At present, a hospital’s economics are a nightmare. Insurers are constantly pressuring providers to provide better care at lower costs, forcing hospitals to either acquire or expand to capture savings through economies of scale. Expanding, however, requires extensive capital investments—building buildings, purchasing pricey medical equipment, and hiring highly sought after specialists. In 2016, 52% of US hospitals lost money on operations .
The healthcare industry also faces a major physician shortage, with the gap of needed doctors estimated to be 90,000 by 2025 . In addition, 54% of current physicians are experiencing professional burnout, higher than US workers in any other field . To offer quality care at lower costs, hospitals will need to deliver care in a very different way.
Enter: Telemedicine. After years of mediocre attempts, telemedicine is finally living up to its potential at the Cleveland Clinic. To expand their reach, Cleveland Clinic partnered with American Well in 2015 to deliver urgent care via telehealth. Since then, it has since expanded past urgent care to 40 different departments including neurology, endocrinology, and women’s health.
The crown jewel, though, is its eHospital for intensive-care units (ICUs). From 7pm to 7 am, a team of doctors, nurses and medical technicians gather in a room known as the ‘bunker’ to watch over 208 patients in special-care units or intensive-care beds. These patients are scattered across Ohio and Florida-based community hospitals in Cleveland Clinic’s system . Each individual hospital lacks the scale to staff a specialist overnight, and rely on the ‘bunker’ team to provide a layer of oversight. Each ICU bed is equipped with individual high-resolution video cameras and customized alerts. At the ‘bunker’, a live data feed on the patient’s vital signs, labs, agitation, and even pupil dilation is integrated with the patient’s electronic medical record. If anything looks worrisome, the team can alert the nurse on the ground to check-in and even coach them to perform procedures if necessary. In addition to better quality, the eHospital minimizes the pressure for clinicians on the ground to constantly round on the high-risk patients.
Cleveland Clinic’s goal is to apply the eHospital model to other departments, especially surgeries. In an interview with The Economist, Sricharan Chalikonda, a surgeon at the Cleveland Clinic, envisioned, “I can totally see myself sitting here at my desk, guiding three operations in three different locations” . And he’s not alone—Toby Cosgrove, CEO of Cleveland Clinic imagined, “When I think of the hospital of the future, I think of a bunch of people sitting in a room full of screens and phones.”
This ‘mission control’ room is also empowering hospitals to train physicians to streamline decision-making based on actionable patient information. The influx in data has allowed Cleveland Clinic to begin standardizing care pathways and reduce variation in care across providers. Cleveland Clinic is even putting IBM’s Watson through med school to learn as it is fed this actionable data .
With Cleveland Clinic’s eHospitals reducing the need for patients to be densely packed together, there is further opportunity to optimize the experience for the patient and his or her family. Less need for clinicians to constantly round means potential for more space for each patient, even private rooms. Making the patient more comfortable and improving patient’s rest can also further improve quality of care. Some hospitals have been found to have acoustic levels of over 70 decibels at night, the equivalent of a closeby vacuum cleaner .
In addition, there may be a longer term opportunity for hospital ‘mission control’ rooms to monitor patients outside the acute care setting. Utilizing wearables that remotely monitor vital signs, tremendously ill patients like cancer patients can greatly benefit from clinical oversight in the home. For instance, nurses can call high-risk patients who develop a fever, to check-in and potentially start interventions as needed to avoid last-minute interventions which are less effective.
Despite Cleveland Clinic’s success with telemedicine, a few concerns remain. Payment of telehealth continues to be vague, particularly for physician-to-physician services. Around 32 states have passed “parity” laws that require private insurers to reimburse doctors for services delivered remotely if that service is covered in person, though not necessarily at the same rate or frequency. Federal payers like Medicare lag even further behind . In addition, rules defining and regulating telemedicine vary state by state, and it is unclear when regulation will catch up with technology. Cosgrove shared Cleveland Clinic’s struggle where “right now we have to license doctors in 50 states in order to [provide telehealth services across the country]” . These barriers need to be resolved before telehealth can begin to make a real impact on hospital economics.
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 Zeitlin Josh, “Cleveland Clinic CEO: 3 ways to make health care cost less,” AdvisoryBoard, April 6, 2017, [https://www.advisory.com/daily-briefing/2017/04/06/cleveland-clinic], accessed November 2017
 Shanafelt, Tait D. et al., “ Changes in Burnout and Satisfaction With Work Life Balance in Physicians and the General US Working Population Between 2011 and 2014,” Mayo Clinic Proceedings, Vol. 90 Issue 12 (December 2015) p. 1600-1614
 “How hospitals could be rebuilt, better than before,” The Economist, April 8, 2017, [https://www.economist.com/news/international/21720278-technology-could-revolutionise-way-they-work-how-hospitals-could-be-rebuilt-better], accessed November 2017
 MacDonald, Ilene, “Cleveland Clinic’s Donley on telehealth advances, clinician wellness and ongoing efforts to achieve the Triple Aim,” FierceHealthcare, May 17, 2017, [https://www.fiercehealthcare.com/healthcare/cleveland-clinic-s-donley-telehealth-advances-clinician-wellness-and-ongoing-efforts-to], accessed November 2017
 Beck, Melinda, “How Telemedicine is Transforming Health Care,” Wall Street Journal, June 26, 2016, [https://www.wsj.com/articles/how-telemedicine-is-transforming-health-care-1466993402], accessed November 2017