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Telemedicine on Trial


 

A new study questioning the efficacy of telemedicine in reducing length of stay (LOS) and improving patient care in the ICU is further proof that remote patient care only works when there is a strong support structure behind it, according to a former SHM president.

“The studies in the past have not shown that just because you have an intensivist available that you are going to get a lot of bang for the buck. You need to have a real process. … If you don’t implement something properly, you can’t expect to get results,” says Mary Jo Gorman, MD, MBA, FHM, former SHM president and CEO of St. Louis-based Advanced ICU Care, which provides intensivists to community hospitals using telemedicine.

Investigators at the University of Texas Health Science Center at Houston reviewed some 4,000 patients in six ICUs at five hospitals in a large U.S. healthcare system by measuring outcomes before and after implementation of a “tele-ICU” from 2003 to 2006. No statistically significant impacts were seen in mortality rates, complications, or LOS (JAMA. 2009;302[24]:2671-2678). Conversely, an accompanying editorial in the Journal of the American Medical Association argued that “tele-ICU is a potentially valuable change in ICU care, but its complexity means that ‘tele-ICU improves care’ is not a testable hypothesis.”

The use of off-site intensivists to monitor patients has been used in recent years to address the shortage of ICU physicians. Still, the study team argues that “there are few data in the peer-reviewed literature evaluating its effect on morbidity and mortality.”

Dr. Gorman suggests that HM groups looking to partner with telemedicine providers consider the importance of:

  • Following the costs and intricacies of technical implementation;
  • Getting local physician buy-in;
  • Creating a multidisciplinary approach that includes nurses and pharmacists; and
  • Putting periodic reviews in place to measure quality metrics.

“The tool is not the problem,” Dr. Gorman adds. “It’s how do you implement the tool.”

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