Leading US hospice care provider creates centralized patient care coordination tool with Power Platform and Teams

Nothing matters more to a terminally ill patient than time. When a patient is admitted to hospice, every minute is precious, and preserving each patient’s remaining time with the highest quality of life is what VITAS Healthcare is in business to provide. 

As the nation's largest single-source provider of end-of-life care, VITAS intimately understands the complex and time-sensitive challenges of delivering meaningful hospice and palliative care to its patients and their families across 14 states and the District of Columbia.  

VITAS was founded more than 40 years ago by Hugh Westbrook, a Methodist minister, and Esther Colliflower, a nurse—both passionate about giving enrichment-of-life care to terminally ill patients. They created a new way of doing hospice care with the help of their first patient, Emmy Philhour. At the time, Emmy told her oncologist, “I don’t want to die in the hospital. I want to be at home.” After exhausting every kind of cancer treatment, Emmy was referred to VITAS, where she told Esther, “I’m terminally ill, and I hear a group of people are trying to start a hospice. My agreement would be, if you will take care of me so that I will not have to go to the hospital, I will teach you what you need to know about caring for terminal patients.” 

Today, VITAS proudly delivers this specialized care through an interdisciplinary group (IDG) of approximately 12,000 physicians, nurses, home health aides, social workers, chaplains, and volunteers. They work together to provide comfort-focused medical care and psychosocial support to more than 19,000 patients and their families.  

A day in the life of hospice clinicians and managers

Roughly 80 percent of VITAS patient care delivery is provided in the patient's home, which requires a different kind of care coordination. VITAS is present in 14 states and the District of Columbia. This means team managers manually coordinate clinician schedules based on region, as well as patient status and care team availability. Meanwhile, clinicians are operating in the field, moving between multiple patient home locations throughout the day. 

Knowing the average length of care for a hospice patient is three weeks means there is a continuous cycle of patient discharges and admissions. From the time clinicians sign off for their respective weekends and return to work, their patient rosters, plus weekly and daily schedules, have changed. 

Patient charting and IDG schedules are documented manually on paper, and frequent schedule and patient status changes require a flurry of phone calls, voicemails, and emails between team managers, clinicians, and families. Approximately five critical paper forms are part of this existing workflow that all need to have proper oversight and documentation. 

During mandatory weekly IDG meetings, the patient care team meets at the office and goes patient by patient to review care plans, new admissions, and bereavements. This not only ensures each patient is seen by the appropriate caregiver, but that the entire IDG is mindful of the number of times they’re entering a patient’s home. Each meeting requires several hours of manual, paper-based preparation for team managers, and patient statuses often change overnight—meaning what they’ve charted yesterday needs to be updated the morning of the meeting. At the end of every IDG meeting, clinicians manually copy the required forms and submit them to their team manager for input into an Excel spreadsheet.  

The healthcare organization knew it needed to digitally transform this manual process, envisioning a centralized platform to better coordinate patient care delivery around ever-changing patient statuses and clinician schedules in real time. This would not only improve the clinicians' work experience day to day, but it would enable them to be more responsive and present to deliver critical care to the right patient when most needed.  

Exploring digital transformation in healthcare with Microsoft cloud technology  

One of the primary areas of focus for the VITAS Strategy and Innovation team is to ensure the organization is using the best technology and tools to help optimize clinicians’ work experience. Brandon Stock, Senior VP of Strategy and Innovation at VITAS, explains that this sometimes means the team’s role is to ideate and create a solution that may not exist yet. Emily Hill, VP of Strategy and Analytics at VITAS, has made it her mission to lead the development of a digital solution that would completely transform the patient care coordination process.  

During its budding digital transformation journey, VITAS recently partnered with Microsoft to move its CRM platform to Dynamics 365 with great success. Additionally, with the accessibility of Microsoft Power BI Desktop, the VITAS team became increasingly impressed with new BI capabilities as the tool was being further developed. Emily and Brandon recognized the solution they needed had to be built and Microsoft Power Platform, paired with Microsoft Teams, were the obvious tools to make it.  

“The Microsoft Consulting Team (MCT) has been a phenomenal resource for VITAS as we shift our healthcare organization to a cloud-based environment,” explains Brandon.  

Patrick Hale, Chief Information Officer and Executive Vice President at VITAS, adds, “We already had a huge interest in Power Platform after seeing what data visualizations were possible with Power BI—a major limitation of existing electronic medical record (EMR) systems.”   

Initially, the Strategy and Innovation team worked with a systems integrator (SI) to design and create the first iteration of its patient care coordination solution in 2019 and released the live proof of concept (PoC) in August 2020. Emily and Brandon’s focus for the PoC was to better understand the “day in the life” scenario for clinicians and managers to improve the user experience and to prove that their digital workflow concept could work.  

The team learned a lot from the solution’s initial release; primarily that change management needed greater focus to increase user adoption and secure leadership support across the entire organization.  

To help, Emily and Brandon presented the business case of their solution and the major impact it would have on their clinicians and patients to link arms with “change champions” at every level of organization—from clinicians in the field, to team managers coordinating schedules, all the way to general managers.  

Also, to ensure the solution met the precise business requirements, they brought technical development in-house, adopting a fusion approach with their enterprise engineering team and placing the user experience at the heart.   

Starting in June 2021, the team did a phased rollout to approximately 300 users and 7,000 users shortly after. Scaling the user base was challenging, as each patient within the solution is a separate Teams channel and they quickly reached the existing limit of channels. MCT worked closely with VITAS to customize Teams to increase the threshold for the number of channels allowed.  

Moreover, VITAS continues to rely on its partnership with Microsoft for targeted guidance as it scales more cloud-based enterprise solutions. 

A living legacy—Emmy is still teaching us how to better care for patients

Emmy—named in honor of VITAS’ first hospice patient—is a suite of Power Apps canvas applications nested in Teams that allows clinicians and managers to have real-time feedback with their teammates, support care coordination, and continuity of care.   

Two of the apps are for team mangers, who are office-based desktop users. The other is for clinicians, who are mobile users in the field. All the Power Apps applications are nested in Teams to seamlessly integrate patient charting, real-time schedule coordination, and effortless team communication. Throughout the end-to-end workflow there are numerous Power Automate flows enabling real-time schedule and patient status visibility. 

Power BI reports track and visualize metrics around adoption, appointment lifecycle, clinical scheduling trends, and more. Also, Emmy uses Microsoft Graph API integrated with Teams to enable dynamic channel creation when a new patient is admitted. This automatically adds the right members to the patient channel and sends a notification post to the clinical team that reads, “Emmy created a new channel.”  

Brandon shares, “It was a beautiful moment seeing an action item attributed to ‘Emmy’ programmed into the solution our team has worked tirelessly to deliver. I feel it’s a fitting tribute to honor the first patient VITAS learned from all those years ago.”  

Emmy’s Power Apps common data model communicates with a variety of VITAS data sources—enterprise data warehouse, homegrown EMR, HR platform in Oracle, and Dynamics 365 CRM—through a data gateway and various pre-built connectors.  

“Microsoft technologies are built for integration,” explains Patrick. “Not only do they operate seamlessly between one another, but using low-code development allows us to rapidly create, iterate, and deploy solutions with greater impact.”  

A day in the life of delivering hospice care using Emmy

Emmy is now the central tool for managing clinician schedules and patient care coordination. VITAS team managers are no longer dependent on using disparate tools or manual processes to manage the schedules of VITAS’ 7,000 clinicians.  

The team managers’ view of Emmy via desktop device shows the care team’s schedule they are responsible for overseeing with daily and weekly views; however, the daily team view is more heavily used. The view shows whether clinicians are scheduled or not, how many visits are scheduled per clinician, and what visits have been completed—all updated instantaneously. At the start of each day, managers hold a daily standup meeting with their teams to go through the schedule of patients for the day. Before using Emmy, managers would spend two or three hours just looking at schedule coordination. Now, this complex task is completed in minutes with Emmy.

“Emmy makes doing my job so much easier,” shares Michelle Lucas, Team Manager at VITAS. “This technology saves me hours and hours of repetitive manual work on a daily basis.”  

Emmy also gives all users a simplified view of the other patient care providers who are scheduled to see each patient, which is a frequent question that families and patients ask clinicians. Now, instead of making a phone call to ask, they have the information at their fingertips in Emmy. 

The clinicians’ view of Emmy via mobile device also shows a daily and weekly schedule specific to the individual clinician. It shows each patient visit scheduled for that day, and Emmy offers convenient push-to-launch navigation to each patient’s home. Also, clinicians have a direct line of communication with the primary caregiver and attending physician within the platform.

The solution also allows managers and clinicians to make quick changes to patient status through a pop-up patient mini case sheet to trigger the appropriate clinical care protocols. For example, after a clinician visits a patient and determines that visit frequency should increase but has a schedule conflict when the patient needs to be seen next, Emmy notifies the manager that a patient visit needs another clinician assigned and flags the change in visit frequency for review at the next weekly IDG meeting.  

Higher-priority patient status changes, such as when a patient becomes imminent (close to death), trigger an auto-scheduling of the appropriate clinician to ensure that patient is seen as quickly as possible.  

Another important feature in Emmy is the virtual patient waiting room that allows managers to coordinate across multiple teams to ensure each patient needing to be seen but isn’t scheduled yet is handled in priority order. This feature gives managers visibility into other teams’ staff availability so they can assign patient visits without having to make phone calls.  

The waiting room is also a critical component of handing off scheduling responsibilities to the after-hours Care Coordination Center (CCC). At the end of the day, managers hold a daily stand down meeting via Teams in Emmy to make sure patients in the waiting room cannot be scheduled with the existing staff availability. From there, the CCC will schedule patients with the after-hours and/or weekend care teams.  

Delivering proactive patient care with Power Platform and Teams 

Emmy offers real-time visibility into schedule changes, visit completion, and the entire patient care team. These efficiencies allow team managers to focus on complex clinical care, provide mentorship and training to their clinicians, and better support patients and families. Additionally, Emmy allows the care teams to safely continue IDG meetings virtually—especially important during the COVID-19 pandemic—and has dramatically reduced the paperwork associated with these meetings.  

When families couldn’t visit their terminally ill loved ones, clinicians facilitated virtual visits using Emmy, which had a major impact on patient and family well-being during an extremely difficult time.  

“Low-code development with Power Platform allowed our team to focus on the user experience,” explains Emily. “This translates into delivering a better working experience for clinicians so that they can provide a higher level of care to our patients on an hourly basis.”  

A recently added feature in Emmy allows for managers to have visibility of clinicians’ COVID-19 test and vaccination status configured by regional regulations to ensure clinicians are cleared to visit patients, or to proactively assign a different clinician if needed.    

To date, 92 percent of patient visits are being captured in Emmy and clinicians are scheduling and completing approximately 60,000 visits per week in the platform. Three-hundred interdisciplinary group (IDG) meetings per week are hosted via Emmy and more than 2 million patient visits were completed through Emmy since June 2021.  

Evolving Emmy and expanding citizen development with Power Platform

The VITAS Strategy and Innovation team plans to integrate Emmy with the organization’s payroll system and have several new Power Apps tools in development geared toward physicians and pharmacy use cases.  

Additionally, the organization recently hosted a citizen developer hackathon and leadership saw several Power Apps applications with potential. Going forward, Emily and Brandon are leading efforts to evolve the maturity of VITAS center of excellence and citizen development efforts.   

From a broad industry perspective, VITAS leadership is looking at the implications of a solution such as Emmy not just in hospice care but also care for chronically ill patients. A significant portion of healthcare costs in the US are attributed to care for terminally and chronically ill patients, largely due to hospital admissions from acute episodes. A solution such as Emmy answers the question of how healthcare providers can facilitate a relationship born from the patient’s home and proactively prevent acute episodes that lead to hospitalization.  

“We’ve barely scratched the surface with Emmy despite the major impact it has made already,” explains Patrick. “Creating efficiencies in the healthcare industry on a national level to reduce costs by even 2 or 3 percent translates into billions of dollars in savings. Developing solutions like Emmy with Microsoft technologies is a step in the right direction to reform the way we care for terminally and chronically ill patients.”  

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