Will Growth in Number of Tele-ICU Programs in the Nation’s Hospitals Create an Opportunity for Clinical Pathologists to Deliver Added Value?
Aging populations and increase in chronic disease fuel worldwide growth in tele-ICU care models that improve patient outcomes, reduce length of ICU stays, and save hospitals money, according to a study
There’s an interesting trend in healthcare that may prove beneficial to clinical pathologists and medical laboratory scientists. It is increased use by hospitals of remotely-monitored intensive care units (ICUs), which creates the opportunity for clinical laboratory specialists to remotely collaborate with their colleagues in real time.
This new approach in how hospitals alter how they monitor their patients’ care and organize their intensive care units is dubbed Tele-ICU. The technology uses “an off-site command center in which a critical care team [made up of intensivists and critical care nurses] is connected with patients in distant ICUs to exchange health information through real-time audio, visual, and electronic means,” according to a study published by AHIMA (American Health Information Management Association) that sought to identify the “possible barriers to broader adoption.”
This approach to emergency care from a distance employs telemedicine technology and has the potential to impact how in-house medical laboratories provide clinical testing services to hospital physicians.
Tele-ICU Gaining Foothold in Healthcare
Tele-ICUs are making speedy inroads into hospitals and healthcare systems. According to a statistic provided to Healthcare Dive by Advanced ICU Care, a provider of remote ICU monitoring services, an estimated 15% to 20% of hospitals currently use tele-ICU programs.
The use of this “second set of eyes” in ICUs is expected to grow. It is encouraged by an increasing number of studies showing:
- Improved patient outcomes;
- Reduced length of ICU stays; and
- Cost savings.
A Global Market Insights report predicts the tele-ICU market will reach $5 billion in 2023. That’s more than four times 2015’s $1.2 billion level. The rise, the report states, will be fueled by an increase in aging populations and chronic conditions such as cancer, neurological disorders, and other chronic diseases.
Intermountain Healthcare’s TeleCritical Care program has paid dividends for the not-for-profit health system. Since 2014, Intermountain has introduced tele-ICUs in 12 of its 22 hospitals that have ICUs, and in five non-system hospitals. A pilot project has expanded the program to two rural critical access hospitals that do not have ICUs. Five more rural hospitals are also expected to join Intermountain Healthcare’s tele-ICU program.
“There’s a tremendous amount we can do from this location without being literally present,” William Beninati, MD, Medical Director for TeleCritical Care at Intermountain Healthcare, stated in a Healthcare Dive article.
Intermountain Healthcare’s analysis of 6,500 of its patients indicates tele-ICU implementation has enabled its community hospitals to treat patients with more complex cases and reduce mortality by 33%. An initial cost analysis was equally favorable, with a $4.4 million decrease in the cost of care provided and a $3.3 million decrease in reimbursement amounts.
“We’re seeing a rapid return on investment on a roughly one-year timeframe,” Beninati told Healthcare Dive.
Helping Hospitals Thrive in Value-based Environments
A study published in CHEST Journal in February 2017 by UMass Memorial Medical Center supports the argument for tele-ICU’s financial benefits. According to a Philips press release announcing the UMass Memorial study results, the researchers found the Philips telehealth eICU Program with centralized bed management control increased case volume by up to 44% and improved contribution margins by up to 665%, or $52.7 million.
Other investigations have recognized the value intensivist-centric models can play in improved patient outcomes, such as this 2014 HIMSS study, which compared ICU length-of-stay findings among three primary studies of tele-ICU use that were published from 2009 to 2014. The analysis found tele-ICU programs improved patient outcomes, particularly length of stays (from 6.9 days pre-intervention to 4.2 days post-intervention). And there was “strong evidence” that secondary outcomes such as ICU mortality and hospital mortality also decreased as a result of tele-ICU use.
“An ICU bed costs approximately $2 million to build, and this study demonstrates a significant increase in case volume by better utilizing existing resources,” said Tom Zajac, Chief Executive Officer and Business Leader, Population Health Management, Philips, in the Philips press release. “This shift enables care for expanding populations without having to build and staff additional ICU beds, thus helping hospitals thrive in a value-based care environment.”
Alignment of Attitudes Key to Tele-ICU Success
“If intensivists are internally staffed by the hospital, tele-ICU provides a second set of eyes—an additional layer of patient safety in partnership with the bedside team,” Silverman noted. “When intensivists are not readily present, tele-intensivists take a more active role directing patient care, including intervening in urgent situations.”
However, the physician who led the UMass study argues that successful tele-ICU programs requires an alignment of attitudes as well as technology. Craig M. Lilly, MD, Director of the eICU program at UMass Memorial Medical Center, says healthcare providers at the bedside, and those overseeing the ICU from a distance, must communicate well and collaborate on both ends of the telemedicine platform.
“If you apply the technology the way it was designed [to be applied], it can make a difference,” Lilly told mHealthIntelligence. “But if you don’t have collaboration, it’s not going to work. Then you have … relative antagonism.”
As Dark Daily has previously noted, anatomic pathology laboratories were among the first to adopt remote telemedicine models though the use of whole-slide imaging and digital pathology services. As tele-ICU becomes more prevalent, medical laboratories will have the opportunity to use their access to real-time patient lab test data to help the clinicians in tele-ICU centers better manage patient care. This would also be an opportunity for pro-active clinical pathologists to step up with consultative services that contribute to improving patient outcomes.
—Andrea Downing Peck