Carilion Clinic Mobile Health

By Amanda Jepson | Categories: | Comments Off on Carilion Clinic Mobile Health

Carilion Clinic’s Department of Family and Community Medicine provides primary care to more than 230,000 Virginians through 42 practices, three virtual physicians, and a dedicated Mobile Health (MH) team. The MH team expands access through a mobile van that is staffed by registered nurses and travels directly to patients’ homes. A part-time nurse practitioner offers additional support via telemedicine.

The mobile program primarily serves individuals with mobility or transportation challenges, those with unmet care needs, and patients requiring follow-up care after hospital discharge. During home visits, nurses use remote physical exam tools integrated with a telemedicine platform to conduct comprehensive evaluations. They also provide screenings, point-of-care testing and blood draws, health education, and connections to ongoing primary and specialty care.

Throughout the mobile health learning collaborative, the Carilion MH team incorporated the MH service into the “virtual primary care” clinic within the electronic health record (EHR). Aligning mobile and virtual services was essential to create a referral and initiate nurse-visits. The MH team designed and integrated a Mobile Health referral into the EHR, which enables a primary care provider to seamlessly refer a patient for a home visit and select the services they need. Additionally, the MH team designed a “nurse visit” within the EHR, which is essential to document and record care delivery such as lab draws, patient education, medication and care gap review.

Collaboration with Carilion Clinic’s Infection Disease (ID) team has renewed interest in operating an additional mobile health unit. The ID and MH teams will work together to visit patients diagnosed with Hepatitis C to deliver laboratory work and other support to ensure treatment adherence. These patients often live in rural areas and are unable to travel to the clinic site to see the ID team due to transportation barriers. The health system is training staff for this initiative, expected to launch in November 2025.

By bringing high-quality care directly to patients, this alternative model of mobile care delivery reduces access barriers, improves continuity of care, and strengthens health outcomes in rural southwest Virginia.