Adoption of ICU Telemedicine in the United States
Adoption of ICU Telemedicine in the United States
Objective: ICU telemedicine is a novel approach for providing critical care services from a distance. We sought to study the extent of use and patterns of adoption of this technology in U.S. ICUs.
Design: Retrospective study combining a systematic listing of ICU telemedicine installations with hospital characteristic data from the Centers for Medicare and Medicaid Services. We examined adoption over time and compared hospital characteristics between facilities that have adopted ICU telemedicine and those that have not.
Setting: U.S. ICUs.
Setting: U.S. hospitals from 2002 to 2010.
Interventions: None.
Measurements and Main Results: The number of hospitals using ICU telemedicine increased from 16 (0.4% of total) to 213 (4.6% of total) between 2003 and 2010. The number of ICU beds covered by telemedicine increased from 598 (0.9% of total) to 5,799 (7.9% of total). The average annual rate of ICU bed coverage growth was 101% per year in the first four study years but slowed to 8.1% per year over the last four study years (p < 0.001 for difference in linear trend). Compared with non-adopting hospitals, hospitals adopting ICU telemedicine were more likely to be large (percentage with > 400 beds: 11.1% vs 3.7%, p < 0.001), teaching (percentage with resident coverage: 31.4% vs 21.9%, p = 0.003), and urban (percentage located in metropolitan statistical areas with more than 1 million residents: 45.3% vs 30.1%, p < 0.001).
Conclusions: ICU telemedicine adoption was initially rapid but recently slowed. Efforts are needed to uncover the barriers to future growth, particularly regarding the optimal strategy for using this technology most effectively and efficiently.
ICU telemedicine uses audiovisual technology to provide critical care services from a remote location. In its most common form, ICU telemedicine consists of remote monitoring of ICU patients using fixed installations, either continuously or during nighttime hours. Telemedicine can potentially improve ICU outcomes by increasing access to the expertise of dedicated intensivist physicians, facilitating early recognition of physiological deterioration, and prompting bedside providers to implement routine evidence-based practices. Yet studies evaluating the effect of telemedicine on ICU outcomes show mixed results, with some studies showing significant improvements in mortality and others showing no benefit. In addition, there are major organizational barriers to the broad adoption of ICU telemedicine, including the high technological and staffing costs, as well as a lack of consensus about how and where it is best applied.
Given these tensions, we sought to understand the patterns of ICU telemedicine adoption and implementation in the United States. In particular, we examined both the pace of adoption and the degree to which telemedicine has been preferentially adopted in small, rural hospitals where it may have the greatest potential to improve outcomes. Although ICU telemedicine was first described in the 1970s, modern applications were not introduced until 2000 and meaningful adoption did not begin until 2003. Beginning in that year we linked information on ICU telemedicine use to publically available hospital-level data from the Centers for Medicare and Medicaid Services (CMS), examining the rate of ICU telemedicine adoption, the geographic distribution of existing installations, and the hospital characteristics associated with adoption.
Abstract and Introduction
Abstract
Objective: ICU telemedicine is a novel approach for providing critical care services from a distance. We sought to study the extent of use and patterns of adoption of this technology in U.S. ICUs.
Design: Retrospective study combining a systematic listing of ICU telemedicine installations with hospital characteristic data from the Centers for Medicare and Medicaid Services. We examined adoption over time and compared hospital characteristics between facilities that have adopted ICU telemedicine and those that have not.
Setting: U.S. ICUs.
Setting: U.S. hospitals from 2002 to 2010.
Interventions: None.
Measurements and Main Results: The number of hospitals using ICU telemedicine increased from 16 (0.4% of total) to 213 (4.6% of total) between 2003 and 2010. The number of ICU beds covered by telemedicine increased from 598 (0.9% of total) to 5,799 (7.9% of total). The average annual rate of ICU bed coverage growth was 101% per year in the first four study years but slowed to 8.1% per year over the last four study years (p < 0.001 for difference in linear trend). Compared with non-adopting hospitals, hospitals adopting ICU telemedicine were more likely to be large (percentage with > 400 beds: 11.1% vs 3.7%, p < 0.001), teaching (percentage with resident coverage: 31.4% vs 21.9%, p = 0.003), and urban (percentage located in metropolitan statistical areas with more than 1 million residents: 45.3% vs 30.1%, p < 0.001).
Conclusions: ICU telemedicine adoption was initially rapid but recently slowed. Efforts are needed to uncover the barriers to future growth, particularly regarding the optimal strategy for using this technology most effectively and efficiently.
Introduction
ICU telemedicine uses audiovisual technology to provide critical care services from a remote location. In its most common form, ICU telemedicine consists of remote monitoring of ICU patients using fixed installations, either continuously or during nighttime hours. Telemedicine can potentially improve ICU outcomes by increasing access to the expertise of dedicated intensivist physicians, facilitating early recognition of physiological deterioration, and prompting bedside providers to implement routine evidence-based practices. Yet studies evaluating the effect of telemedicine on ICU outcomes show mixed results, with some studies showing significant improvements in mortality and others showing no benefit. In addition, there are major organizational barriers to the broad adoption of ICU telemedicine, including the high technological and staffing costs, as well as a lack of consensus about how and where it is best applied.
Given these tensions, we sought to understand the patterns of ICU telemedicine adoption and implementation in the United States. In particular, we examined both the pace of adoption and the degree to which telemedicine has been preferentially adopted in small, rural hospitals where it may have the greatest potential to improve outcomes. Although ICU telemedicine was first described in the 1970s, modern applications were not introduced until 2000 and meaningful adoption did not begin until 2003. Beginning in that year we linked information on ICU telemedicine use to publically available hospital-level data from the Centers for Medicare and Medicaid Services (CMS), examining the rate of ICU telemedicine adoption, the geographic distribution of existing installations, and the hospital characteristics associated with adoption.
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