Skip to main content

Beyond the Bunker

A Decentralized Model for Tele-Critical Care

For the entire history of critical care telemedicine, the practice of tele-ICU has been primarily associated with central command centers. Central command centers, also referred to as bunkers or hubs, link intensivists and other personnel to multiple hospitals so that a relatively small number of critical care physicians can oversee the care of a large number of ICU patients.

Capital costs of construction, installation, and training for a new command center range from $6 million to $8 million. At a time when healthcare costs must be minimized, reconsidering the value of central command centers is necessary.

In numerous studies, tele-ICU has shown to improve patient outcomes and decrease mortality as well as ICU length of stay. Tele-ICU has clearly shown value in keeping patients closer to home, allowing smaller hospitals to treat high-acuity situations. So the question is, how key is a central command center to an effective tele-ICU program and can a decentralized model be as effective.

A command center is staffed by many nurses who are deeply engaged in data collection for analytics and quality audits. With the advent of AI and machine learning, many of these tasks could be automated and the expertise of these personnel could be devoted elsewhere within the highly constrained healthcare system.

The key resource in the command center is the intensivist. On a basic level, we must consider if there are less expensive models to deliver intensivist services to remote settings. Simply stated, thousands of hospitals cannot afford to subscribe to the bunker-style tele-ICU with its heavy infrastructure. What they are looking for is a cost-effective and efficient means of access to ICU specialists.

With provider burnout at an all-time high and a shortage of intensivists, to not exacerbate the shortage we must also consider what conditions will be attractive to intensivists. Critical care physicians sit in these central command centers for shifts that are typically 12-hours long, scanning dozens of computer screens. This arrangement does not present a very attractive lifestyle option to intensivists, especially when many have additional specialties such as pulmonology that provide the option to work in an outpatient setting. If an intensivist can provide quality care to a remote hospital from the comfort of his or her own home as opposed to sitting in a bunker, he or she will likely see that as more attractive and devote more time to intensive care. Omnicure supports better quality of life.

Omnicure presents an option for critical care that does not require a central command center. With modern wi-fi and the emergence of 5G, internet connection from home is more robust than ever. The expensive infrastructure of central command centers for dedicated internet and T1 lines is a remnant of the past. This infrastructure was necessary when tele-ICU began in the year 2000, but as technology evolves, our delivery of care must also be upgraded and updated in a cost-effective manner.

Popular posts from this blog

Omnicure alleviates staffing shortages

According to a recent US News & Word Report article , an estimated 1.5 million healthcare jobs were lost in the first two months of COVID-19 as the country raced to curb the novel coronavirus by temporarily closing clinics and restricting non-emergency services at U.S. hospitals. This marked the start of the worst healthcare staffing crisis the United States has seen. While some returned to the workforce, others left permanently, creating a vacuum at a time of especially high demand. As time passed, many workers chose early retirement due to the high stress of the situation, and others chose to work shorter hours in outpatient settings, thus creating a lack of staffing, especially in ICU and inpatient settings. Along with this, prices for contracted labor, travel nurses, and locum tenens physicians have increased across the board, especially in areas with low accessibility. The need for healthcare professionals is at an all time high across the country as we continue to battle the ...

Tele-ICU Cost Benefit Analysis

The CEO of Omnicure, Sanjay Subramanian, MD , has a great deal of tele-ICU experience. His experience and leadership in critical care medicine have given him insight into cost and revenue centers in tele-ICU. As the prohibitive costs of legacy tele-ICU systems present a significant barrier, a primary motive of Omnicure is to provide a low-cost telemedicine ICU service. In the 2019 publication, Telemedicine in the ICU [1], Sanjay co-authors a chapter titled “Cost Benefit Analysis of Implementing Telemedicine in the ICU.” Costs of tele-ICU are broken down into the following categories: Hardware Fixed mounted cameras in patient rooms Cabling for cameras Desktop computers and multiple monitors for remote physician/nursing workstations T1 lines to assure connectivity Software  Staffing costs The chapter details the maintenance and support costs of hardware, as well as the staffing support of tele-ICU command centers. The hardware and IT costs are quite significant. For example, the har...