By Jenn Smith, RN | Director of Product, Reimagine Care
A question I’ve been asking for twenty years
For most of my career, I’ve been focused on a single question: what does it actually take to move care safely outside the hospital?
Early in my nursing career, I worked in a variety of traditional roles — including bedside care in the operating room, risk management, quality improvement and building Ambulatory Surgery Centers (ASCs). The work kept changing, but the underlying challenge was always the same. Care moves when the right infrastructure is in place to support it. Surgeries, like total joints and spine procedures, that once required multi-day inpatient stays became routine in ambulatory settings. It took new protocols, deeper patient selection criteria, tighter care coordination, and early teams willing to operationalize and stand behind new models of care.
That pattern has stayed with me and now I see it visible in oncology. What’s different now is the level of complexity.
Oncology is different. And that’s exactly the point.
Advanced therapies, particularly infusion-based treatments like CAR-T, bispecifics, and high-complexity regimens, are scaling faster than the care models built to support them. Patients are living longer on more aggressive treatment plans, and the expectation that this care can and should happen closer to home is growing.
But oncology isn’t outpatient surgery. The risk profile isn’t procedural and time-bound. It’s continuous.
Toxicities evolve over hours to days. A patient who leaves an infusion center feeling fine on Tuesday may experience cytokine release syndrome by Thursday. The window between “manageable” and “acute” can be narrow, and the timing of evaluation and intervention dictates outcomes. A care model built around periodic clinic visits is not equipped to manage that reality.
What this care requires is something different: continuous visibility, structured escalation pathways, and a team with clear ownership of the response — whether the patient is in a clinic, an infusion suite, or at home.
The coordination gap
Here’s what I see in most systems today: the pieces exist, but they don’t connect.
Monitoring happens at the visit. Escalation pathways are written into protocols but rarely operationalized in real time. Patient engagement lives in a portal but with limited feedback loops. Coverage after hours is reactive, not anticipatory. Each element functions in isolation, and the gaps between them are where patients fall through.
Delivering advanced therapy safely outside the hospital is fundamentally a coordination problem. And solving it requires more than technology, it requires a complete operating model built around the patient’s continuous needs.
What we’re building at Reimagine Care
This is the work I joined Reimagine Care to do.
Our Advanced Therapy Management program is designed to close the coordination gap by bringing together remote patient monitoring, structured clinical escalation, and proactive outreach into a single operating model that extends across care settings.
At the center of it is Remi, our AI-powered virtual assistant purpose-built for oncology. Remi isn’t a general-purpose chatbot adapted for cancer care — it’s designed from the ground up to understand the specific symptom patterns, treatment timelines, and escalation triggers that define oncology. It communicates with patients in the way they actually communicate: through natural conversation, not clinical intake forms.
Remi works in concert with remote patient monitoring (RPM) devices that capture episodic biometric data — vitals, activity, and other key indicators — between visits. Together, they feed a live picture of each patient’s status to our Virtual Care Center (VCC), where a dedicated clinical team has the visibility to see a patient’s trajectory in real time and act before a manageable symptom becomes an ER visit. The escalation pathways are defined, not improvised. The coverage model is built for continuous care, not business hours. And the ownership of the patient’s experience between visits is explicit — not assumed.
The setting follows the infrastructure
The pressure to deliver advanced oncology care in lower-acuity settings is real and it’s growing. That’s a good thing. More access, less burden on patients and their families, better alignment between where care happens and where people live their lives.
But access without infrastructure isn’t progress. It’s risk.
The work ahead is building the foundation that makes this shift safe — the continuous visibility, the structured response, and the clinical confidence that comes from knowing an experienced oncology clinician is watching. But it’s more than oversight. For patients, it means having open access to an extension of their care team between visits — someone who knows their treatment, understands their risk, and is there when they need them. That’s what allows more complex oncology care to move beyond the hospital walls without leaving patients exposed in the space between visits.
We’re building that foundation now. And it’s the most important infrastructure problem in oncology that nobody is talking about.
Jenn Smith, MSN, RN is Director of Product at Reimagine Care, a Nashville-based virtual oncology care company.