Virtual Hospital
A virtual hospital is hospital-level care delivered or supported remotely, using monitoring, video and a central clinical team instead of, or alongside, staff at the bedside. The term covers several models: hospital at home, virtual nursing on inpatient units, tele-ICU and remote command centers. Each differs in where the patient is and who watches them.
Key takeaways
- Describes where the care team is, not a lower level of care
- Four common models: hospital at home, virtual nursing, tele-ICU and command centers
- The patient stays under a hospital encounter in the EHR in every model
- Remote physicians still need credentialing and privileges at the patient's hospital
- Every model needs an escalation path that ends with someone at the bedside
What a virtual hospital means
The word virtual describes where the care team is, not the level of care. In some models the patient is at home and the team is remote. In others the patient is in a hospital bed and part of the team, such as an intensivist or an admission nurse, works from a central site. The model decides what the software must do.
Hospital at home moves an acute inpatient stay into the patient's home with devices, visits and a command center. Virtual nursing adds a remote nurse to a ward for admissions, discharges, education and checks. Tele-ICU gives critical care units remote intensivist and nurse coverage over camera and monitor feeds. A command center watches capacity, transfers and patient flow across a health system.
Agnotic Technologies builds the software behind these models for hospitals and digital health companies. The full hospital at home architecture and the AI side of virtual nursing each have their own page.
Which systems do all virtual hospital models share?
Four, whatever the model. Monitoring brings in device or bedside data. A command center view turns it into a worklist for the remote team. The EHR holds the encounter, orders and notes so remote and local staff work from one record. And an escalation workflow gets the right person to the patient when something changes.
Video runs across all four. Medicare's telehealth rule defines an interactive telecommunications system as, at a minimum, two-way, real-time audio and video between the patient and the distant site practitioner.
Who is accountable when care is delivered remotely?
The hospital keeps its duties. A registered nurse must still supervise and evaluate each patient's nursing care, so software has to show which nurse, on site or remote, owns each task. For remote physicians from another hospital, the governing body can rely on that hospital's credentialing decisions under a written agreement, which shapes how tele-ICU coverage is set up.
How do the virtual hospital models compare?
| Model | Patient location | Monitoring | Staff location | Escalation path |
|---|---|---|---|---|
| Hospital at home | Patient's home | Home device kit sending vital signs, plus scheduled visits | Command center clinicians, with nurses or paramedics who visit | Remote team sends an in-person visit or brings the patient back to hospital |
| Virtual nursing | Inpatient unit | Bedside camera and the EHR, with the unit's own monitors | Remote nurse at a central site, working with nurses on the unit | Remote nurse alerts the bedside nurse or the rapid response team |
| Tele-ICU | Intensive care unit | Continuous physiologic monitors and cameras in each room | Remote intensivists and critical care nurses | Remote team directs the bedside ICU team by video and phone |
| Command center | Any bed in the health system | Bed status, transfer requests and patient flow data | Central operations staff and clinical leads | Center reassigns beds, transfers or staff, or alerts the unit |
Facts and primary sources
For Medicare telehealth, an interactive telecommunications system means multimedia equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and the distant site practitioner.
Source: eCFR, 42 CFR 410.78When a hospital receives telemedicine services through an agreement with a distant-site hospital, its governing body may have its medical staff rely on the distant-site hospital's credentialing and privileging decisions.
Source: eCFR, 42 CFR 482.22(a)(3)Under the hospital conditions of participation, a registered nurse must supervise and evaluate the nursing care for each patient.
Source: eCFR, 42 CFR 482.23(b)(3)A hospital's governing body is responsible for services furnished in the hospital whether or not they are furnished under contracts.
Source: eCFR, 42 CFR 482.12(e)
Explore this on Agnotic
Where a virtual hospital shows up in how we build.