When people think about telemedicine, they generally consider it an option for primary care or urgent, rather than emergent, issues. However, the coronavirus pandemic has fundamentally changed how providers think about telemedicine, pushing the boundaries of what kinds of care can be delivered remotely.
With many intensive care units (ICUs) across the United States still struggling to meet demand, particularly regarding patients with COVID-19, telemedicine has emerged as a viable approach to treatment. In rural areas of the country, shortages of intensive care specialists are not uncommon. Unfortunately, this reality has raised a lot of issues about how to treat patients with COVID-19 effectively. The answer has been tele-ICU services, a new approach to telemedicine.
How Telemedicine Can Be Adapted to the ICU Setting
Lack of access to critical care specialists has become an extremely dangerous situation during the coronavirus pandemic. For example, consider a patient with respiratory failure who has difficulty oxygenating even after being put on a ventilator—but the nearest ICU specialist team is two hours away. This scenario sounds scary, but it has become a common one in past months.
Now, hospitals can turn to remote ICU-monitoring services, which make it possible to get the advice and guidance of an intensivist even if that person is across the world. This technology has made it possible to treat critically ill patients despite a national shortage of intensivists, which is especially felt in remote parts of the country.
Naturally, the use of remote ICU treatment looks different from the telemedicine that many people have used in the past. The system is much more elaborate, which helps ensure the safety of patients in critical condition. One hospital in South Carolina, for example, has installed cameras and equipment that allows for around-the-clock monitoring by both ICU physicians and nurses located in other parts of the country, even the world.
These remote healthcare workers monitor vital signs and other data while using two-way video conferencing to communicate with staff members about how to respond to various changes in condition. Also, onsite employees have access to a button they can press for emergency help.
Two Companies Providing Tele-ICU Services Abroad
To address the needs created by the coronavirus pandemic, multiple companies have created remote intensivist services. One of these solutions is Cloudphysician, which offers a tele-ICU platform known as RADAR. Through this platform, a centrally located intensivist can care for between 60 and 80 patients regardless of where they are being physically treated.
While Cloudphysician has offered RADAR for several years, the need for such a service has become more acute since the onset of the pandemic. The company uses real-time audio-visual equipment and sensors connected to the Internet to collect the data necessary for providing treatment.
Another company offering a similar service is Springer Tele-ICU, which has standardized protocols for providing 24-hour monitoring. Springer connects directly to hospitals’ electronic medical records to collect data while also employing audio-visual technology and various alert systems that prevent life-threatening issues from falling between the cracks. The doctors and nurses on the floor with patients receive basic training, while all data is fed back to a primary command center manned by intensivists who can provide additional insight and guidance in the treatment of patients. Notably, both Cloudphysician and Springer are Indian companies, but similar services have begun to offer remote monitoring in the United States.
Barriers to Creating Tele-ICU Systems in the United States
Implementing tele-ICU services in the United States is extremely important in remote areas where intensivists are rare yet rates of chronic disease that put people at risk of COVID-19 are high. These types of services also minimize contact and help avoid spreading the disease through patient contact.
However, there are many hurdles to overcome before implementing tele-ICU services in the United States. For example, physicians offering these services typically need licensure in each state they “practice” even if they are not physically there. This licensure can become an administrative and economic burden. Luckily, the current administration has done some work to address this issue by easing the rules about telehealth during the pandemic and expanding the reimbursement available through Medicare.
Additionally, some people skeptical of the technology have suggested that an intensivist must physically assess patients at least once per day before handing off management to digital colleagues. Also, realistic caps on patient loads need to be placed. When physicians manage dozens upon dozens of patients, they may fail to respond promptly to an emergency.
Certainly, there are pitfalls to adopting a tele-ICU model, but it does provide some hope of receiving adequate care for individuals who live hours away from the nearest ICU.