Article | February 03, 2016 | Advanced ICU Care Tele-ICU: Delivery on the gold mine of data Written by Marty Miller, Vice President of Technical Innovation, Advanced ICU Care | February 03, 2016. Originally appeared in Becker’s Health IT & CIO Review online Analyzing terabytes of data and leveraging analytics has created disruption and spurred dramatic improvement in a range of industries. Increasingly, hospitals and hospital systems are turning to data to develop proactive care delivery models in their quest to achieve healthcare’s Triple Aim of improving population health, enhancing the patient experience and lowering costs. Unfortunately, too few hospital processes and systems are nimble enough to fully take advantage of rapidly emerging technology and analytics capabilities. Clinical and administrative leaders largely recognize the potential of actionable data, but many hospitals and health systems have limited dedicated resources to access and analyze the large volume of patient data. Rich technical and clinical infrastructures are required to transform data into meaningful information and deploy proactive data-centric patient care to positively impact patient outcomes. Critical care, characterized by high-acuity patients, urgent situations, and high cost of care, illustrates both the challenge and the opportunity. While intensive care units (ICUs) account for 10 percent of hospital beds typically, they generate approximately 30 percent of hospital costs and cumulatively can account for 1 percent of U.S. gross domestic product (GDP). Unfortunately, the ICU is among the most information-starved areas of the hospital. In this high stakes, fast-paced environment, data capture and analysis fall victim to processes and systems that were structured to treat critically ill patients. However, there is proof that integration of data into proactive decision support tools and workflows translates into earlier and more effective interventions, which leads to better patient outcomes and positively impacts the ICU’s bottom line. And there is hope for more easily capturing and analyzing the necessary data. The Technical Advantage of Tele-ICUs Even though they generate large volumes of data, resource-strapped ICUs often aren’t able to achieve clinical-quality evidence thresholds because they don’t have adequate systems in place to consistently capture and process the data or the experience to fully realize its potential. Fortunately, hospitals can leverage partnerships in the healthcare ecosystem if they do not possess the resources in-house. Hospitals and health systems are increasingly implementing tele-ICU models, in part to bridge the gap between internal resources and the opportunity to optimize the role of data in proactive care delivery. To enable 24/7 monitoring by remote intensivist-led tele-teams, tele-ICUs are by their very nature built for intense technology connectedness. Tele-ICUs capture and process a constant inflow of patient data and add a sophisticated overlay of data analytics to elevate care delivery and improve patient outcomes in ICUs nationwide. Leveraging Data to Elevate Performance In many ICU environments, early warning systems utilize a real-time stream of patient information, but it is not sufficient to simply trigger singular threshold alerts and fuel linear processes. This leads to alarm fatigue and process inefficiencies because too many alerts are immaterial. To fully realize the potential of data in patient care, ICUs must use analytics to yield insights, uncover performance trends and identify opportunities for clinical and process improvements. Few hospitals and health systems have sufficient infrastructure to collect and analyze ICU-specific measures in this fashion. However, appropriate tele-ICU partnerships provide actionable insight to drive proactive data-centric patient care and improved alignment with clinical best-practices. Proactive Patient Care Tele-ICU models use real-time patient data to create more sophisticated alerts, built on multiple parameters and patient-specific physiology rather than the traditional simple threshold approach. Additionally, patient data populates advanced algorithms which provide robust, actionable clinical decision support (CDS) systems. These tools empower experienced clinicians to identify downward trends in patient conditions earlier and intervene before they deteriorate further. For instance, tele-ICU clinical information systems drive the early identification and intervention imperative to treat sepsis, which accounts for 215,000 deaths and costs $16.7 billion annually in the United States. The clinical information systems utilize comprehensive patient assessment data and use algorithms to continuously assess a patient’s acuity and recognize changes in their sepsis status. The system then alerts clinicians if patients develop risk for severe sepsis, promoting earlier intervention which reduces mortality and length of stay in the ICU. Following clinical best-practices An important component of performance measurement is the ability to gauge how closely the ICU complies with evidence-based clinical best-practices. Driven by data, ICUs can design and continuously adjust workflows and monitor the impact of their efforts. Tele-ICUs have proved to be a key collaborator in the design, deployment and maintenance of these systems on an ongoing basis. For example, one hospital leveraging a tele-ICU partnership was able to identify the need for additional focus on their management of mechanically ventilated patients. The hospital and tele-ICU partner were able to jointly design collaborative workflows that enabled earlier identification of patients ready to be weaned from the ventilator. Proactively managing patient removal from the ventilator allows the patient to be released from the ICU earlier and to avoid additional infection and complications. In addition, so granular are the data provided through the tele-ICU systems that the collaborative teams can even zero in on the volume of air ventilated patients receive and ensure evidence-based lung protective ventilation best practices are followed. By leveraging data to standardize care delivery, the ICU and its tele-ICU partner were able to collaboratively reduce ventilator days between 30 and 40 percent and improve lung protective protocol adherence. Conclusion There are growing opportunities in the healthcare ecosystem to impact care through the integration of data and technology. Specifically, hospitals and health systems can look to leverage telehealth in high acuity environments where not only patient acuity, but the cost of care, are highest. However, to realize the potential, data must be transformed into insightful information and then integrated with technology to produce clinical decision support tools and collaborative workflows. Hospitals and health systems should consider tele-ICUs partnerships to navigate the complex data, technology, staffing and operational infrastructures necessary to optimize proactive patient care delivery and improve patient outcomes.