A new study finds that Duke Heath’s Virtual Care Center (VCC) is improving patient and physician experiences and reducing operating costs through its centralized telehealth model.
Results showed that medical specialties in the VCC had higher rates of appointments starting on time, higher rates of virtual check-ins, and lower no-show rates, when compared with non-VCC supported specialties.
“By using digital health and new technologies, we’re able to improve the efficiency of the healthcare system while also meeting our patients' needs,” said Joanna Cavalier, assistant professor of Medicine and associate medical director for the Digital Strategy Office (DSO).
The VCC is housed in the Duke Health Digital Strategy Office, a group within the Office of Information Technology. It currently supports clinicians across 13 medical specialties. “The VCC enables us, at scale, to provide care to patients in their home or at the convenience of wherever they need to be for that care,” Cavalier said.
The VCC was first implemented in a phased approach in 2021 to help clinicians struggling to deliver in-person and virtual care to patients, and to streamline clinic operations. The Duke Department of Dermatology and the Department of Medicine’s divisions of Endocrinology and Gastroenterology were initially onboarded to the VCC program. It took just three months for the specialties to migrate to the model.
When compared with non-VCC visits, study results showed all three specialties saw the average video length for appointments reduced by five minutes, had lower no show rates, and higher rates of clinician satisfaction.
The center is staffed with a team of registered nurses, certified medical assistants, and telehealth operational leaders, who assist patients before and after the appointment.
“Nurses make sure the patient knows that they have an appointment, and helps the patients complete all their pre-visit work, such as questionnaires and uploading continuous glucose meter reports. Then they help patients get online and on camera,” Cavalier said. “Having that wraparound support leaves patients feeling more at ease and prepared,” she said.
The process is beneficial for clinicians, who no longer have to take the time to deliver technical assistance. They show up to the virtual visit room, and the patient is on camera and ready to go, which allows them to spend the entire visit delivering expert medical care, Cavalier noted.
Clinicians and advanced practice providers in the VCC are scheduled to meet with patients virtually in half day or full day sessions to ensure seamless transitions between appointments. Alternatively, without a centralized model, providing care can become disjointed. It forces providers to bounce from video to in-person visits throughout the day, leaving little to no time in between appointments, and no space to troubleshoot technical difficulties.
Notable Margin Improvement
Study results revealed that the VCC’s lower no show rates contributed to a notable margin improvement for the health system. “Those visits that would have been no show rates, are now completed visits, and we are able to attribute direct revenue from those visits,” Cavalier explained. VCC supported visits are also less expensive due to lower staffing and overhead costs.
Additionally, the VCC team provides inpatient virtual nursing, remote safety observation, e-consults, e-visits, virtual consults, and remote patient monitoring services to specialties.
Donna Phinney, MSN, RN, is the Director of the Duke Telehealth Office and VCC. She has been instrumental in designing and expanding the program. “Donna is always willing to design and try out new initiatives. She reliably says, ‘yes,’ when people come up with exciting new ideas,” Cavalier said.
Dr. Cavalier began working with VCC leaders in 2023 after accepting a clinician leadership role in the Digital Strategy Office. She quickly realized the center was dramatically enhancing the functionality of participating clinics and worked with the DSO and VCC to initiate the study. Relying on her background in research and quality improvement, Cavalier conducted a formalized analysis of VCC services with a biostatistician.
Moving the VCC Forward
The next phase for Cavalier and the VCC is in the inpatient setting. The virtual nursing program, housed within the ever-expanding VCC, will be instrumental in care redesign in Duke University Hospital’s “Innovation Units”. Duke Health leaders are integrating new technologies into these three beta units in the hospital to support patients, nurses, and clinicians. Electronic patient boards will be installed, cameras and screens will be added to patient rooms, and AI-powered robots will be used to deliver medications and supplies.
Blending technology and new models of delivering care has long been a passion for Cavalier. She gained an interest in digital health as a resident in the Management and Leadership Pathway in Duke’s Internal Medicine Residency Program. “I love taking care of patients and being at the bedside, but I also saw a lot of inefficiencies and challenges in our healthcare system.” Now as associate medical director of the DSO and unit medical director of one of DUH’s innovation units, she’s using technology to solve the various problems institutions are facing.
Cavalier and VCC leaders plan to continue to emphasize the positive impact the VCC has on operational workflows in both the inpatient and outpatient setting, and to encourage more medical specialties to migrate to the model for clinic-based care. For next steps, they will be comparing clinical outcomes and follow-up completion rates for patients between VCC visits and non-VCC visits.