Virtual ICUs got a bad rap: That's what early adopters of remote intensive care unit monitoring systems said in response to a study published last year in the Journal of the American Medical Association. The authors of the JAMA study said they found "no association between implementation of telemedicine technology and adjusted hospital or ICU mortality, [length of stay], or complications." And, the authors noted, the systems are expensive, easily running to seven figures a year for software, hardware, two-way video and audio equipment, clinical salaries, and licensing fees.
But more recent evidence suggests that the technology could, in fact, be an antidote for the high cost of providing care in ICUs and other healthcare settings. Further, telemedicine advocates say, the programs can help alleviate the shortage of intensivists, improve access to care in remote or rural areas and across large systems with many hospitals, reduce mortality and length of stay, and even reduce ICU nurse turnover.
For example, the three-hospital Lehigh Valley Health Network (LVHN) compared the outcomes of 954 patients who received care in the ICU for 16 months prior to its remote ICU launch and 959 who received care from intensivist physicians using the remote ICU. Mortality dropped from about 21% to nearly 15%. LVHN, located in Bethlehem and Allentown, PA, uses an advanced ICU system to monitor about 120 beds overnight.
LVHN's remote ICU, which includes an EMR, a computer-assisted physician order entry system, medication bar-coding, and a picture archiving and communication system, costs about $1.7 million a year—an expense that is not reimbursed. But LVHN leaders say that reduced mortality and length of stay as well as increased capacity to treat critical patients covers their costs.