Setting a new standard in Virtual health care

Mitchell Fong is the Vice President of virtual care at Renown Health in Northern Nevada, which provides care to Nevada and Eastern California communities. He oversees the organization's strategy and operations for telemedicine and wearable device remote monitoring. His expertise is in population health and virtual care, and has experience working in various capacities within the healthcare industry, including finance, analytics, and data science. After serving as the Director of telehealth for three years, he became the Vice President of virtual care.

What, in your opinion, will be the post-pandemic reality of virtual care as Vice President of virtual care at your organization?

The pandemic has required us to explore how technology will drive change in patient behaviour. Instead of wanting to come to our brick-and-mortar facilities, patients may prefer to use virtual care by utilizing technology to get necessary care at home and making this fit in the patient's daily life better. In the future, I expect there will be virtual reality (VR) and augmented reality (AR) solutions that we offer to enhance our services further. However, it is imperative that we ensure everyone has equal access to virtual care tools to eliminate disparity and create health equity. The increased accessibility of quality care will help drive virtual care's widespread adoption. Getting the necessary infrastructure can be difficult in low-income, rural, or underdeveloped areas, so investing in infrastructure in these communities is essential to create access. The partnership will be necessary to expand virtual care, so tertiary and quaternary facilities must support critical access hospitals, rural health facilities, and tribal health facilities to deliver the appropriate care at the right time.

Based on your role in establishing virtual care technology, can you shed some light on population health and healthcare strategy?

Interoperating between virtual care technologies is essential regarding virtual care access, quality, and technology. It requires a seamless user interface, integration and proper training to support the technology. To scale to support a vast population, a strong support system with robust training is essential for all users of the technology, from providers to patients. Collaboration across teams and locations is required to support healthcare strategy. Care teams must partner across care settings to ensure populations are cared for at scale using any technology. Partnering with communities, government agencies and private funding agencies to ensure that the infrastructure is in place has successfully guaranteed equitable access to care for all who need it.

It is essential to ensure there is a strategy in place that integrates technology in the current services as well as future services. For example, we strive to create an environment that facilitates a "healthcare GPS" partnership to support our patients proactively. This will allow personalized care plans to be adjusted in real-time as patient health changes, such as a new health condition diagnosis or an unanticipated vehicle accident, to ensure patients receive optimal care for their circumstances. Technology is required to facilitate "just in time" care but must also be interoperable to ensure all health information is current for all care team members.

Are there any developing revolutionary technologies in the virtual care area that you are excited about? How will they improve virtual care delivery for physicians and patient outcomes?

Virtual reality is a technology that I am excited about as it has several implications for clinicians, including training, education, and surgical simulation, to name a few uses. One use I have seen is an exciting development, specifically with virtual reality behavioural health therapy. It is commonly believed that for a treatment to be most effective, one should be immersed in the therapy. With virtual reality, patients can truly disconnect from the current reality and focus on the therapeutic intervention yielding improved engagement, results, and satisfaction.

Another technology of interest is continuous remote patient monitoring with passive wearable technology. This can capture patient vital baseline consistently without requiring manual effort by patients and can be used in various care settings.  

The capability to support and manage populations remotely utilizing this technology will make it less invasive for the patient yet improve the care patients can receive. Using this technology, clinicians can deliver high-quality care to a large volume of patients requiring remote monitoring and chronic care management, increasing access to care for patients. If done correctly, this can improve the experience for the patients while also improving clinical outcomes.

What are some of the projects or programs you have championed at your business regarding virtual care?

Before the pandemic, we focused on a hub and spoke model of telemedicine to support our rural communities. We mainly focused on clinic-to-clinic, speciality outpatient visits, rural clinics, critical access hospitals, prison populations and tribal health communities. Our first goal was to improve access to these specialists for rural patients to alleviate the patient burden for speciality services in those communities (i.e. travel time, transportation, time away from work and family. We further expanded into the acute services to include Telepsychiatry and Telestroke to support our hospital partners in addressing these patients in a timely fashion and to improve the quality and speed of treatment.

During COVID, we initially observed a massive influx of volume, at the peak a nearly 20-fold increase, in virtual visits compared to before the pandemic. While there was an enormous growth in urgent care volume, our specialities expanded services by offering virtual visits across all things leading to additional growth. We also launched a continuous Remote Patient Monitoring program to create capacity and support COVID recovering patients at home, expedited discharges, and reduce readmissions. We used a combination of continuous pulse oximetry, virtual visits, and oxygen support to provide patients with quality home monitoring programs. Partnering with local resources such as Emergency Services (EMS) and DME partners allowed us to deliver quality interventions for COVID patients at home as necessary yet keep them as comfortable and safe as possible. The combination of virtual visits and real-time monitoring allowed our clinicians to intervene quickly if patient oxygen saturation levels declined to provide the appropriate care for these patients.

Furthermore, we have implemented a telesitter program to monitor patients with high fall risk at our hospitals. We can effectively monitor multiple patients from a central location using speakers, cameras and audible alarms so that the monitoring personnel can communicate with the patient and bedside nursing team in real-time to prevent a fall.

What recommendations would you provide to other senior leaders in the virtual care space? How can they strike the full potential of virtual care technologies?

I would recommend starting with a broad strategy for virtual care and where it fits in the care continuum for your organization. This means you are clear on your intentions and aspirations and have the appropriate checks and balances to ensure the goals are aligned with the organization. This will allow the ability to grow and maintain quality in alignment with other services offered. Collaboration is the key, so it is important to gather feedback from all stakeholders to maximize the value of technology and ensure that virtual care is efficient and effective.

Leading virtual care implementation is a journey which requires significant change management. Leaders should continuously push themselves and their teams as this is a new service, and change management can be challenging. However, it is essential to appreciate the positive results you have accomplished while staying laser-focused on future opportunities.

While preparing for any new design, be apprehensive of the early warning signs of failure. When should I pause and reevaluate? Defining success is extremely important, so quantify the key metrics and track these consistently. Use these metrics as triggers to decide when to grow or when to stop a program. Understanding these thresholds and criteria for success is essential. Be agile and willing to adjust as the program grows but keep in mind the original goal.

Given the labor force deficit and impending budget cuts, healthcare is outdated and has to evolve. Every innovation will have unintended consequences, so be prepared for them by taking the necessary preventive steps to guarantee that you put a patient at risk and sacrifice the quality of care. Virtual care leaders must create inspiration for others, highlighting the benefits of virtual care while clearly articulating the necessary steps to make that dream a reality.