Philips Healthcare's IntelliSpace
Console Critical Care

ICU – Clinical decision support and telemedicine may save money

December 19, 2016
by Lauren Dubinsky, Senior Reporter
One in five Americans die in the intensive care unit, according to a study published in the journal Critical Care Medicine. From the time patients are admitted to the hospital to the time they enter the ICU, they generate 100 data points per hour and clinicians struggle to interpret it. The Institute of Medicine’s 1999 landmark report estimated that the annual cost of preventable medical errors is between $17 billion and $29 billion.

“It’s a significant cost issue,” says Dr. Joe Frassica, chief medical and innovation officer at Philips Healthcare. “In that ICU setting, there are systems in place that invariably help or hinder the care process.” Over the last two years, Philips set out with its partners to figure out the source of this issue and to try to find a way to address it. They found that there’s too much data in a hospital’s EMR for one person to adequately review. “We have done a great job at collecting the data in the EMR, but having all that comprehensive data put in front of you is equivalent to having a record that’s the size of a warranty,” says Frassica. “Somewhere in the text is something that’s very important for you to know, but it’s impossible to know which page it’s on.”

In March, Philips launched its cloud-based clinical decision support dashboard for the ICU called IntelliSpace Console Critical Care. It gathers information from multiple systems and EMRs that can be analyzed and prioritized. It provides clinicians with an overview of each patient in the ICU, including their acuity level, details regarding life support and other important information they need to make decisions.

IntelliSpace Console is the result of a multi-year research collaboration with Ambient Clinical Analytics and the Mayo Clinic. A multi-site clinical trial funded by the Centers for Medicare and Medicaid Services (CMS) was recently completed. The trial found that IntelliSpace Console significantly improved the performance and efficiency of ICU patient workup. It saved about 110 minutes per day on data gathering in the surgical ICU.

Should your hospital get on board?
Over the past five years, the Health Information Technology for Economic and Clinical Health (HITECH) Act pushed the implementation of EMR. Today, most hospitals have the infrastructure to collect data within a basic EMR. As hospitals become increasingly familiar with the technology, they realize that not everything they want to do can be done within the EMR, and that decision support tools are needed to fill that gap, according to Frassica.

Implementing an EMR is a costly and cumbersome process, but the decision support tools are only a small fraction of the overall expense. In addition, the return on investment is high. If you prevent medical errors or identify a patient with sepsis early, that avoids prolonged ICU stays on the ventilator, which essentially pays for the decision support tool, says Frassica.

Another option
Philips is not the only company that offers these tools. The clinical information systems company iMDsoft offers an ICU decision support tool called MetaVision. A study conducted at Paul Brousse Hospital in France that was published in June 2014 found that MetaVision reduces the length of stay in the ICU by 20 percent. “We need decision support to help us make the right decisions at the right time,” Frassica says. “Decision support will never replace the physician or the nurse at the bedside, but it will make us better clinicians and [we’ll be able] to follow guidelines in a more reproducible way.”

Are tele-ICUs cost-effective?
A University of California-Davis study published in Critical Care Medicine in January found that telemedicine in the ICU is cost-effective. Tele-ICUs allow clinicians to remotely monitor critically ill patients from a central station. “Tele-ICUs partially compensate for the absence of on-site intensivist expertise [physician, nurse, pharmacist], and offer additional clinical surveillance and support as a ‘second set of eyes,’” says Byung-Kwang Yoo, lead author of the study and associate professor of public health sciences at the university. Tele-ICUs can cost between $70,000 and $92,000 per bed in the first year, and between $34,000 and $53,000 per bed in subsequent annual operating costs, according to the study.

Yoo and his team applied mathematical modeling to costs and benefits on data gathered from multiple tele-ICU studies. The health benefits were calculated in quality adjusted life years (QALYs), which takes into account quality and length of life. The researchers concluded that a tele-ICU would be cost-effective if the incremental telemedicine-related costs to extend a year of life for one patient were less than $100,000 per QALY. “It is straightforward to judge that the tele-ICU is costworthy if it is reducing both cost-perpatient and mortality in [the] ICU,” says Yoo.

James Laskaris, clinical analyst at MD Buyline, says that the starting salary for an intensivist is $200,000 per year. He adds that not many 100- or 200-bed hospitals can afford to have three or four intensivists on staff. The study also found that ICUs with fewer resources and less access to critical care health providers would most likely benefit the most from a tele-ICU. “Our model assumed that [those ICUs] had a higher ICU mortality before introducing tele-ICU,” says Yoo. “Our model also assumed that these ICUs will have a greater magnitude of mortality reduction after introducing tele-ICU.”

Previous studies that investigated the cost-effectiveness of tele-ICUs had inconclusive results. That was because different studies reported conflicting results and none of the studies conducted a standard cost-effectiveness analysis with an established criterion that defines “cost-worthy.” “Our study was the first to develop a mathematical simulation model, accounting for the diverse results of past studies examining diverse tele-ICU settings,” says Yoo. “This model enabled us to perform a standard cost-effectiveness study to conclude that the tele-ICU is costworthy in 67 percent of 1,000 hypothetical ICU patients.”

He thinks most hospitals in the U.S. will have a tele-ICU at some point in the future, but that depends on several factors. Reimbursement for tele-ICUs is limited. More hospitals would make the investment if reimbursement was increased. “As models of payment move from volume- based to value-based, hospitals and physicians could realize greater payments or lower expenses if quality is improved, mortality is lowered and ICU stays are shortened,” says Yoo.

The cost savings vary among hospitals. The study provided a set of benchmarks, including the maximum cost for physician staffing to achieve tele-ICU cost savings, and each hospital can use that to judge if it’s worth the expense. “[Tele-ICUs] are growing rapidly right now,” says Laskaris. “It depends on [the hospital’s] patient mix. If you’re dealing with orthopedic patients and you have a younger population, then it may not be cost-effective. But if you’re dealing with a lot of high-risk patients, then it would be.”