Care From Afar

For patients, being awakened before dawn to be examined by doctors on rounds is one of the many unpleasant aspects of life in a hospital. But at three Swedish Medical Center facilities in Seattle, patients in the intensive-care unit face fewer interruptions: their doctors may just let them sleep while they watch from afar. Swedish Medical is one of a growing number of hospitals opting for a radical form of outsourcing by using technology and doctors stationed off-site to monitor the well-being of critically ill patients. Instead of listening through a stethoscope, a single doctor can track multiple patients at all three hospitals from a remote facility by watching monitors and Webcams, working from a post that looks a lot like an air-traffic controller's station. And not only do patients rest easier without the predawn interruptions, they're actually getting better medical care, says Swedish Medical president Rodney Hochman. "They love having the watchful eye looking over them all the time," he says.

It's the latest way America's overburdened health-care system is trying to adapt to an era in which there are too many patients, too few doctors and too little insurance money to pay for treatments. Remote ICU centers, in which critical-care doctors (called intensivists) and nurses watch patients from afar, can save lives and money, according to Visicu, the Baltimore firm that developed the concept. The firm's eICU, developed by former Johns Hopkins intensivists Brian Rosenfeld and Michael J. Breslow, is now used by 40 hospital systems to monitor roughly 4,800 beds. "In five years, this will be the accepted standard of care for patients in this country," says Rosenfeld.

The system uses remote monitors to supplement the on-floor medical staffs, and relies on trend-tracking software that acts as an early-warning sign of problems. "The heart and soul of the technology is 'smart alerting' that lets you know that a patient is not doing well before an alarm bell starts to go off," says Hochman. The monitoring doctors and nurses have audio, visual and data connections to the patients and their rooms. If they see a problem developing, they can talk directly with nurses or medical residents on the ward or in the patient's room, or through the hospital's normal phone system.

It costs upwards of $2.5 million to license the system, but the savings can be substantial. Sentara Healthcare, a six-hospital system in Norfolk, Va., that was the first to adopt the Visicu technology in 2000, claims it resulted in a 27 percent reduction in the ICU's mortality rate, a 17 percent reduction in length of stay and savings of $2,150 per patient—or $3 million systemwide. Most of the savings don't come from paying fewer doctors. Instead, they result from helping patients recover faster. Insurers typically pay hospitals a flat fee for patients based on their illnesses. If complications arise—typically infections or breathing problems—patients will stay in an ICU longer, taking up space but creating no new revenue for the hospital. In the same way a restaurant that turns its tables faster makes more money, hospitals are using remote ICUs to free up beds, boosting revenues.

But not every hospital realizes those savings. Kaleida Health, a Buffalo, N.Y.-based hospital system, installed the Visicu eICU in 2004 at a reported cost of $4 million, and then dropped it in October 2006, claiming it didn't deliver the hoped-for results. And saving money for hospitals won't necessarily translate into big profits for Visicu. Apparently Wall Street has doubts about the company's prospects: its stock traded near $26 a share shortly after it went public in April 2006, and it now trades just over $7. Argus Research analysts suggest Visicu could face increased competition from other medical technology and may have to reduce its prices.

But the technology is winning fans, and while the idea of an off-site doctor may seem unsettling initially, there's been little criticism of the company from the medical community. That could be because most hospitals are using eICUs to supplement their on-site personnel, and not replace them. It also has the potential to bring ICU monitoring to smaller, rural hospitals that can't afford their own critical-care wards.

Over time, the doctors who watch the monitors may move even farther away. Military doctors in Hawaii are already monitoring military patients in South Korea and Guam. Some health-care analysts are looking at the possibility of setting up eICU monitors in Bangalore and other foreign sites where doctors are well trained but much lower paid than in the United States.

Winning patients over to that idea might take a while. Today most of the intensivists who do shifts watching eICU monitors are still doing floor rounds on other days. So even in a digital age, the need for good bedside manners remains.

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