NEHI, a national health policy institute, conducted a research project in collaboration with CCHP that examined the regulatory and financial barriers to the use of telehealth technologies in California intensive care units.
The project, entitled "Planning for Tele-ICUs in California," identified specific barriers to the use of tele-ICUs, and identified regions of California with the greatest need for expanding or improving critical care.
- Critical care in California faces significant challenges, including the state’s ICU mortality rate, third highest in the nation; an insufficient supply of intensivists and critical care nurses; insufficient patient access to critical care in rural areas; and strained ICU capac¬ity in some regions.
- Regional opportunities exist for improving critical care, particularly in rural areas with little or no access to critical care specialists and urban centers where many ICUs operate at high capacity.
- These regions were identified as needing to improve or expand critical care: Los Angeles County; San Bernardino and Riverside counties; Santa Barbara and San Luis Obispo counties; the Central Valley, including San Joaquin, Stanislaus, Merced, Fresno, Kings, Tulare, and Kern Counties; and Inyo, Mono, and Alpine counties, in the rural Eastern Sierra region.
- Expansion of tele-ICUs is anticipated in California. In spite of barriers such as lack of capital for start-up, potential physician resistance, competition for IT financing, and lack of interoperability with existing electronic medical record systems, experts believe that telehealth-supported critical care will expand in California over the next five years.
- Drivers of successful tele-ICU implementation include effective com¬munications and relationships among providers in community partner hospitals and hubs; IT system interoperability; and clarity about the potential for tele-ICU return on investment.
- The environment overall is becoming more favorable for tele-ICU implementation, including recent state and federal policies to improve tele¬health availability; physician credentialing processes; payment reform; and telehealth infrastructure improvements.with the assistance of CCHP, is conducting a market scan of ICU capacity in California, which will analyze opportunities to expand that capacity with tele-ICU technology.
Why Tele-ICUs Matter
- ICUs are a vitally important component of hospital care.
- Nationally, an estimated 6 million of the sickest and often the oldest patients in the health care system receive treatment in hospital ICUs each year. ICUs are expensive, have high mortality rates, and face a decreasing supply of critical care specialists, just as demand for ICU care is growing.
- Tele-ICUs have the potential to address ICU staffing shortages, improve quality of care and save money—important components of health care's "triple aim" of better patient outcomes, access to care, and cost savings.
- Tele-ICUs electronically connect a central support center staffed by critical care specialists to a hospital’s ICU, through such technologies as electronic bedside monitoring and real-time audio-video communications. This enables clinicians in one support center to monitor, consult and care for ICU patiuents in multiple, distant locations.
- The support center tracks the status of patients, issues alerts to on-site providers when patient monitoring programs detect a problem, and uses computerized decision support systems to recommend treatments.
- Tele-ICUs have also been shown to boost provider productivity, lower health care costs, and improve the quality of care that ICU patients receive. They not only enable support center clinicians to monitor greater numbers of ICU patients, they also allow hospital-based ICU teams to both manage more patients and more complex cases.
- Tele-ICUs have the potential to reduce patients’ length of stay and allow patients to be treated in their own communities, rather than having to be transported to distant, more sophisticated ICUs. And tele-ICUs, with their computerized decision support systems and use of intensive care specialists, increase patient access to best medical practices.
NEHI, which is based in Massachusetts, participated in a 2008-2010 demonstration project with University of Massachusetts Memorial Medical Center (UMMMC), and two Massachusetts community hospitals, to test the clinical and financial benefits of tele-ICUs.
The project documented substantial drops in mortality rates, patient lengths of stay, and per-patient costs, and found that tele-ICUs helped the community hospitals turn a profit on critical care services. The UMMMC research was published in the Journal of the American Medical Association with an accompanying editorial that the data are “the first convincing evidence that ICU telemedicine can be an effective complement to bedside care in some settings.”
Support for the California Tele-ICU Assessment project came from the California HealthCare Foundation.