St. Louis-based telehealth company Advanced ICU Care was born of simple necessity: Two intensivists were asked to care for patients in two different intensive care units (ICUs) simultaneously—but those ICUs were on opposite sides of the city.
Thirteen years later, those two St. Louis hospitals remain clients of that company, which has been working to spread the concept of the tele-ICU. And even just five years ago, CEO Lou Silverman said he was still starting prospective client meetings with, “What (the heck) is tele-ICU?”
“Our body of work in the ICU has allowed us to define and refine the state of the tele-ICU art. We are delivering care to the sickest of patients and in the most difficult of the current telemedicine specialties. We wouldn’t have it any other way.”
Silverman recently sat down with FierceHealthcare to talk about the breakdown of the wall between virtual and in-person care.
FierceHealthcare: Why is tele-ICU so important to the future of healthcare?
Lou Silverman: People are getting older, older people understandably use more ICU resources, and the supply of intensivists is and will remain flat. Therefore, the demand for critical care expertise far outstrips the supply. Further, supply and demand are rarely matched up geographically. Tele-ICU programs leverage technology to deliver world-class critical care expertise exactly where it is needed, and it enables more patients to benefit from each available intensivist physician than would otherwise be possible.
FH: How is tele-ICU impacting costs for providers and payers?
LS: Historically, our clients recognize between a two-to-one and a six-to-one return on investment (ROI) from our tele-ICU partnerships. While there are many factors that go into a sophisticated ROI calculation, some of the primary benefits include shorter ICU stays, improved utilization of ICU beds, fewer patient transfers, lower infection rates, fewer ventilator days and decreased incidence of sepsis. There are also additional clinical impact areas, such as reduced ICU mortality and adherence to well-established clinical best practices, which are material benefits of the program. These benefits arise in areas in which patients, providers and payers have alignment of interests.
FH: Do physicians need to train differently?
LS: The clinical basics are similar for bedside practitioners and tele-ICU practitioners. However, the telemedicine space creates a need for a somewhat different set of interpersonal and communications skills which enable clinicians working remotely to deliver compassionate and effective care for patients, and to collaborate effectively with their bedside counterparts. Collaborating to provide the best possible care for each patient is a truly unifying goal for providers, both at the bedside and on the screen.
FH: What are the biggest challenges to getting telehealth into an ICU?
LS: Hospitals and hospital systems have many priorities at the present time. Perhaps too many. In cases where hospitals and hospital systems are focused on enhancing ICU patient outcomes, creating “system-ness,” or enhancing the contribution of their ICUs to patient, family and facility benefit, adding our service has become a reasonably straightforward decision. We are pleased to report a sustained and material expansion in the number of hospitals and hospital systems now focused on their ICU units.
FH: What are the potential drawbacks to telehealth in the ICU?
LS: The biggest challenges we’ve observed involve attempting to replicate every element of bedside practice into a telemedicine setting. The greatest successes occur when workflows and patient engagement are built around the unique attributes of a specific telemedicine specialty rather than focused on importing bedside traditions into the telemedicine environment.
FH: Are there any pending policy decisions that concern you with regards to telehealth?
LS: Absolutely, positively none. Today, there are very favorable tailwinds regarding government policy in telemedicine. Individual states and the federal government are making tangible progress in advancing telemedicine initiatives, making it easier for telemedicine to enable increased access to and quality of healthcare to many patients across many sectors, settings and specialties.
FH: Tell us a little bit about how the technology works to enhance human medical work?
LS: Great healthcare delivery is a fusion of data, expertise, experience and empathy. Viewing technology as a facilitator—and not a shiny new toy unto itself—is also an important part of the mindset. Healthcare is about people helping people. Twenty-first century healthcare is about helping the most people possible achieve outcomes that they did not think were possible. Our technology-enabled tele-ICU service achieves this lofty goal.
FH: What are your goals as the CEO?
LS: We work with the philosophy that success is achieved by the team, that performance counts and politics do not. Our attitude is that the best answer always wins. Period. It doesn’t matter who had the idea or how we got there. With those elements in place, we bring out the best in each other and focus our full energy on making meaningful contributions to the patients we serve, to the providers we collaborate with and to the hospitals and hospital systems we partner with. We have our share of “energetic” discussions. But even in the most intense moments, we remain grounded by our principles.
FH: What’s a common misunderstanding about telehealth that you wish patients and physicians knew?
LS: I think that the industry has done itself a disservice by continuing to imply that “health” is distinct from “telehealth” or that “medicine” is distinguishable from “telemedicine.” My view is that we are all part of a singular ecosystem with uniform goals and a unified vision around improving care for patients and delivering the care where and when it is needed in a manner that is both clinically and cost effective.