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Telemedicine in Critical Care: the Doctor is Always In

September 02, 2015

More than half of all U.S. hospitals use some form of telemedicine, according to the American Telemedicine Association, with each specialty applying its benefits in their own way. The development of Tele-ICUs has been an especially important innovation in critical care, as it helps us address the shortage of intensivists (doctors who work in the ICU) nationwide. While telemedicine isn’t meant to replace bedside doctors, it does help fill the gap at facilities that cannot support a doctor or intensivist during certain times of the day. Instead of one intensivist at one critical care facility, telemedicine allows one physician to work across multiple facilities, using secure telecommunication technologies and mobile robots to remotely deliver health care. The physician works with the care team at the hospital to ensure patients receive the best of care, using one of two models for a Tele-ICU.

Two Models of Telemedicine

The first is the bunker model, where physicians and nurses use a central station to provide mostly reactive medicine by monitoring 100-250 patients, many of whom have medical conditions that include respiratory failure, pneumonia, gastrointestinal bleeding, heart attack and severe pancreatitis.

The second model, which Orlando Health uses, is an individual mobile model that’s more proactive. We have robots at several of our facilities. We refer to them as “RoboDocs”. They can be driven through secured internet connections via multiple types of portable control stations. Currently this includes desktop or laptop computers, iPad’s and most recently, iPhones. We have the capability to utilize RoboDoc’s digital stethoscope. The patients and their families can actually see us via a live stream on the robot’s computer screen. We can deliver care as long as there’s Internet access or a hotspot connection, and patients can communicate directly with us by speaking to the Robodoc. These technologies can go anywhere and are accessible any time we are needed.

Using telemedicine, we can admit patients directly from the emergency department or operating room and take rapid responses from the floor. The way we provide care is no different from how we would do it in-person. We beam in and assess a patient, do a comprehensive examination concentrated on the affected organs, place orders, make ventilator changes and run codes or deal with most types of medical emergencies. We also communicate with our cardiac colleagues if the medical issue is heart-related or with our surgical colleagues if their expertise is needed.

Benefits of Telemedicine

Telemedicine has significant benefits, though some have questions about it. We’ve become accustomed to face-to-face contact in a doctor’s office or hospital, but in some cases this may not be possible, especially with patients who are immobile or live in very remote or rural areas. That’s why a centralized approach or one that uses digital technology works well. We also rely on nurses, who help patients understand the technology. Nurses give them a heads up that the robo-docs will be coming to the hospital or facility to provide care, which lets them feel more comfortable.

Technology has changed every area of our lives, so it’s only natural that it would have an impact in health care. The quality of the machines and technology we use is so advanced that we are able to appraise patients as if we were physically there. I believe telemedicine will only become more widespread and capabilities will broaden as technology becomes more sophisticated. The creation of Tele-ICUs lets us give patients the same level and quality of care they’d get face-to-face and allows us to be there for them when they need us most.