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.
Resurrection Health Care, a six-hospital system in Chicago, has also found success—both financial and in improved outcomes and reduced length of stay—with its remote ICU. Resurrection's return on investment in the program—which monitors 182 beds and costs the system about $6 million a year—is calculated using a variety of metrics, including length of stay.
In the past two years, the organization saved about 9,200 ICU days. Using a conservative formula of $1,250 a day, that's a savings of about $11.5 million over two years, says Rebecca J. Zapatochny Rufo, RN, Resurrection's eICU operations director.
The system has seen a decrease in length of stay after a patient is released from the ICU, she adds, saving about 18,500 non-ICU days over two years. At $300 per day, that's an additional $5.6 million in savings.
But the most important bottom line, Rufo says, is that the virtual ICU has saved an estimated 1,090 lives in that two-year period. Yes, the infrastructure and technology are expensive, she says. But the cost of poor quality, complications, and death are greater. "That's your return on investment," she says. "There's no price tag that can fit that. Quality of care is priceless."
To read more about the eICU programs at LVHN and Resurrection Health Care, see Virtual ICUs: Big Investment, Bigger Returns, which is the third in a three-part series on how technology impacts the cost of healthcare.