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TeleICU Proposal

TeleICU Proposal. Team Members Eric Chavez Sophia Mantovanelli Cheryl Schunk Ashok Tyagi. Telemedicine for the ICU (TeleICU).

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TeleICU Proposal

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  1. TeleICU Proposal Team Members Eric Chavez Sophia Mantovanelli Cheryl Schunk Ashok Tyagi

  2. Telemedicine for the ICU (TeleICU) • TeleICU is technology that allows critical care specialists to monitor and manage the care of critically ill patients at multiple remote sites from a centralized command center. • Remote sites are connected to the command center by sophisticated telecommunication systems which provide real-time and continuous audio and video feeds as well as electronic data streams of patient physiological parameters, ventilator settings, and infusion pump settings. New England Healthcare Institute (2007)

  3. TeleICU Technology • Hardware systems collect, assemble, and transmit remote patient physiologic data, medical records, and treatment data to the command center. • Software systems operate the hardware, transmit data, and analyze data for use in decision support with alarms and triggers for actionable situations. Software systems are integrated into the electronic health record, lab, and pharmacy systems. • Live audio and video streams allow providers at the remote and command sites to communicate with each other and allow providers at the command site to examine the remote patients. Cummings (2007), Kahn (2014)

  4. TeleICU Program Objectives • There are currently no intensivists practicing in the ICUs at our satellite hospitals. • We will develop and deploy a TeleICU system command center staffed with intensivists at our flagship hospital. • We will extend critical care treatment through intensivist monitoring to the four satellite hospitals. • This is cutting edge technology and we will save many lives with this state-of-the-art TeleICU.

  5. Measurable outcomes Effective & Efficient 24 hour intensivist coverage in an ICU improves patient outcomes as lengths of stay are shortened and mortality is lowered. As these metrics go down, total cost of care is lowered. (Breslow 2004)

  6. Measurable Outcomes Equitable and patient-centered Many more patients monitored by a single intensivist team including those in underserved areas. Safe and timely Fewer patients in satellite hospitals that need a risky transfer in order to receive real-time intensivist care.

  7. Leapfrog Initiatives “Research has shown that in ICUs where intensivists manage or co-manage all patients versus low intensity there is a 30% reduction in hospital mortality and a 40% reduction in ICU mortality” from the Leapfrog Group’s safety practice, ICU physician staffing web page. Lives can be saved. The Leapfrog Group estimates 53,000 annually nationwide.

  8. Market Assessment Nationwide Intensivist shortage • 6000 critical care specialists in the United States – less than one for each ICU • Experts predict this shortage will continue • TeleICU is the solution to the intensivist shortage Young (2000), Pronovost (2001), Rosenfeld (2000), Kelly (2004), Knaus (1985), Knaus (1991)

  9. Why do we need TeleICU?

  10. Economic Impact Financial benefit: $3.14 million over 6 months Young (2000), Breslow (2004)

  11. Projected Economic Impact Initial cost $30,000 per ICU bed for equipment • Program costs • (hardware and software leasing, technical support, and TeleICU operating expenses $248,000) • TeleICU physician staffing $624,000 • Total costs over 6 months: $872,000 6 month cost analysis Net Profit: $3.14 million - $0.87 million = $2.27 million over 6 months Young (2000), Pronovost (2001), Breslow (2004), American Journal Medicine Quality 2007

  12. Self-assessmentProject support • ICU physician champion: Ted Armbruster M.D. who has a strong foundation and interest in TeleICU development • C-suite strongly in favor • Satellite & Flagship Hospital administrators: Overall strongly in favor of TeleICU (reduce overall costs & increase revenue)

  13. Self-assessment • Project advocates: • Improved ICU mortality and LOS • Cost savings & sharing, additional revenue • Competitive edge over other health systems • Staff support at flagship hospital readily available • Leapfrog Group initiatives met with intensivist coverage for all • Project critics: • ICU Physicians: More liability and increased workload, same pay • Learning curve for new ICU software • Reimbursement for TeleICU is limited

  14. Projected NeedsHuman Resources Currently available Projected Total Need Necessary to Acquire 16 Intensivists 10 Critical care specialty nurses 20 intensivists 15 critical care specialty nurses 4 intensivists 5 critical care specialty nurses One IT position

  15. TeleICU Architecture • Clinical Workstations • Video Conferencing • Application Software • Real Time Vital Signs Front-End • Hot Phone Risk management • Security • Privacy • Server Room • Database Server • Alerts Server • Application Server • WAN/LAN Equipment • Network Backbone • T1 Frame Relay or LAN backbone Vendor of Choice: VisiICU Established vendor for delivering TeleICU Breslow (2004), Philips eICU Program (2014), enVision eICU (2014)

  16. Billing and Insurance • CPT or HCPCS code for the professional service • Telehealth modifier GT certifies that the virtual service was reformed. • CMS has published CPT codes for Telehealth • Minimal CPT code additions

  17. Legal, ethical, regulatory, credentialing, privacy, and security issues can all be managed by current in-house personnel. Once TeleICU set up and running well, intensivist command center services can be leased to other hospitals = more return on investment.

  18. Timeline for development and implementation • Physician Credentialing process for Telemedicine in our state • Approximately 60-120 days • Equipment ( approximately 4 months) • Order • Install • Testing • Training • Single ICU focused deployment plan (one at a time)

  19. Negatives Associated with TeleICU • Telemedicine is an emerging technology and long-range understanding of its impact has been challenging • Cost savings is varied based on vendor association and individual hospital reported expenditures • Technology implementation highly specialized • Significant initial out of pocket hospital expense Kumar (2013)

  20. Positive Reports of TeleICUs • Baptist Health in South Florida, Fernandez (2013) • 24,656 adult TeleICU patients • 13 % decrease in LOS • 23 % decrease mortality rate • Patient satisfaction reported because they felt “watched over” • Berenson (2009) • Increased patient satisfaction as nurses had more time for families

  21. Summary • TeleICU will support the mission and vision of the medical center by extending critical care intensivist management to all affiliated hospitals • TeleICU Programs have been shown to reduce length of stay and reduce mortality rates • The TeleICU Program will take approximately 4 months to implement • $3.14M Revenue in 6 months • $0.87M Cost over 6 months • $2.27M Net Profit over 6 months

  22. References • Berenson R (2009). Does Telemonitoring Of Patients—The eICU—Improve Intensive Care?. Health Affairs. 28(5), 937-947. • Breslow M (2004). Effect of a Multiple-Site Intensive Care Unit Telemedicine Program on Clinical and Economic Outcomes: An Alternative Paradigm for Intensivist Staffing. Critical Care Medicine. 32(1), 31-38. • Combination ICU Mortality Calculator. (2014, February, 11). retrieved August 16 2014, from ClinCalc.com Web Site: http://clincalc.com/IcuMortality/ • Cummings C (2007). Intensive Care Unit Telemedicine: Review and Consensus Recommendations. American Journal of Medical Quality. 22(4), 239-250. • enVision eICU. (2014). retrieved August 16 2014, from Inova Web Site: http://www.inova.org/healthcare-services/inova-telemedicine-institute/enVision-eICU • Fernandez, J (2013, May, 13). eICU: Improving Care and Reassuring Patients. retrieved August 16 2014, from Baptist Health South Florida Web Site: https://baptisthealth.net/baptist-health-news/eicu-improving-care-and-reassuring-patients/

  23. References • Kahn J (2014). Adoption of ICU Telemedicine in the United States. Critical Care Medicine. 42(2), 362-368. • Kelly M (2004). The Critical Care Crisis in the United States: A Report from the Profession. Chest. 125(4), 1514-1517. • Kumar G (2013). The Costs of Critical Care Telemedicine Programs A Systematic Review and Analysis. Chest. 143(1)28(5), 19-29. • New England Healthcare Institute, (2007). Tele-ICUs: Remote Management in Intensive Care Units. Cambridge, MA: Massachusetts Technology Collaborative and Health Technology Center.

  24. References • Philips eICU Program. (2014). retrieved August 16 2014, from Philips Web Site: http://www.healthcare.philips.com/main/products/patient_monitoring/products/eicu/Ph] • Pronovost P (2001). Impact of Critical Care Physician Workforce for Intensive Care Unit Physician Staffing. Current Opinion Critical Care. 7(6),256-459. • Rosenfeld B (2000). Intensive Care Unit Telemedicine: Alternate Paradigm for Providing Continuous Intensivist Care. Critical Care Medicine. 28(12), 3925-3931. • Young M (2000). Potential Reduction in Mortality Rates Using an Intensivist Model to Manage Intensive Care Units. Effective Clinical Practice. 3(6)6,284-289.

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