Mercy: Designing the nation's first virtual care center

Healthcare has been accused of lagging behind other industries when it comes to consumer access to technology. However, there is no doubt technology is increasingly influencing the sector today, partly because of the shift in financial and payment incentives under the Affordable Care Act.

According to a 2014 telemedicine survey by Foley and Lardner, a majority of healthcare leaders (90 percent) reported their organizations had already started developing or implementing a telemedicine program.

Furthermore, 84 percent of respondents felt the development of telemedicine services is either very important (52 percent) or important (32 percent) to their organizations. A majority of respondents already offered remote monitoring (64 percent), store and forward technology (54 percent) and real-time interaction capabilities (52 percent).

Two different approaches

Telemedicine programs provide numerous benefits, including the potential to exponentially expand a provider's geographic footprint, use physicians' time more efficiently and dramatically reduce the barriers to patient interaction, according to the survey. But providers go about implementing programs in different ways.

For instance, St. Louis-based Advanced ICU Care took a multicenter approach to its telemedicine service delivery. The organization, which focuses on providing 24x7x365 remote clinical patient monitoring to intensive care units, has recruited critical care teams of nurse practitioners, registered nurses and board-certified intensivists in a variety of markets, enabling proactive collaboration with the bedside care team and patients from any number of telehealth centers. All of its centers, located in St. Louis, Houston, New York City and Irvine, Calif., can be delivering tele-ICU services at the same time.

"We love the physicians and clinicians that we have in St. Louis, and we're just as enthusiastic about clinicians in any of the other markets," Advanced ICU Care CEO Lou Silverman said. "We believe that patients and hospitals are best served by a multicenter approach, which enables us to recruit talented clinical teams in multiple markets. This approach enables us to locate and leverage the best talent available in a broad range of markets toward delivering the very highest levels of clinical insight and expertise. Our success with this multicenter approach enables us to be a nimble service provider to our cohort of clients, now in 21 states."

Chesterfield, Mo.-based Mercy has done it differently. Just this month, the health system opened the first virtual care center in the United States.

The four-story, 125,000-square-foot center located in Chesterfield serves as the command center for all of Mercy's telemedicine programs.

It accommodates more than 300 physicians, nurses, specialists, researchers and support staff. Care is delivered 24/7 via audio, video and data connections to locations across Mercy as well as outside of the system through partnerships with other healthcare providers and large employers. The center also focuses on advancing telemedicine through research and training.

Here, Terry Bader, vice president of design and construction for Mercy, and Matthew Hanis, senior vice president of business development for Mercy's Virtual Care Center, talk with Becker's Hospital Review about how the facility was designed, its features and goals for the future.

Question: What went into the design of the center?

Matthew Hanis: We think about virtual care as combining the technology of telemedicine with a centralized multidisciplinary clinical team. It also includes algorithms that automate decision-making and a partnership with the bedside clinical team. Our goal is to elevate not only the patient's experience, but also the workflow of the bedside clinician and simultaneously improve their [patients'] quality of life.

So when we built the building, those design parameters were built in from the ground up. We think of it as a hospital without beds. We thought long and hard about how to make sure our coworkers continue to maintain a connection with the physical experience of caring for patients. The first floor is about the mission of Mercy, the traditions of our health ministry and also the intersection of technology, innovation and our mission to deliver care for all those in need.

The second floor is where our virtual care center operates. We run 24-hour shifts. At any given time, we're providing care to 30 hospitals, and so the actual layout of the space is designed to be highly adaptive to the demands of the facilities we serve. For example, each pod – or workstation – is built both with a sound detuning infrastructure... [and] with privacy screens because we do direct video into the patients' rooms or into their home to maintain patient privacy.

The pods themselves are highly adaptable. One pod can have a sepsis nurse monitoring all our sepsis patients across the system and then a moment later a critical care physician can sit in that very same pod, and all the technology in the pod will reconfigure itself to be supporting a critical care physician.

Q: What makes the center different?

Terry Bader: I think it's probably the first time everything's been done holistically. This facility was designed for new operations, new ideas and new departments. Most hospitals that were built in the 50s and 60sdon't have the capacity to accommodate today’s technology in how patient care is provided and how fast it is changing. From day one, Mercy took a step back to look at the complete picture – everything from infrastructure to cabling needs, and from heating to cooling needs . Every detail was thought out. In a three-decade health care career as an architect, it was a first for me and our team to visit the Google headquarters [in Mountain View, Calif.] in order to learn everything we could in how to design a high-tech health facility that will meet needs today and into the future.

Q: What design and construction challenges did you encounter?

TB: This was unique because not only were we doing something totally new and exciting, but it was interesting for me to watch our design teams work week in and week out with our operational teams as they put together plans that affected how we were going to lay things out.

We had to consider every decision on the business side of how that care was going to be given, to how that care was going to look for the person receiving it on one end to the other side of the screen. How do we design that? How do we make the elements they're viewing feel good? How do we make the employees ...comfortable and provide the best setting for them as they're working with the patients?

Again, it was that whole total fraction of business planning. What were the outcomes we were trying to achieve for our employees and our patients? How do we integrate that into the plans and even into the selection of the furniture, even the colors on the walls?

MH: Oftentimes hospitals are sterile. They're meant to be that way. But, you lose natural light because of ventilation requirements and other health needs. In this building we wanted to make sure the co-workers themselves were refreshed by the building, and so when a coworker sits in a pod...that coworker has a view to the outside from anywhere in the building. When that coworker takes a break, there are a lot of spaces for them to go to unwind. When people think about virtual care, they're very focused on technology. Technology is only 15 percent of the problem we were trying to solve. Eighty-five percent of the problem was really about this different way we're delivering care, this transformation we're doing, and the impact it has on the co-workers and making sure the building they're in reinforces and reinvigorates them throughout the day.

Q: What is the ultimate goal of the center?

MH: The overall goal is to really tackle two fundamental problems. One problem is to improve patient care in the acute care setting from when a patient is in the emergency department to when they depart the hospital and for up to 30 days thereafter. So one goal is to make that process work better, be more satisfying to patients, improve quality and be more efficient. The other goal was very much a population health agenda. How can we engage populations such that we reduce the need for acute care hospitals? How do we catch the patient before they get sick?

We're [also] very interested in like-minded health systems to partner with. For example, we'd love to work with other health systems to help stand up virtual care centers like what we've done. For instance, with some of their clinicians, maybe they have skill sets we don't have that will benefit our patients. Maybe they have available pulmonologists and all our pulmonologists are consumed. So we're interested in not only helping others get to where we are, but building a national network of like-minded health systems to improve the care for each of our customer bases.


More articles on health IT:

EHR patient portals & healthcare disparities: 4 things to know
Cleveland Clinic partners with startup to boost radiology using the cloud
4 keys to improving clinical efficiency



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