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Robert A. Berenson, Joy M. Grossman, and Elizabeth A. November Does Telemonitoring Of Patients—The eICU—Improve Intensive Care? Health Affairs, September/October 2009; 28(5): w937-w947. [Abstract] [Full Text] [PDF] [Additional Sources] [Reprints & Permissions]

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The Imperative for Evidence Dissemination

Wendy Everett   ( 21 August 2009 )

eICU: More Research Needed

Brian Rosenfeld   ( 21 August 2009 )

Telemedicine In ICUs Is Enabling Technology

Michael D. Miller   ( 24 August 2009 )

Innovation That Works!

Becky Rufo DNSc RN CCRN   ( 25 August 2009 )

The Imperative for Evidence Dissemination 21 August 2009
Wendy Everett, President New England Healthcare Institute Send comment to journal: Re: The Imperative for Evidence Dissemination weverett{at}nehi.net Wendy Everett	This excellent article underscores the timely need for health policy researchers to include clinical services in our national comparative effectiveness agenda. The extraordinary time lag between the methodologically sound assessment of innovative medical practices and their broad adoption by providers and patients severely limits our collective goal of improving health care quality while reducing costs. If we are to improve U.S. health care, we must go beyond the important generation of knowledge and drive the dissemination of evidence -- what works and what doesn't -- to physicians and patients in a much more timely and practical way. The adoption of telemedicine for improved ICU care (tele-ICU) is a vibrant example of the need to use sound evidence to guide decisionmakers in the adoption of valuable innovations. In partnership with the University of Massachusetts Memorial Medical Center (UMMMC) and the Massachusetts Technology Collaborative, we are completing an independent evaluation of the impact of tele-ICU on quality and cost at UMMMC and two community hospitals. A manuscript detailing the findings is under review, but the initial clinical outcomes show quality improvements with tele-ICU, at lower overall costs. In addition to the barriers to adoption described by Berenson and colleagues, many ICU medical directors believe there is no need for tele-ICUs since they are certain that care in their ICUs is "superb” (albeit unmeasured). Let the evidence be heard: the rapid dissemination of valid data will better inform our decisions and deserves our immediate attention and most imaginative thinking.
eICU: More Research Needed 21 August 2009
Brian Rosenfeld, Chief Medical Officer Philips-VISICU Send comment to journal: Re: eICU: More Research Needed brian.rosenfeld{at}philips.com Brian Rosenfeld	This well-written article includes conversations with five eICU sites and others during 2007 and addresses the perceived impact on care quality and financial benefits. While the article is generally positive (“All ten respondents from eICU hospitals were enthusiastic about the technology's impact on ICU performance, particularly on quality and safety”), it appropriately points out that these sites had no outcome data to support their contentions and suggests that additional research is needed. Unfortunately, the date of the survey prevented the respondents from citing positive results from two of the sites that were not completed at the time of the survey. A recently published study from Zawada et al., “Impact of an Intensive Care Unit Telemedicine Program on a Rural Health Care System,” demonstrates the clinical and financial benefits to a rural health system (tertiary, community, and critical access hospitals). Another manuscript (in press) combines pre- and post-eICU program data from 28,000 patients across eight sites that demonstrate meaningful improvements in both mortality and length-of-stay. The importance of studying how tele-ICU changes the processes of critical care delivery has led the four major critical care professional societies to apply to the Agency for Healthcare Research and Quality (AHRQ) for a conference grant and to study the relation of tele-ICU related changes in ICU processes to changes in outcomes. We applaud Berenson and colleagues for bringing this issue to the forefront at this point in our country’s health care debate.
Telemedicine In ICUs Is Enabling Technology 24 August 2009
Michael D. Miller, President HealthPolCom Send comment to journal: Re: Telemedicine In ICUs Is Enabling Technology MDMiller{at}HealthPolCom.com Michael D. Miller	Interesting article by Robert Berenson and his colleagues. I drafted a report about the technical, policy, and implementation challenges of tele-ICUs in 2006 (see http://www.healthpolcom.com/Tele-ICU- DiscussionDRAFT-condensed-0707.pdf), where I interviewed leaders from these systems across the country and reviewed some of their data as well as the published literature. While data about the ability of this technology were limited -- and much of them unpublished or unreviewed -- it did seem that implementing these systems with active engagement of the entire ICU care community resulted in positive results. (For example, this was the case with the system in Allentown, PA -- and documented in their published paper.) As Arnie Milstein pointed out in reviewing an earlier draft of the report, one key value-adding aspect of tele-ICU systems is that they are an "enabling technology," in that they require the development of broader care teams and enable them to work and communicate better. This was evident by one manager who told me that since the adoption of their tele-ICU system, they had been able to implement many more quality-of-care initiatives in their ICUs -- and to update their quality-improving protocols much more frequently. This intertwining of the technology with the clinical quality improvement initiatives makes evaluating the effects of the technology more challenging. But having interviewed senior tele-ICU managers, and studied health system transformation and quality improvement, I believe that such multidimensional analyses and thinking are crucial for appreciating what is required for delivery system reform to improve both quality and cost-efficiency.
Innovation That Works! 25 August 2009
Becky Rufo DNSc RN CCRN, eICU Operations Director Resurrection Health Care Send comment to journal: Re: Innovation That Works! rebecca.rufo{at}reshealthcare.org Becky Rufo DNSc RN CCRN	This article calls into question the return on investment (ROI) of tele-ICUs. As an experienced eICU operations director who led integration of two different tele-ICUs in large health care organizations, I witness daily the direct benefits of this new care delivery model to patients, physicians, and nurses. Nationwide tele-ICUs are challenged to demonstrate ROI and quantify quality performance. Resurrection Health Care (RHC), in Chicago, Illinois, implemented the tele-ICU technology in 182 critical care beds across 7 acute care facilities and 1 long-term care hospital. Implementation was successful through systemwide executive leadership and multidisciplinary integration of this enabling technology to drive clinical transformation. During the first 6 months (with only 3 out of 8 sites implemented), RHC demonstrated the following results: • Reduction in mortality (41%); length-of-stay (LOS) (38%); and 1,700 fewer ICU days as compared to baseline • 3 million dollar cost savings in LOS • Approximately 5-6 million dollars in preventable claim settlements based on previous data Over the past two years we have implemented the tele-ICU systemwide, and continue to demonstrate consistent reductions in ICU/hospital mortality and LOS that are driving clinical, operational, and financial performance (e.g. increased payment on ICU patients by major managed care accounts). Clinical transformation begins with organizational direction, vision, and systemwide integration of tele-ICU technology to produce financial performance and secure future growth. Tele-ICUs offer an important solution to health care reform through a new delivery model that secures a safer patient environment that everyone deserves. Embrace innovation that works!