Evaluate eICUs for impact on care cost, quality

While nearly 10% of U.S. hospital intensive care unit (ICU) beds with telemonitoring-known as eICUs-there has never been a systematic evaluation of how it affects quality and costs, according to a study by the Center for Studying Health System Change (HSC).

Rapid diffusion of eICUs in hospitals across the country illustrates the need for comparative effectiveness research to study innovations in how patients are cared far, not just specific drugs, devices and services, according to researchers.

"Proponents and detractors of eICUs feel strongly that their assessments are correct,” says HSC Consulting Researcher Robert A. Berenson, MD, also an institute fellow at the Urban Institute, and co-author of the study. “But without a rigorous assessment, who knows which side is right?”

The Health Affairs article, “Does Telemonitoring of Patients-The eICU-Improve Intensive Care?” was a follow-up study from HSC’s 2007 site visits to 12 nationally representative communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. HSC has been tracking changes in these markets since 1995.

According to Dr. Berenson, the centers that adopted the eICU not only did so out of motivation to improve quality and safety, but also because they think that once implemented, it has dramatically improved quality and safety and may be reducing costs.

Other key findings include:

• Among hospitals not adopting eICUs, there was general agreement that the limited potential benefits didn’t justify significant upfront and ongoing costs-estimated at $3 million to $5 million in startup costs for 100 ICU beds, along with ongoing annual operating and staff costs of $1.3 million to $2.3 million per 100 beds. Virtually all of the hospitals without eICUs believe their current onsite ICU staffing was adequate and preferable to off-site staff. The lack of third-party reimbursement also was seen as a disincentive to adopt eICUs.

• Despite the lack of specific payment or other incentives, most hospitals in the study-both with and without eICUs-were working to improve ICU performance, primarily by adding more intensivists and adopting ICU-specific quality improvement tools, including prevention of ventilator-associated pneumonia and central-line infections.

• In all but one of the five eICU hospitals, poor interoperability between the eICU software and the hospitals’ enterprisewide information technology systems created barriers to using the full extent of eICU’s advanced monitoring and outcome analysis features.

According to Shane Hade, chief executive officer of EDIMS, a provider of interoperable emergency department information management systems for hospitals, interoperability of systems is and will continue to be a key issue in leveraging the full potential of the new healthcare technologies available.

“Unfortunately, concerns about interoperability issues, like those raised in the eICU study, are often used by executives as a reason to not adopt or delay adopting new technology that can significantly improve the quality of care,” Hade says.

Alan Portela, COO of CliniComp International, provider of clinical documentation systems, believes that nobody knows if widespread adoption of eICUs would save money, improve outcomes, or increase intensivist coverage.

“eICUs would work better if they were more interoperable with other clinical systems,” Portela says.