As University of Iowa Health Care sprawls, ‘telehealth technology’ ramps up

Featuring up to 48 beds, 16 operating rooms and 14 emergency department rooms, the University of Iowa’s new three-story hospital in North Liberty will add much-needed inpatient space — albeit away from the main Iowa City campus and many of its specialists.

At the same time UI Health Care is building the new 469,000-square-foot North Liberty hospital about 7 miles from its home base, the system is integrating a 234-bed downtown campus — having bought the former Mercy Iowa City for $28 million in a bankruptcy auction this year.

With UIHC’s existing 860 inpatient beds already spread across its sprawling main campus — spanning four pavilions, a tower, emergency department and a 14-story Stead Family Children’s Hospital — introducing new off-campus inpatient space could further complicate the logistics of delivering complex care, even while alleviating crowding.

“So the vision here at UI Health Care is that we're going to start to leverage technology — not that we haven't leveraged it in the past — but we're going to start to leverage it more aggressively to improve the care that we deliver to our patients at UI Health Care,” UIHC Chief Health Information Officer Jim Blum told The Gazette.

The university earlier this summer began shopping for “inpatient telehealth products and solutions currently on the market to support inpatient teleconsult, telestroke, telesitting and virtual nursing workflows.”

At the outset, the telehealth technology is envisioned for the new North Liberty campus, which is set to open in 2025. The hospital which will feature in each inpatient room “wall-mounted televisions with OneView patient entertainment systems that could potentially be incorporated into the final inpatient telehealth solution,” according to a request for proposals the university issued in June.

But any telehealth technology that UIHC acquires could accommodate its downtown growth, too.

“We recognize that there's a need for specialized consultative services at both of those locations, and so the ability for us to use telehealth to get our specialists at the university to be able to visit with those patients remotely is advantageous for everyone,” Blum said. “It avoids us needing to have a doc drive out there, or have the patient transferred to university. Where things are more time sensitive, it enables us to get someone visually there more rapidly.”

‘Remote video monitoring’

In spelling out ways in which the university hopes to use telehealth technology, its request for proposals noted potential benefits for patients needing observation.

“Ideally we can use the technology for remote video monitoring of patients requiring constant observation,” according to the request, describing inpatient behaviors to watch for as “confusion, getting out of bed, pulling at lines, etc.”

“From the (emergency department) perspective, the university will be mainly using the telehealth product for direct communication between the patient and a consultant. We will also monitor the patients in the behavioral health rooms for evidence of self-harm behavior including cutting, hitting their head on the wall, or attempting to constrict their own airway with a bedsheet or other clothes.”

Blum stressed the goal isn’t to decrease doctor-patient interaction — especially at the bedside in the midst of a patient’s care and length of stay.

“But I do think there's a huge opportunity for us to be doing this with what's called virtual nursing,” he said. “And there’s a huge nursing shortage right now.”

Describing the standard procedure of welcoming someone to his or her room post-operation and running through a list of questions, Blum said technology could provide opportunity for improved efficiency.

“When a patient gets admitted, a nurse has to do a lot of questioning of patients and clarifying of things and providing them some information,” he said, asking: What if a nurse could do that from the other end of a camera?

“What's really nice about that is that then we don’t have to spend time flexing that nurse around the building, telling them where to go, which would eat a lot of time walking around,” Blum said. Plus, he said, this could create a way for nurses with physical disabilities or who have been injured to keep working.

“It actually enables them to do some less physically-intense work, stay productive, help the patients, help our health system, and those types of things,” he said. “And the same thing can be done at discharge.”

What’s being considered, he said, is not taking away a patient’s bedside nurse or doctor, but alleviating wait times and streamlining more mundane and menial tasks associated with admission and discharge, for example.

“Like it’s discharge day and we have to give you a bunch of instructions about your medications,” he said. “And the nice thing is that they still have that really high quality. We aren't talking about changing nurse staffing ratios or anything like that to facilitate this. It's really just that additional capability that would exist.”

Blum said his team is planning to experiment with the possibilities and capabilities of technology on the market. Among questions potential technology providers asked in responding to the UIHC request for proposals was one asking whether the primary screens involved would be TVs in patient rooms.

“Through the existing TV is preferred,” according to the UIHC response. “There will be a tablet at bedside as well that could also be considered.”

‘Changing our approach to technology’

As the university looks to expand not only its facilities but its staffing needs, Blum highlighted other new artificial-intelligence tools the hospital recently has started using to ease the workload and streamline operations.

Earlier this week, UIHC rolled out use of “Nabla,” described as “an advanced ambient scribing technology that takes notes for the clinician during a patient’s visit.” Because it was created with expertise in medical terms and the capability to transfer transcripts to a patient’s medical record, Blum said clinicians could cut down the time they spend on desk work.

“We are changing our approach to technology and moving toward becoming an early adopter that helps drive the further development of new technologies that may improve traditional outcomes metrics or other domains such as staff wellness,” Blum said. “One of the things we are trying to do is partner with new phase companies, becoming an early client who is willing to pilot tools and provide feedback for further development.”

UIHC also recently starting using a tool called “Evidently” — a chart-review application that uses AI to summarize and display relevant patient data, streamlining the physician hurdle of wading through fragmented and disjointed pieces of a person’s medical history.

“Data integration is very important when you are a quaternary referral center like us,” said Blum. “Many of our patients do not receive primary care here and don’t have complete medical records in our (electronic health records database). Their medical history is often fragmented and needs to be pieced together from many areas of the record, which is a time-consuming process.”

The tool was in high demand, he said, with the university reporting — on Day 1 of its systemwide roll out at UIHC — that over 2,000 clinicians accessed the application.

“We are committed to rolling out additional tools in the coming months to further ease the administrative and documentation burden,” Blum said.

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