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Critical Care Telemedicine: Evolution and State of the Art*

Lilly, Craig M. MD, FCCM, FCCP, FACP; Zubrow, Marc T. MD, FCCM; Kempner, Kenneth M. MS; Reynolds, H. Neal MD; Subramanian, Sanjay MD; Eriksson, Evert A. MD, FACS, FCCP; Jenkins, Crystal L. RN, MHI; Rincon, Teresa A. BSN, CCRN-E, FCCM; Kohl, Benjamin A. MD, FCCM; Groves, Robert H. Jr MD; Cowboy, Elizabeth R. MD, FCCP; Mbekeani, Kamana E. MD, MBA, MJ; McDonald, Mark J. MD; Rascona, Dominick A. MD, FACP, FCCP; Ries, Michael H. MD, MBA, FCCM, FCCP, FACP; Rogove, Herbert J DO, FCCM, FACP; Badr, Ahmed E. MD, FCCM, FACS; Kopec, Isabelle C. MD, FACP, FCCP

doi: 10.1097/CCM.0000000000000539
Review Article

Objectives: To review the growth and current penetration of ICU telemedicine programs, association with outcomes, studies of their impact on medical education, associations with medicolegal risks, identify program revenue sources and costs, regulatory aspects, and the ICU telemedicine research agenda.

Data Sources: Review of the published medical literature, governmental documents, and opinions of experts from the Society of Critical Care Medicine ICU Telemedicine Committee.

Data Synthesis: Formal ICU telemedicine programs now support 11% of nonfederal hospital critically ill adult patients. There is increasingly robust evidence of association with lower ICU (0.79; 95% CI, 0.65–0.96) and hospital mortality (0.83; 95% CI, 0.73–0.94) and shorter ICU (–0.62 d; 95% CI, –1.21 to –0.04 d) and hospital (–1.26 d; 95% CI, –2.49 to –0.03 d) length of stay. Physicians in training report experiences with telemedicine intensivists that are positive and increased patient safety. Early studies suggest that implementation of ICU telemedicine programs has been associated with lower numbers of malpractice claims and costs. The requirements for Medicare reimbursement and states with legislation addressing providing professional services by telemedicine are detailed.

Conclusions: The inclusion of an ICU telemedicine program as a major part of their critical care delivery paradigm has been implemented for 11% of critically ill U.S. adults as a solution for the problem of access to adult critical care services. Implementation of an ICU telemedicine program is one practical way to increase access and reduce mortality as well as length of stay. ICU telemedicine research including comparative effectiveness studies is urgently needed.

Supplemental Digital Content is available in the text.

1Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA.

2Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA.

3Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA.

* See also p. 2457.

Dr. Lilly had full access to the data and takes responsibility for its integrity and the accuracy of the analyses. Drs. Lilly, Zubrow, Cowboy, and Kopec, and Mr. Kempner contributed to project concept and design. Drs. Lilly, Jenkins, and Groves contributed to acquisition of data. Drs. Zubrow and Rascona contributed to review of governmental regulations. All authors contributed to construction and content expert review of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Dr. Lilly received support for article research from the National Institutes of Health (NIH). Mr. Kempner is employed by the NIH and Department of Health and Human Services (work done as an outside work activity). Dr. Reynolds served as board member for InTouch Health, received grant support from InTouch Health (grant submitted to the National Institute of Minority Healthcare Disparities for further development of autonomous robotic support to support understaffing within underserved critical care units), has stock options with InTouch Health, and received support for travel for InTouch Health symposium. Ms. Rincon received grant support from the American Association of Critical Care Nurses, honorarium/travel fees from Eli Lily from 2006 to 2008, travel fees from Phillips and American Telemedicine Association, honorarium/speaking/travel fees from California Telehealth Resource Center, honorarium/travel fees from the American College of Chest Physicians 2009–2011, travel fees from the Society of Critical Care Medicine, honorarium/travel expenses from the American Lung Association and the California Society for Respiratory Care from 2005 to 2010, was employed by Sutter Health 2003–2013, is employed by University of Massachusetts Memorial 2013 to present, and lectured for California Telehealth Resource Center. Dr. Cowboy is employed as the Aetna Medical Director (Aetna did not financially support this work). Dr. McDonald is employed by the University of Louisville, has received compensation for expert testimony from Thomason Hendrix Harvey Johnson & Mitchell, PLLC, Memphis, TN, is a grant subcontractor with the University of Michigan, and has received grant support from Astellas and travel/accommodation fees provided from the Society of Critical Care Medicine for the SCCM Pediatric Online Practice Exam Committee. Dr. Ries is employed by Advocate Health Care and provided expert testimony (has and still is reviewing cases). Dr. Rogove is employed by C3O Telemedicine and the Allegheny Health Network. His institution received grant support from the NIH to Texas Tech University. Dr. Badr consulted for St Jude Medical. Dr. Kopec has stock options with Advanced ICU Care. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Craig M. Lilly, MD, Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, 281 Lincoln Street, Worcester, MA 01605. E-mail:

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