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Remote ICU Saves Lives in Intensive Care
By Andria Cimino
Jul 10, 2006, 12:57

To VISICU, intensive care is a lot like air traffic control: Using advanced systems and networks, a few specialists can monitor hundreds of patients remotely.

 

Providing intensive care has always been a balancing act for hospitals. Patients in intensive care units (ICUs) are vulnerable to life-threatening and costly complications, and they fare much better with dedicated care from physicians who specialize in intensive care, called intensivists. But intensivist care is expensive, and there just aren't enough intensivists to go around.

Intensivists confer at the VISICU eICU center.

In 1998, two intensivists from Johns Hopkins Hospital came up with a new model for providing intensive care. After managing adult critical care at Hopkins for more than 25 years, Dr. Michael Breslow and Dr. Brian Rosenfeld knew firsthand that critical care delivery in ICUs needed improvement.

At that time, fewer than 6,000 intensivists were practicing in the U.S., enough to care for only 13 percent of ICU patients. Studies showed that proper intensivist care could increase patients’ chances of speedy recovery by as much as 25 percent and save as many as 50,000 lives each year. Breslow and Rosenfeld wanted to find a way to let each intensivist care for more patients.

Inspired by advances made in networking, information systems, and telemedicine, they modeled their approach on air traffic control, in which a few controllers monitor hundreds of planes from a centralized location. They envisioned a solution that would enable a few intensivists to monitor and provide care for hundreds of patients—remotely.

Healthier Patients, Lower Costs 

In July, 2000, the company they founded, VISICU, went live with the first operational eICU Program at Sentara Healthcare in Norfolk, a six-hospital system in Virginia.

The two ICUs piloting the system quickly demonstrated a 27 percent reduction in ICU patient mortality, a 17 percent reduction in ICU length of stay, and savings of $2,150 per patient, or roughly $150,000 per year for each ICU bed. In addition to saving lives, the system was also stretching tight health-care dollars, enabling the hospitals to serve more patients.

Since that first rollout, eICU centers have been established to serve nearly 100 hospitals, with a total of over 2,250 ICU beds. Studies published in the peer-reviewed journal Critical Care Medicine have found that eICU care reduces the number of days that ICU patients stay on ventilators and improves outcomes for patients who suffer cardiopulmonary arrest.

John Wade, VP and CIO of Saint Luke’s Health System in Kansas City, a Malcolm Baldrige National Quality Award Recipient, states, “The eICU Program fuses technology, clinical expertise, and teamwork for the benefit of the patients at Saint Luke’s Health System. As IT professionals, we don’t always have the opportunity to directly impact care. With the Saint Luke’s eICU Program, I know patients are returning to their families as a result of the VISICU technology and the efforts of the clinicians and IT professionals.”

Cameras are positioned to transmit real-time images of the patient.

The eICU Program not only ensures intensivist care for every ICU patient, but provides the intensivists with tools that improve care. Smart Alert prompts evaluate patient monitors in real time, spotting worrisome trends and readings that exceed normal thresholds and letting the intensivists intervene in time to avoid crises.

The eCareManager System provides a “dashboard-like” interface that helps the remote intensivists coordinate patient care with doctors and nurses at the bedside. An online decision-support tool called “The Source” draws on the latest evidence-based care guidelines, and eCareManager tracks and benchmarks performance according to evidence-based best practices.

An essential part of the system is the technology infrastructure that manages the flow of clinical information from the hospitals to the eICU center – not only the real-time data from bedside monitors, but all the supporting data that includes lab results, medications, patient registration and administration data, medical images such as X-rays and MRIs, and audio and video streams for remote observation of patients.

High-Speed Networks Enable Remote Care

What makes possible this radical redesign of intensive care are the high-speed TCP/IP networks over which ICUs transmit information to the eICU center. Although most ICUs are not heavy bandwidth users, video imaging can be a “bandwidth hog,” according to VISICU CTO Bill Super. The bandwidth required for a virtual doctor’s visit can utilize as much as 2 Mbps, but because this is activated when needed rather than continually, it does not lead to data “traffic jams.”

The eICU center has access to multiple sources of data.

Minimum bandwidth requirements for hospitals are 3Mbps per ICU, 3Mbps per data center (e.g., where the eCareManager system consolidates and reviews all of the hospital data), and 6Mbps for the eICU center. For instance, at peak, a 75-bed, two-hospital system typically requires 10Mbps of bandwidth for all types of data, including episodic use of audio and video. Larger hospital systems, such as the six-hospital Sentara system, require more bandwidth proportional to the total number of patients monitored.

Although data are sent unencrypted across LANs, most hospitals already have a Protected Health Information (PHI) private network backbone to which access is tightly restricted. Authentication is required twice -- first, to log into the hospital WAN/LAN and then again to access the eICU application. The eCareManager system has received FDA 510(k) clearance and meets the Healthcare Insurance Portability and Accountability Act (HIPAA) requirements, ensuring the privacy and security of patient data.

VISICU is agnostic about the WANs used by hospitals and will work with VPNs, wireless networks, point-to-point, SONET Ring, or OC3, to name a few. What matters most is the network’s latency, or the time it takes for a packet of data to get from one designated point to another. According to Super, “The eICU Program is driving improvements in WAN network latency, availability, and recoverability. Historically, physiological patient data were only on isolated monitoring networks to assure predictable latency for bedside alarms. However, VISICU’s eICU Program uses those patient data in order to deliver real-time critical care remotely. Therefore, the WAN backbone that carries data from the isolated ICU monitor networks to the eICU centers is designed to minimize latency, improve availability, and reduce outage recovery time -- standards like those used for bedside monitor networks.”

VISICU's success in improving critical care has inspired the company to look toward new horizons for its eICU system -- for instance, emergency departments and post-anesthesia care units. As Frank Sample, chair and CEO of VISICU, states, “Our mission at VISICU is to provide solutions that help our clients provide their patients the highest level of care and vigilance. Advances in information technology and networking have opened a new world -- a world in which it is now possible to ensure every critical care patient receives intensivist-directed care using evidence-based practices, whether they are in a metropolitan area such as Washington, DC, or in rural South Dakota.”