Critical care telemedicine: evolution and state of the art

Craig M Lilly; Marc T Zubrow; Kenneth M Kempner; H Neal Reynolds; Sanjay Subramanian; Evert A Eriksson; Crystal L Jenkins; Teresa A Rincon; Benjamin A Kohl; Robert H Groves Jr; Elizabeth R Cowboy; Kamana E Mbekeani; Mark J McDonald; Dominick A Rascona; Michael H Ries; Herbert J Rogove; Ahmed E Badr; Isabelle C Kopec; Society of Critical Care Medicine Tele-ICU Committee

doi:10.1097/CCM.0000000000000539

Critical care telemedicine: evolution and state of the art

Crit Care Med. 2014 Nov;42(11):2429-36. doi: 10.1097/CCM.0000000000000539.

Authors

Craig M Lilly¹, Marc T Zubrow², Kenneth M Kempner², H Neal Reynolds³, Sanjay Subramanian³, Evert A Eriksson³, Crystal L Jenkins³, Teresa A Rincon³, Benjamin A Kohl³, Robert H Groves Jr³, Elizabeth R Cowboy³, Kamana E Mbekeani³, Mark J McDonald⁴, Dominick A Rascona⁵, Michael H Ries³, Herbert J Rogove³, Ahmed E Badr³, Isabelle C Kopec⁶; Society of Critical Care Medicine Tele-ICU Committee

Collaborators

Society of Critical Care Medicine Tele-ICU Committee:
Kathleen M Baker, Craig M Coopersmith, Kerry Copeland, Jay S Cowen, Jim M Curtis, Michael A De Georgia, Clifford S Deutschman, Robert H Groves Jr, Lori A Harmon, Charles K Hu, Jane Marie Hughes, Maria L Jison, Sarah Kraus, Paul A Lange, Stephen C Matchett, Piyush Mathur, Janine M Mazabob, Vinay M Nadkarni, Loren D Nelson, Elizabeth Oshinson, Richard R Riker, George A Sample, Valerie Seabaugh, James P Shaffer, Joseph F Sucher, Lisa M Weavind, Steve M Wyatt, Jean-Pierre Yared

Affiliations

¹ Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA., Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
² Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
³ Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
⁴ Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Center, Worcester, MA, USA.
⁵ Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Ceneter, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
⁶ Department of Medicine, University of Massachusetts Medical School, UMass Memorial Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.

PMID: 25080052
DOI: 10.1097/CCM.0000000000000539

Abstract

Objectives: To review the growth and current penetration of ICU telemedicine programs, association with outcomes, studies of their impact on medical education, associations with medicolegal risks, identify program revenue sources and costs, regulatory aspects, and the ICU telemedicine research agenda.

Data sources: Review of the published medical literature, governmental documents, and opinions of experts from the Society of Critical Care Medicine ICU Telemedicine Committee.

Data synthesis: Formal ICU telemedicine programs now support 11% of nonfederal hospital critically ill adult patients. There is increasingly robust evidence of association with lower ICU (0.79; 95% CI, 0.65-0.96) and hospital mortality (0.83; 95% CI, 0.73-0.94) and shorter ICU (-0.62 d; 95% CI, -1.21 to -0.04 d) and hospital (-1.26 d; 95% CI, -2.49 to -0.03 d) length of stay. Physicians in training report experiences with telemedicine intensivists that are positive and increased patient safety. Early studies suggest that implementation of ICU telemedicine programs has been associated with lower numbers of malpractice claims and costs. The requirements for Medicare reimbursement and states with legislation addressing providing professional services by telemedicine are detailed.

Conclusions: The inclusion of an ICU telemedicine program as a major part of their critical care delivery paradigm has been implemented for 11% of critically ill U.S. adults as a solution for the problem of access to adult critical care services. Implementation of an ICU telemedicine program is one practical way to increase access and reduce mortality as well as length of stay. ICU telemedicine research including comparative effectiveness studies is urgently needed.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review

MeSH terms

Adult
Critical Care / organization & administration*
Critical Illness / mortality
Critical Illness / therapy
Female
Humans
Intensive Care Units / organization & administration*
Male
Program Development
Program Evaluation
Quality of Health Care*
Telemedicine / organization & administration*
United States