Telemedicine in the ICU

I just came across some good links on Telemedicine ICU applications:


Check out the Doctors who developed the use of an ICU Telemedicine system used at Penn developed by a company, Visicu, the "eICU system" (Visicu, like "Visual ICU") .

Take a look at their technical architecture diagram.

Notice the similaries with RHIO technical architectural diagrams. Same HL7 challenges etc. Again, I see Telemedicine as a natural extension of disparate clinical data integration challenge.

In an earlier post, I mentioned how, because of lack of payer reimbursement for telemedicine, the costs may be borne out by facilities such as hospitals because of a perceived notion that telemedicine brings better outcomes and as a result reduced costs. This is apparently the case at Penn's Telemedicine ICU:

Doc in a Box blog writes:

"And also we must not forget about whether we can
bill for this service. Presently the hospital supports it based on the notion
that increased quality saves money."

ICU Medical Services company using this technology

RHIOs, HIEs and Telemedicine

A HIMSS Presentation on RHIOs and Telehealth/Telemedicine
The presentation makes the following points:

Telemedicine & RHIOs

• RHIOs can integrate Telemedicine
programs into the local health information
exchange

• Telemedicine will create efficiencies, improve
quality and give rural patients better ACCESS

• RHIOs can tie patients to specialists around
the country and the world through Telemedicine

Telemedicine Benefits to RHIO

• Increased diagnostic resources

• Improved quality of medical services

• Strengthened ties to specialty care

• Alleviated isolation of rural providers

• Enhanced ability to attract and keep primary care
physicians and staff

• Facilitated training of health professionals in rural
communities • Patients can stay close to home for their care

As I mentioned in an earlier post, I see a major function of a RHIOs and HIEs as facilitators of clinical data exchange, moving data from a source provider (hospital, clinical lab etc) to a physician or other healthcare provider. Telemedicine adds to the data services provided by the RHIO.

Telemedicine Resources

Telemedicine is another area in health IT that interests me. Being a practicing physician with patients in multiple settings such as nursing homes and hospitals, I believe that telemedicine shows great promise and has yet to reach its potential in transforming how we practice healthcare . It's the combination clinical medicine and cutting edge healthcare IT that is really appealing to a techie physician. Telemedicine technology in many ways is about moving data around between patients and physicians, similar to a RHIO or an HIE.

To me, an HIE (Healthcare Information Exchange) is about moving and aggregating actionable clinical data from multiple data sources to a physician (or other healthcare provider) in order to provider patient care. Telemedicine is just another type of data that must be moved from the source (the patient from the remote location) to the physician.

I will be putting together a list of useful Telemedicine resources. please let me know if I should include anything else.

Telemedicine and Delaying Hospitalization: Interesting item on how telemedicine can reduce hospitalization of nursing home patients from a blog on senior care.

Some interesting points from the blog item:

• "...many doctors have skilled nursing facilities third on their to-do lists"


• “37 percent of the hospitalizations of long-term residents at urban nursing homes nationwide were potentially avoidable.”
• "A doctor can teleconference with a patient, see them via a monitor and make a decision as to what the patient needs."
  " Many nursing homes have found this reduces the need for unnecessary hospitalizations.."

More links related to Telemedicine and Hospitalizations:

• Treating Acute Infections by Telemedicine in the Home PDF
• New telemedicine program pairs comfort of home with heart care
• Treating Acute Infections at Home with Telemedicine Presentation on real implementation of telemedicine. Has pictures of the equipment used, list of costs for the equipment and benefits of the program: Shows the reduction in hospital days, costs savings, patient satisfaction etc.
• Telemedicine Information Exchange (TIE) website : Great resource with a wealth of information on Telemedicine.
• Boston Globe article on Nursing home deficiencies and cutting unneeded hospitalizations. How Telemedicine is being used to address these challenges.

Telemedicine in Wound Care

Wound care practice, Woundcare Consultants

Wound care in long term setting from Ostomy Wound Management

Telemedicine Wound care using cell phones

WoundMatrix, wound care EMR

Smith & Nephew's has a Device to measure Wound area. See their website for more information.

Laser device to measure wounds.

Telemedicine Liability: Unfortunately, liability and malpractice are issues that must also be considered even in telemedicine. Here are a few resources:

Blog item on Telemedicine Liability: contains a link to potential liability issues in teleradiology.

Telemedicine Risk makes the following points:

• "...while remote medical practice can bring efficiency and cost savings... it can increase liability."
• "Malpractice insurance is merely the first step in risk management for telemedicine, since local laws may be different on each end of the link..."

Regional Telemedicine Issues

A map of Telemedicine and Telehealth State-by-State: A map with links to each state's telemedicine related issues such as existing programs, reimbursement policies etc.

Arizona's Telemedicine Program, equipment description

Telemedicine in Dermatology

TeleDerm Guidelines

Study using TeleDerm. A comparison of TeleDerm with conventional dermatology.

Telemedicine in Nursing Home

Here is a 2006 presentation on the use telemedicine for nursing home care in the state of Maine.

Employing a Wireless Mobile Solution to Bring
Telemedicine to the Nursing Home Bedside
This is proposal to link three rural Michigan nursing homes via telemedicine.

Telehealth Wound Protocol

Northeast Telehealth Resource Center , Partners Healthcare Telemedicine, ME and VT state.

There is a set of document links on their resource page. I have provided them here for convenience.

Informed Consent Reimbursement Policy and Procedures Tele-mental health Protocol for Correctional Inmates Protocol for Medical ASL Interpretation for the Deaf--Video Relay Interpreting Tele-Wound Care Protocol for Nursing Home Residents Tele-Pain management Protocol Tele-pharmacy Protocol

Wound care in long term setting from Ostomy Wound Management

Telemedicine Solution Vendors

REACH Remote Stroke Care

The use a 100% web enabled solution using webs cams, telemedicine carts to deliver reote stroke care to hospital emergency rooms.

InteractiveCare Provides a complete solution for telemedicine. Focus is presently on hospitals but the solution can be deployed in multiple clinical settings. They have a good demo here.

Healthcare Vision Inc

ExhibitOne This company does high definition video conferencing for multiple applications including healthcare.

HealthPia America, Medical Device company. Their flagship product is the "All-in-One Diabetes phone, a cell phone with a built-in glucose monitor that essentially functions as a full-time nurse"

Second Opinion Telemedicine Software: A complete solution for telemedicine consultations.

Telemedicine Radiology:

Team Health is a Tele-Radiology group: "TeamHealth Teleradiology (THTR) was founded in 1991, in Durham, North Carolina, by a group of physicians from Duke University. At that time, the centralized interpretative services group offered reading expertise in MRI and CT for rural physicians who lacked access or experience in these modalities. The group provided 24-hour-a-day coverage, including nights and weekends. THTR was the first and the largest teleradiology company of its kind."

Telemedicine Presentations

TeleHealth and EMRs (5/2007) Makes a good case for telemedicine and its integration with EMRs. Also has a great set of EMR screenshots.

A. Hasan Sapci, M.D at the Telemedicine Resource Center at the University of Michigan Health System has included a comprehensive set of interesting telemedicine technical presentations on his online resume.

Telemedicine for developing countries, MIT developed solution

Telemedicine in Disease Management

Telemedicine in Diabetes

Diabetes Telemedicine/EMR product. Describes the benefits of telemedicine in diabetic care.

Comprehensive discussion of Telemedicine in Diabetes, and the endocrinologist's role

IDEATel- Informatics for Diabetes Education and Telemedicine

Home Telemedicine- A Practical Guide Addresses a number of issues: HIPAA, implementation, nurse case management, provider issues

Telemedicine RHIO

RHIOs, Telehealth & Interop (HIMSS Architects of Change 3/2006) Lists several RHIOs with Telehealth components

Telemedicine Technical Resources:

Store and Forward Technology

ICU Telemedicine

ICU Medical Service company using Visicu's technology

Article on Inova Health System, North Dakota adoption of Visicu.

The Value of Provider-to-Provider Telehealth Technologies, CITL

TeleHealth Technologies Report

Reducing emergency department transfers

Reducing transfers from correctional facilities to emergency departments and physician offices

Reducing transfers from nursing home facilities to emergency departments and physician offices

Replacing in-person consults with virtual consults

Reducing redundant and unnecessary laboratory tests

Telemedicine Market Article is a little dated, 2004, but does have an excellent market analysis.

Video Conferencing Solutions Vendors

New and Pre-owned equipment , Video Conference Store

Carries Sony Video Conferencing products

LifeSize, High Definition Video solution. This company has their own product which looks pretty slick. They have several excellent video demos of their product in action. Here is a review of their system.

Telemedicine Programs

MTN Missouri Telehealth Network

University of Iowa , Dept of Family Medicine: Samsung SDS of Korea, a development team at the University of Iowa has developed a Nursing Home Telemedicine system, Colonial Manor in Amana, Iowa. See their system diagram.

Karishma Telemedicine: Program based in India, their brochures are here.

Maine Telemedidine Services

Policies and Procedures for providing telemedicine services in Maine

Telemedicine Equipment

Alaska's AFHCAN user manuals