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HITEXCHANGEMEDIA.COM sustain a robust ICU program when local residents migrate to the big cities for inten- sive care, and that leaves them at risk for losing other crucial service lines, as well. Tele-ICU provides a terrific opportunity for these hospitals to retain, stabilize, and gradually increase their ICU traffic." Filling a New Role According to Dr. Gorman, the hospital best suited for tele-ICU is one that has between metropolitan areas to fill a new position, known as a tele-intensivist. These physi- cians collaborate with the physician or nurse on staff at the hospital to provide their expertise remotely. In this scenario, hospital staff members become liaisons to manage acute care patients and administer treatment under the direction of the tele- intensivist. The tele-intensivist's job is to remotely monitor and interpret patients' visual cues, vital signs, physiologic data, medications, and lab results. "These tele-intensivists are facilitat- ing first-class intensive care in hospitals that don't have a full-service ICU," Dr. Gorman says. By the Numbers The greatest objection to bringing tele- medicine into the ICU is the potential for decreased quality outcomes. Without the intensivist being in the room with the patient, some argue crucial aspects of acute care might be lost in translation, leading to inappropriate care in a setting where "get- intervention with closer adherence to best practices and lower rates of hospital-related pneumonia and bloodstream infections. Advanced ICU Care has culled even more impressive data from its own hospital clientele. Dr. Gorman cites a 17 percent increase in ICU patient volume among Advanced ICU Care's clients in the first year of tele-ICU implementation. The hospitals see a 40 percent decrease in ICU mortality rate on average, with average length of stay shortening by 25 percent. "In an overcrowded, understaffed ICU, best practices are not always followed," Dr. Gorman says. "We're not surprised to find that, by closing the ratio of patients to intensivists, telemedicine is already achieving such positive outcomes." Making Telemedicine Work In order for telemedicine to be applied successfully to the ICU, some key compo- nents must be in place. For one, tele-ICUs must provide around-the-clock tele- "In an overcrowded, understaffed ICU, best practices are not always followed. By closing the ratio of patients to intensivists, telemedicine is ting it right" the first time can be a matter of life and death. But the numbers seem to disagree. Though still early out of the gate, studies actually show tele-ICU is improving critical care outcomes. One landmark study out of the 15 to 40 ICU beds. The typical Advanced ICU Care client is a hospital that offers higher-end services—such as trauma, car- diology, neurosurgery, etc.—but that can't staff intensivists in a financially viable way. Rather than staffing intensivists, these hospitals contract with intensivists in the University of Massachusetts Medical School in Worcester followed 6,290 tele-ICU patients between April 2005 and September 2007. The findings show that: hospital-wide mortal- ity rate decreased from 13.6 to 11.8 percent following tele-ICU implementation. ICU mortality rate fell from 10.7 percent to 8.6 percent for the tele-ICU group. average length of stay in the ICU dropped from 6.4 days to 4.5 days. The research also associates tele-ICU already achieving such positive outcomes." — MARY JO GORMAN, MD, MBA, CEO AND CO-FOUNDER OF ADVANCED ICU CARE IN ST. LOUIS, MO. intensivist presence, not just intermittent care when an emergent episode arises. Hospitals must also seek to integrate their tele-ICU program into their existing infor- mation systems, such as EMR and CPOE. Lastly, a successful tele-ICU will hinge largely on whether or not the hospital's physicians and nurses accept, under- stand, and use the required technologies. Historically, changes in the structure of healthcare delivery, especially when contingent upon digital platforms, have been met with some resistance. But with telemedicine use growing at a rate of 20 percent per year internationally, integra- tion of telemedicine is not a question of if, but when. To learn more about Advanced ICU Care, visit icumedicine.com JANUARY/FEBRUARY 2012 HIT EXCHANGE Healthcare Business + Technology | 36

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