the ability for the tele-ICU staff to be the first line of troubleshooting,” Walkup said. “They have the ability to reboot the cameras from within the portal. This saves time by not having to call biomed and wait for their response. It is very user friendly and quick for the tele-ICU staff to do this.”
ADVICE FOR OTHERS
“This process was a transition from one system to another,” said Walkup. “The audio/visual system took the longest and required a separate go-live. Because of the difficulty of replacing existing audio/visual equipment, allow extra time for this process.”
She also advised those hospitals looking to try something similar that they obtain an agreement of an acuity score early and have the staff evaluate it for a time period prior to go-live. This will allow the chosen score to be validated against an existing system acuity score, she said.
She also suggested they “work very close with the staff and find out exactly their goals with the system.”