A Telemedicine Program Links ICU Patients to Clinicians Down Under

May 15, 2018 - An Atlanta health system is seeing enough good results from a telemedicine platform in Australia that it’s opening a second eICU Down Under.

Officials at Emory Healthcare have announced a new remote intensive care partnership with Royal Perth Hospital, on Australia’s western coast. Through the eICU platform, Emory doctors and nurses based at the Perth hospital will use telemedicine technology to monitor patients in US hospitals that are part of Emory’s hub-and-spoke telehealth network.

“The eICU represents the future of globalized critical care, transforming the delivery of care from the bedside in partnership with the Informatics Center to any site where the advanced technology can be implemented, extending beyond the barriers of location and time,” Tim Buchman, Director of Emory Healthcare’s Critical Care Center, said in a press release. “Overnight, when adverse events are most likely to occur for ICU patients, the eICU program allows clinicians to support the Atlanta-based bedside team by recognizing adverse physiology, making critical diagnosis, and intervening as a patient begins to veer off trajectory.”

The new partnership builds on a six-month pilot program launched in 2016 with Macquarie University in Sydney. Officials say the Perth location is better suited because Perth is 12 or 13 hours distant from the US East Coast, meaning clinicians in Perth will be able to cover US hospitals during nighttime hours.

Emory officials said they haven’t gotten all the data back from the pilot program yet, but saw enough good results to launch the new partnership.

READ MORE: Telemedicine Study Cites Tele-ICU’s Positive Impact on Patients

Cheryl Hiddleson, Operations Director of the Emory eICU program, says the partnership not only helps patients, but providers as well.

“All of our staff have expressed a desire to return and, in fact, some of them have, and all of them have stated that it was ‘the best working experience of their lives,’” she said. “They felt so much more rested and had much better sleeping patterns. This program allowed them to go to sleep at the same time each night and wake up the same time in the mornings, allowing them to function well during their shifts in the eICU and their usual life activities.”

“They also had the ability to visit places they normally would not have been able to visit before,” Hiddleson added. “They also felt they were more alert and efficient in their care. We have some preliminary data that shows our clinicians performed efficiency tasks faster while in Australia during the day time hours than during the night time hours in Atlanta, even though they were doing the exact same work with the same staff and patients.”

While healthcare has long operated under the model of achieving the “triple aim” of reducing cost, improving the patient experience and outcomes and enhancing population health, telehealth advocates are adding a fourth goal to that model: improving provider health and wellness. With provider burnout and suicides at an all-time high, healthcare executives are beginning to look at telehealth as a means of improving clinician workflows and, as a result, improving their lives.

Peter Yellowlees, the outgoing president of the American Telemedicine Association, made that point during his opening address at the ATA’s 2018 conference and exhibition in Chicago earlier this month.

READ MORE: VA Hospitals Connect Via Tele-ICU, Remote Patient Monitoring

“I actually find it less stressful to see a patient online than I do in person,” Yellowlees, a professor of psychiatry at the University of California’s Davis campus, said.

The Emory eICU program puts a couple of healthcare theories to the test. One is that the level and quality of care drop during a hospital’s off-hours, when clinicians aren’t at their best or most awake. The second is that off-hours shifts are often staffed by young and less experienced doctors and nurses, those who need the extra hours or don’t have the seniority to avoid them.

In fact, studies have shown a sharp drop-off in clinical outcomes for patients treated off-hours, compared to those treated during the day. Conversely, studies have shown that eICU programs improve patient survival rates by some 26 percent over traditional ICU programs, with a 20 percent faster discharge rate.

Speaking with mHealthIntelligence.com in late 2016, during the eICU pilot program’s run in Sydney, Buchman and Hiddleson both said the new program is tailored to put doctors and nurses at the top of their game when they’re monitoring very sick patients.

“There are very few people who are truly nocturnal,” Buchman noted.

READ MORE: Telemedicine Survey Shows Strong Support From ICU Nurses

They’re also looking out for improved clinical outcomes. Their partner in this program is Royal Philips, whose eICU telemedicine platform has demonstrated better clinical results in studies done at Emory and UMass Memorial Medical Center.

"The ability of tele-ICU programs to increase case volume and access to high quality critical care while improving margins suggests a strong financial argument for wider adoption of ICU telemedicine by health systems and intensivists," Craig M. Lilly, director of the UMass Memorial eICU program, a professor of medicine, anesthesiology and surgery at the University of Massachusetts Medical School and lead author of the UMass Memorial study, said. "It has been well documented that properly implemented telehealth programs can have a significant impact on patient outcomes, and this study now supports the financial investment behind it."

Emory and Philips officials, citing a 15-month analysis of the eICU program at Emory, say the telemedicine platform helped the health system increase its discharges to home by almost 5 percent, reduced discharges to long-term care facilities or nursing homes by almost 7 percent, decreased 60-day in-patient readmission rates by about 2 percent, and saved $4.6 million in healthcare costs over that 15-month period, an average of almost $1,500 per patient in Medicare spending.

Buchman and Hiddleson are expecting those same benefits from a program that places their colleagues on the other side of the globe.

“We are turning night into day to make the lives of our caregivers as positive as possible while improving care quality and patient outcomes,” Buchman said.