Planning for Tele-ICUs in California

CCHP and NEHI’s collaborative project, “Planning for Tele-ICUs in California,”  identified regions in California that were most in need of improved or expanded critical care management, and identified specific barriers that prevented tele-ICUs from playing a key role in improving care.

Intensive care units (ICUs) are a vital yet very expensive component of hospital care. However, these units face a decreasing supply of critical care specialists just as demand for ICU care is growing.

Telehealth-supported ICUs, often called tele-ICUs, have the potential to address staffing shortages by electronically connecting ICUs to a central support center staffed by critical care specialists. The support center tracks patient statuses, issues alerts to on-site providers when a problem is detected, and recommends treatments via computerized decision support systems – and can offer this care to multiple ICUs in distant locations. This practice not only brings specialized care to the most underserved areas, but also improves the quality of care available to ICU patients at a lower cost.

KEY FINDINGS

• Critical care in California faces significant challenges. The state’s ICU mortality rate is the third highest in the nation, and is likely impacted by an insufficient supply of intensivists and critical care nurses and strained ICU capacity in some regions. Further, many rural areas lack sufficient access to critical care, leaving their patient populations in extreme need.
• Both rural areas with little to no critical care access and high-capacity urban centers can benefit from regional opportunities to improve critical care. The study identified the following areas in California as the most in need of improved or expanded critical care:
  • Los Angeles County;
  • San Bernardino and Riverside Counties;
  • Santa Barbara and San Luis Obispo Counties;
  • Central Valley counties including San Joaquin, Stanislaus, Merced, Fresno, Kings, Tulare and Kern Counties; and
  • The rural Eastern Sierra region: Inyo, Mono and Alpine Counties.
• Telehealth-supported critical care is expected to expand in California over the next few years, even in spite of the barriers to use discovered in the report. These barriers include a lack of capital available for start-up costs, competition for IT financing, potential resistance from health care professionals, and a lack of interoperability with existing electronic medical records (EMR).
• Successful tele-ICU implementation needs effective relationships and communication among tele-ICU hubs and providers in community partner hospitals, IT system interoperability, and clarity about the potential for tele-ICU return on investment.
• The policy environment is becoming more favorable for tele-ICU program implementation, including telehealth-supportive state and federal policies, physician credentialing processes, and payment reform.

Support for the project came from the California Health Care Foundation.  The final report can be viewed here.