ICU telemedicine uses audiovisual technology to provide critical care services remotely, typically with fixed installations that can be used continuously or during nighttime hours. “Research has shown that telemedicine can potentially improve ICU outcomes by increasing access to expert physicians,” explains Jeremy M. Kahn, MD, MS. “It can also potentially facilitate the early recognition of physiological deterioration and prompt providers to implement routine evidence-based practices at the bedside.”
However, studies that have evaluated the effects of telemedicine on ICU outcomes have yielded mixed results. Complicating the matter is that adoption of ICU telemedicine is associated with major organizational barriers to overcome, such as high technological and staffing costs. Clinicians also lack consensus about how to best use this technology and where it is best applied. Considering these potential barriers, it is important to understand the patterns of ICU telemedicine adoption and implementation in the United States. “Research is needed to examine the pace of adoption and the degree to which telemedicine has been adopted in smaller, rural hospitals, where it may have the greatest potential to improve outcomes,” Dr. Kahn says.
Use & Patterns
In Critical Care Medicine, Dr. Kahn and colleagues published a study that examined the extent of use and patterns of adoption of ICU telemedicine in the U.S. from 2003 to 2010. The retrospective analysis combined a systematic listing of ICU telemedicine installations with hospital characteristic data from Medicare. According to the findings, the number of hospitals using ICU telemedicine increased from 0.4% in 2003 to 4.6% in 2010, resulting in an average annual increase of 61.0% per year (Figure). However, most of that growth occurred during the first 4 years (101.0% per year) of the study period when compared with the last 4 years (8.1% per year).
The substantial expansion of ICU telemedicine was most rapid immediately following the introduction of commercial programs in 2000 and the publication of early studies suggesting that adoption can reduce mortality rates while lowering costs. However, the rate of ICU telemedicine adoption increased at a much slower pace in more recent years, with fewer new installations over time.
The study by Dr. Kahn and colleagues also assessed hospital characteristics that were associated with ICU telemedicine adoption. When compared with hospitals without ICU telemedicine, those hospitals with ICU telemedicine were more likely to be larger, non-profit, teaching hospitals that were located in large urban areas (Table). Hospitals that did not adopt ICU telemedicine were more likely to be smaller, for profit, non-teaching hospitals located in rural areas. “Given the ability of telemedicine to facilitate critical care across large distances, small rural hospitals can potentially gain the most from adopting it,” says Dr. Kahn. “However, these hospitals had lower adoption rates, suggesting that we may be missing an opportunity to use ICU telemedicine where it is needed most.”
Reasons for Slowed Growth
The slowing growth of ICU telemedicine adoption may be due to several factors, including the technology reaching a saturation point, a lack of perceived usefulness among decision makers, and a failure to address current barriers to adopting the technology. “Our study underscores that there are substantial barriers to ICU telemedicine adoption that must be addressed,” says Dr. Kahn. “For example, the price of telemedicine programs can be substantial, oftentimes reaching millions of dollars in annual costs. Many hospitals simply cannot absorb these costs because they’re already experiencing decreases in revenue. Additionally, the potential positive effects are not assured, and the true cost savings may not be large enough to help a hospital’s bottom line.”
Other factors may also be at play, including limited reimbursement and concerns about overuse of telemedicine on the part of insurers. Furthermore, the current literature on the effects of ICU telemedicine is of low quality, and some investigations have reported negative results from adopting the technology. “We need more research to best define the ideal use of ICU telemedicine,” Dr. Kahn says. “This is a potentially transformative technology that should be used, but the key is to find out where and how it can be applied most effectively and efficiently.”
Data are needed to help determine organizational factors that correlate with successes and failures of ICU telemedicine adoption. “It may behoove clinicians to conduct comparative studies on the effectiveness of ICU telemedicine programs in ICUs with varying case mixes and staffing patterns,” says Dr. Kahn. “Without this research, hospitals are at risk for investing in this technology without knowing if it will improve care.”
Readings & Resources (click to view)
Kahn JM, Cicero BD, Wallace DJ, Iwashyna TJ. Adoption of ICU telemedicine in the United States. Crit Care Med. 2014;42:362-368. Available at: http://www.medscape.com/viewarticle/820120_print.
Rogove HJ, McArthur D, Demaerschalk BM, et al. Barriers to telemedicine: survey of current users in acute care units. Telemed J EHealth. 2012;18:48-53.
Lilly CM, Fisher KA, Ries M, et al. A national ICU telemedicine survey: validation and results. Chest. 2012;142:40-47.
Wilcox ME, Adhikari NK. The effect of telemedicine in critically ill patients: systematic review and meta-analysis. Crit Care. 2012;16:R127.
Berenson RA, Grossman JM, November EA. Does telemonitoring of patients—the eICU—improve intensive care? Health Aff (Millwood). 2009;28:w937-w947.
Freeman VA, Walsh J, Rudolf M, et al. Intensive care in critical access hospitals. J Rural Health. 2007;23:116-123.