Adam McMullin, MBA is CEO of AvaSure of Belmont, MI.
Tell me about yourself and the company.
I’m thankful that I found my way into healthcare in 2006. I had worked around the US and the globe helping companies operate more efficiently by adopting technology. That was intellectually interesting. Getting into healthcare changed my life. That connection to the mission and how you can impact and help care teams and patients helped me find a sixth gear.
Before I got into healthcare, all I knew about healthcare was that a nurse agreed to marry me. It’s an odd coincidence that many of the businesses and teams that I have been involved in a focused around serving nurses with clinically-led and technology-enabled solutions.
AvaSure is the leader in acute virtual care. We are in about 1,000 hospitals, including all of the Top 10 US health systems, one-third of the magnet hospitals, and 70 academic medical centers. We help our customers adopt virtual care to get better outcomes at a lower cost.
What are the clinical and business benefits?
That strong ROI was one of the things that attracted me to AvaSure. The ability to both operate demonstrably more efficiently while having proven clinical outcomes was to a level I hadn’t seen. AvaSure pioneered the tele-sitter market. About 20% of patients have a clinical need for observation, but only 10% or less actually get an observer, which is a person physically sitting in the room with the patient. The data on the performance of the in-room observers is not very strong.
We can take 16 of those observers and monitor them in a virtual care center. We have over 120 studies as to why that improves results, such as reducing falls or harm. That is an ROI around using your team more efficiently during a labor crisis and getting better outcomes. Once you have adopted that, you have also put in the fundamentals of your virtual care infrastructure. That allows you to move into other areas such as virtual nursing, which is seeing a lot of interest.
What is a typical profile of an observer and what is their job like?
In a virtual care center, we have the virtual observers, and increasingly, virtual nurses. The virtual observers usually have a clinical background, where they were providing a significant amount of documentation around the types of patients being observed and what they are seeing in the room. If you look at sitting, there was virtually no documentation. The great catches that we get daily are around preventing falls, because they have clinical insight and can often determine that a step was missed. We have unfortunately found situations where visitors or family members are giving substances to a patient that they shouldn’t be getting, or that they are concealing a weapon. They are doing a lot of things by observing those patients. We are 15% nurses and growing. We work to ensure that those virtual sitters, and increasingly virtual nurses, are integrated well into the rest of the care team.
How are hospitals using the system to improve employee safety?
We unfortunately have had a significant increase across the nation in behavioral health issues. Patients often first present in the ED, where you don’t have the history. We are seeing all sorts of things, whether that’s aggression against a caregiver or elopement, where patients or just take off when they’re not supposed to. By having a virtual observer, we’re able to notify the care team so that they can intervene, call for help, or call for security if necessary.
Are the cameras recording at all times?
That’s a really important point. None of the video is recorded. Otherwise, you would have to have patient consent. The video is being observed in real time and trained observers are doing the job to make sure that they are appropriately monitoring the patients.
Are observers screened or trained to manage the psychology of seeing patients in their most intimate and sometimes unfortunate moments?
That brings to mind a couple of things. We guide hospitals as they are hiring observers to look for people who have clinical experience. It’s a great role where you can have a outsized clinical impact, especially if you’re at a point in your career where you don’t want to be on the floor as much.
Gay Landstrom, the chief nurse of Trinity Health –which credits tele-sitting with saving $22 million per year – told a story at our company meeting about a patient who was nearing end of life. This was during COVID, when there was no additional nurse to be in there to be with that patient. The observer worked it out with their supervisor so they could be one-on-one with that patient. They talked to them at this incredibly intimate moment and then ended up singing to them as they unfortunately and sadly passed. That story really connected what we are doing to the mission.
I’ve heard story after story. I was recently at the VA in North Dallas and there was a virtual sitter who got very attached to the patients she was observing, because you have clear two-way audio. It got to the point that she was bringing treats and brownies. There’s a pretty deep connection because these virtual sitting sessions can go on for days. You need to make sure that you have a high quality connection.
Do observers and patients have a lot of verbal interaction, or is it mostly observers asking patients how they are doing or giving instructions?
Oftentimes there are also redirects. One of the reasons that patients fall is that they need to go to the bathroom and don’t want to call someone to help them. If the observer sees someone with high fall risk who is about to get out of bed, they can redirect them. They can summon the care team, let the nurse know, and let the patient know that help is on the way. Other times the patient might need help with something that is non-clinical, and they can take that need off the care team, which cuts down on the number of times the patient has to engage their clinical team.
As you move into virtual nursing, which is focused on either continuous observation — for example, things like avoiding patient demise and keeping patients out of the ICU — or episodic admissions and discharges. If you’re doing a discharge, the unit is right next to the bed and you’re doing a lot of that discharge documentation and training. That’s a deep engagement between the virtual clinical team member and the patient.
Do observers have access to any of the hospital’s clinical systems for observation or data entry?
Our solution is a purpose-built, high quality, highly reliable, high level of quality of service, audio, video, either mobile or mounted device, plus a very scalable backend technology. For example, we monitor 80 hospitals for Trinity out of two centers. When we talk about integrating with other devices, we integrate with the EMR. You can get into your EMR and you can launch the setting, so you can see both documentation and have the audio-video connection. We integrate out to the clinical communication and collaboration space so that you can appropriately route information to the right caregiver. The cameras are high enough fidelity that you can actually read the monitors in the room, and if there are other key alerts, we can bring those into the system as well.
Once the technology is in place and services have started, who is involved on the hospital side?
You want to make sure that the change management is done with the care team that is actually on the units. We have some best practices to make sure that there is great connectivity and that we facilitate building trust between the virtual care center and those who are caring for the patients. Those in the virtual care center are obviously there ongoing.
We as a company provide 24×7 support for the solution so that we can make sure that you have the quality of service when you are delivering care or observing these patients with a critical need. We think a lot, from the technology side, about Day 2. After you go live, how do you make sure that this is well supported and that we are monitoring the health of the devices and the technology?
Does virtual nursing offer a way for nurses to continue their clinical careers without the punishing physical demands?
I was with a customer last week and we were talking about this. They call them their wisdom workers. In nursing, there’s something called the complexity experience gap. The complexity or acuity of patients has gone up, and as nurses have left the workforce, they are disproportionately the most experienced nurses. You are backfilling them with newer nurses who may have had less clinical training during the pandemic. Using your more experienced nurses in a virtual care center is of extremely high interest. It creates a second set of eyes as a way to better support your new nurses, travel nurses, and foreign nurses.
We’ve even had situations where nurses have suffered a physical disability, but they still want to contribute. Getting them engaged in a virtual care center, where they can be working with patients, supporting patients, and working with care teams, is a phenomenal way to make sure that their wisdom isn’t lost to our healthcare system
Are you seeing creative uses of your system that you didn’t anticipate?
We are seeing a tremendous amount of experimentation with virtual nursing, whereas virtual sitting is a well established use of virtual care in hospitals. People are running new pilots around virtual nursing to test wound care, respiratory therapy, and monitoring patients to keep them out of the ICU. They have put our devices in the hallways to have an extra set of eyes where there’s elopement risk. We do see a fair amount of creativity once you have high fidelity audio and video system with mobile units and units that are wired fully into the room.
What is the company’s strategy going forward?
We are finding a tremendous amount of interest in virtual care, so we are continuing to invest significantly there. As we do that, we are focused on a few things. First, that we continue to make sure that our technology integrates really well with the rest of the technology environment. We’ve unfortunately seen care teams underserved with systems are standalone or not well integrated, and we’ve bulked up in that area.
Second, and this is a bit of an overused term, is artificial intelligence. What that means in our market is computer vision and noticing more about what’s happening in the room. We don’t want to take a care team member out of the chain. We want to augment care team members. But with computer vision, we are seeing success and noticing more about what’s happening in the environment. We know if the patient is in the room or if they are about to leave the room. As we continue to invest in that technology, you can imagine that there are myriad things that we will be understanding, such as an IV bag that is about to be empty or that a tube has been pulled.
We will continue to augment the data layer. As you look in care environments, they are manually run. There’s a lack of data to understand how are we performing, what’s working, and how can we do better. Being able to provide real-time data and visibility into the performance of care units has been highly valued by our customers and we will continue to do more there.
We started with sitting, and now there’s a tremendous focus on nursing, We’ve also seen pharmacists and physicians using the technology. I’ll give you an example. We are working with a micro hospital that wants virtual nursing. They also want a centralized way to bring the specialists into the care team. It allows you to get the right talent to the right place at the right time, improve financials, and get better outcomes.
This is the most energized I’ve ever been in a role. That is because of the opportunity to help hospitals with the staffing crisis, the financial challenges they face, in such a meaningful way. The VA in North Dallas freed up 51 FTEs, so they are able to serve more of our nation’s vets. Being on the forefront of virtual care and acute care has been incredibly exciting. We are making a significant investment into the clinical research that goes along with this so that we can partner with our customers as we work together to pioneer how virtual care can play a role in helping health systems operate effectively going forward.