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Adoption of ICU Telemedicine in the United States

Kahn, Jeremy M. MD, MS1,2; Cicero, Brandon D. MPH1; Wallace, David J. MD, MPH1,3; Iwashyna, Theodore J. MD, PhD4,5

doi: 10.1097/CCM.0b013e3182a6419f
Clinical Investigations

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.

1Clinical Research, Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

2Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.

3Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

4Division of Pulmonary and Critical Care Medicine, University of Michigan School of Medicine, Ann Arbor, MI.

5Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI.

This work was performed at the University of Pittsburgh.

Dr. Kahn received consulting fees from the U.S. Department of Veterans Affairs on matters concerning ICU telemedicine and has received in-kind research support from the Cerner Corporation. Dr. Kahn’s institution received grant support from the National Institutes of Health, Health Resources and Services Administration (current and pending grants to study the organization of ICU care, including ICU telemedicine). Dr. Kahn received support for travel from National Association of Long-Term Acute Care Hospitals. Dr. Wallace received grant support from The National Heart, Lung, and Blood Institute (K12). Dr. Wallace is employed by the University of Pittsburgh. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins