If you're a health system in today's landscape, chances are preventing costly readmissions or unnecessary admissions is top of mind, both because of your bottom line and the potential for government penalties. For UPMC, a system that includes senior living, not only is it top of mind but it might be harder to accomplish, since something as seemingly minor as a urinary tract infection can send a senior to the emergency room.
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After years of observing those types of medical episodes, and the costs that go along with them, UPMC geriatrician Steven Handler helped spawn the development of UPMC Enterprises-backed Curavi Health, a startup that brought forth the telemedicine solution of the same name.
UPMC said it always inventories and analyzes the currently available solutions before choosing to innovate. However, a spokesperson for the system said at the time "there was no existing product that fit nursing home workflow and cost specifications." So the health system built it own.
MEETING THE CHALLANGE
The CuraviCart equipment allows physicians to remotely interact with patients and nursing home staff through a pan/tilt/zoom camera, Bluetooth stethoscope, digital otoscope, document scanner and 12-lead EKG system. The proprietary CuraviCare software, which facilitates interaction between the remote physician and the patient, is designed for simple operation by nursing home staff and tailored to their workflow. The tool extends capabilities of gerontologists, both at UPMC and beyond. So in the middle of the night when a resident patient is in crisis in a nursing home the nursing staff can opt to roll out the Curavi cart and do a consult with a UPMC gerontologist instead of going right for the ER.
Since the advent of the program in November 2016, UPMC has directly avoided 140 transfers from the UPMC Senior Communities facilities, with 96 percent of their consults being treated in place. In the past year, they estimate cost savings to the UPMC nursing facilities of approximately $400,000 having avoided nearly 100 transfers.
UPMC Enterprises President C. Talbot Heppenstall, Jr., said as both the insurer and the provider for these patients, better quality care at lower cost is the mission. The system has about 3,000 skilled nursing/senior living units. Curavi is now up and running in 50 different nursing homes, roughly a third are UPMC-owned and two thirds are outside nursing homes.
It's comforting to family members, too, knowing that their loved one was able to receive the diagnosis and care needed immediately, instead of being woken up by a call in the middle of the night that their relative was taken to the hospital. The technology also offer a helpful boost to everyday life for physicians as well.
"As opposed to driving around and doing all these consults in the middle of the night, this allows you to essentially be on call from your house and do these consults from their home," Heppenstall said.
With current and looming physician shortages, he said UPMC sees telemedicine as a way to expand the skill sets of clinicians outside where they happen to be physically. The consults can happen in a downtown nursing home or a nursing home four hours from here.
ADVICE TO OTHER HOSPITALS CONSIDERING WEATHER TO BUILD OR BUY
Heppenstall said UPMC is happy with the early success and needs to "scale it more." He also said there are not enough clinicians right now that are totally open to telemedicine and want to do it, either part or full time.
He'd like to see technological innovation like this grow but also recognizes that not all systems have the resources -- which is what presented UPMC the opportunity to commercialize its telemedicine tool.
"The reason we are creating solutions is not just to use them internally but to spread them externally," Heppenstall said. "Many hospitals have the same problems that we do but don't have the resources to solve them."