The delivery of health-related services and information has considerably changed over the years. Most recently, telehealth has emerged as one of the newest and most promising frontiers in the delivery of health-related services and information. The term “telehealth” refers to the exchange of electronic health information via telecommunication technologies with the purpose of enhancing the health situations of consumers located in distant geographical locations. Telehealth is being applied in several areas of health care. This paper shows how the advantages of tele-ICU by far surpass its disadvantages. It further describes why the cost-effectiveness of tele-ICU depends with factors such as location, hardware and software systems, the tele-ICU staff training, and its ease of integration with other systems. It also demonstrates why the security concerns in tele-ICU can be adequately addressed by HIPAA regulations. Finally, it points out the need for new laws that would govern tele-ICU, as it is an emerging field not adequately covered by laws governing the administration of most traditional health care.
Telehealth in the ICU Setting
Telehealth is one of the newest and promising frontiers in the delivery of health-related services and information. The application of telehealth in the ICU setting is increasingly being adopted because of the great benefits realized from it. This paper focuses on the application of telehealth in the intensive care units (ICUs). The paper specifically discusses the advantages, disadvantages, financial aspects, security concerns, and legal considerations in the application of telehealth in the ICU setting.
Advantages of Tele-ICU
The application of telehealth in the ICU setting, commonly referred to as tele-ICU, is continuously increasing because of the great benefits realized from its application. First, tele-ICU has proved very important in the monitoring of a patient’s vital signs in real-time. The state-of-the-art audiovisual and computer systems used in tele-ICU are capable of immediately detecting the patient’s change in status that requires urgent nurse or physician attention (Goran, 2010, p. 47). Therefore, while a nurse or physician can be busy addressing the needs of one patient, the tele-ICU system can alert them to direct their attention to a more deserving patient in the ICU who requires immediate attention because of his or her deteriorating condition. In this case, it is evident that a tele-ICU acts as the second set of eyes of the physician and/or nurse because of its ability to provide additional clinical monitoring and support (Goran, 2010, p. 47). Second, the tele-ICU’s ability to instantly detect the change in patient’s vital signs and immediately alert the available nurses and physicians, has been instrumental in reducing and/or preventing potential adverse outcomes in patients, especially when a timely intervention within few minutes can make a significant difference. It is for this reason that tele-ICU, in collaboration with the bedside care teams, has helped reduce patient mortality rates in ICUs. Third, the tele-ICU has allowed the provision of support care to ICU patients without distractions. It therefore helps create an ICU environment that favors the patient’s recovery process. Fourth, tele-ICU technologies and systems have made it possible for the ICU teams to provide surveillance and support services for a considerably large number of ICU patients that are located in different geographical locations for several hospitals (Goran, 2010, p. 47). This capability of tele-ICU can be essential in reducing the gap in the provision of ICU support services due to the shortage of ICU teams in particular regions of the country (Schweickert & Rutledge, 2014, p. 4). Fifth, tele-ICU systems have helped provide improved safety by reducing error rates, and enhance ICU patient outcomes through standardization. The standardization is realized through the integration of a number of ICUs across the health care systems, thereby allowing the creation of a coordinated approach to proven or evidence-based practice (Fahey, 2013, p. 6). Such standardization can be helpful in addressing the inequalities in the delivery of support services to patients in ICUs, and the overall improvement in provision of ICU support. Tele-ICU has also been found to reduce the length of a patient’s stay in the ICU as it optimizes their recovery processes. The real-time monitoring of patient’s vital signs using tele-ICU systems has ensured that the patients receive timely care, which improves their recovery process. This shortens their recovery period, thus reducing their length of stay in the ICUs. Furthermore, tele-ICU can significantly reduce the chances of acquiring infections in ICU hospitals. Finally, tele-ICU has significantly improved communication between ICU staff as it creates an efficient communication network. Furthermore, ability of the tele-ICU system to integrate a number of ICUs across the health care system has improved the ICU staffs’ teamwork and supervision abilities, all of which contribute to the delivery of quality care to patients in ICUs.
Disadvantages of Tele-ICU
Although the adoption of tele-ICU has had various great benefits, its application has been associated with several challenges that have hindered the provision of quality support to ICU patients. First, tele-ICU is a relatively new approach of delivering care to patients in ICUs. As such, many bedside doctors and nurses are yet to fully comprehend how the tele-ICU system operates. For instance, some of them feel that they are being watched by the nurses and are subjected to intense visits in the tele-ICU command center. Furthermore, they have the feeling that the tele-ICU is taking over their jobs, thus, they do not support its full implementation or adoption (Hebda & Czar, 2008, p. 445). They are not aware that the application of telehealth in the ICU setting is in reality meant to ensure improved safety through redundancy, and further enhance outcomes through attainment of standardization. Second, some clinicians are finding it difficult to accept the tele-ICU technology, thereby hampering its full adoption in the provision of support to patients under intensive care. Moreover, it can potentially reduce the productivity of some clinicians who feel that the tele-ICU system is managing everything perfectly; hence, there is no need of fixing anything. There is need for awareness creation that emphasizes that tele-ICU systems are only meant to provide supportive role to physicians, nurses, and the bedside teams in the ICU setting. Third, the success of tele-ICU is largely dependent on the extensive integration of electronic health records in hospitals. Therefore, tele-ICU is of little value to hospitals lacking proper integration of health-related information, especially in situations where there are no any or meaningful electronic records. While the facilitation of any change in the adoption of tele-ICU can be complex, confusing, and time consuming, the need to educate providers, patients, families, and communities all require the allocation of additional resources, education, and even support over a considerable timeframe (Sevean et al., 2008, p. 417). The tele-ICU also requires a readily available and easy to use broadband access, and all the technology interfaces used in tele-ICU should be adaptable, easy to update, and highly compatible with other systems (Fisher, 2013).
Although the adoption of tele-ICU can be highly beneficial, the greatest obstacles to its extensive adoption are the investment needed to put the system in place, and its subsequent high maintenance costs. The expense of getting the tele-ICU system may be prohibitive. Hospitals that that have already put this system in place would also incur high maintenance costs, which in the long-term reduce the cost-effectiveness of acquiring the system. For hospitals that have already attained high standards of quality, its decision to make enormous investment in putting in place a tele-ICU system cannot be cost-effective as the marginal benefits accruing from such an investment would be insignificant. However, it is sometimes difficult to determine the cost-effectiveness of a tele-ICU system as its long-term benefits is not often clear. The reason for this is that the cost of tele-ICU can differ considerably depending on its setting, hardware and software systems, the user’s training, and its compatibility with other systems used alongside it (Vinson et al., 2011, p. 271). Its ability to generate revenue is determined by the extent to which it can reduce the length of stay, thereby creating the opportunity to care for a newly admitted ICU patient.
The use of tele-ICU has raised security concerns regarding the confidentiality and/or privacy of health-related information, especially during transmission over wireless networks. Addressing the security and confidentiality concerns surrounding the exchange of patients’ health-related information is crucial in ensuring widespread acceptance of the tele-ICU system by consumers (Hebda & Czar, 2008, p. 444). The privacy of patient-identifiable information exchanged via the tele-ICU systems should be maintained in accordance to the Health Insurance Portability and Accountability Act (HIPAA) regulations and the state privacy laws. The variation in state privacy laws can bring about challenges in upholding consumer or patient confidentiality in cases where the tele-ICU system has integrated multiple ICUs across several states. The extent to which clinicians have the right to use the patients’ information in studies is also unclear. The degree to which a patient can control the use of his/her health-related information is also not well defined.
The increased adoption of tele-ICU in the delivery of care to patients in ICU setting in recent years has raised three major legal questions. The first key regulatory question that is at the center of the health care practice is whether the support provided electronically through tele-ICU qualifies to be an actual practice of health care (Hutcherson, 2001, p. 4). Although tele-ICU is highly interactive, the lack of “hands on” activities is behind the misconception that tele-ICU is not a health care practice. This question mainly seeks clarification whether tele-ICU care is being provided within the scope of ICU practice as permitted by the state laws regarding provision of care to patients who are in ICUs. The second regulatory question seeks clarification on the dilemma whether the jurisdiction over tele-ICU will remain in the sphere of States Rights provisions, as it has been in most traditional health care, or it would be governed by the federal provisions because it can entail interstate commerce as the tele-ICU system can integrate ICUs across several states (Hutcherson, 2001, p. 4). The federal government has previously used the interstate commerce clause to gain more control or authority over the administration of public health in the United States (U.S.). The legal debates whether tele-ICU is within the jurisdiction of state or federal provisions can negatively affect the delivery of care to patients in ICUs through tele-ICU systems integrated across the states. The third legal question affects health care and other electronic service and business. This is due to lack of a clear law or body of information that addresses the question on whether the tele-ICU care is legally provided where the patient is geographically situated or at the providers’ location (Hutcherson, 2001, p. 4-5). This further raises questions on where the patient would seek recourse in case of occurs any malpractice or provision of substandard care.
In conclusion, it is evident that tele-ICU is emerging as a very important frontier in the provision of support to patients in ICUs. It is also clear that the advantages of tele-ICU by far surpass its disadvantages. Furthermore, the financial aspects of tele-ICU vary with setting, hardware and software systems, the tele-ICU staff training, and its compatibility with other systems. Finally, while the security concerns in tele-ICU can be adequately addressed by HIPAA regulations, there is need for new laws that would clearly determine whether tele-ICU would fall under the States or Federal Rights provisions.
Fahey, A. J. (2013). Tele-ICU: State of the art care. Ohnurses.org.
Fisher, V. (2013). Nursing considerations and the future of telehealth (Chapter 5).
Goran, S. F. (2010). A second set of eyes: an introduction to tele-icu. Critical Care Nurse, 30(4), 46-54.
Hebda, T., & Czar, P. (2008). Handbook of informatics for nurses & healthcare professionals. 4th ed. Upper Saddle River, New Jersey: Pearson Prentice Hall.
Hutcherson, C. M. (2001). Legal considerations for nurses practicing in a telehealth setting. Online Journal of Issues in Nursing, 6(3), 1-7.
Schweickert, P & Rutledge, C. (2014). Telehealth nursing education: the time is now. Virginia Nurses Today, February-March-April 2014, 4.
Sevean, P., Dampier, S., Spadoni, M., Strickland, S., & Pilatzke, S. (2008). Bridging the distance: educating nurses for telehealth practice. The Journal for Continuing Education in Nursing, 39(9), 413-418.
Vinson, M. H., McCallum, R., Thornlow, D. K., & Champagne, M. T. (2011). Design, implementation, and evaluation of population-specific telehealth nursing services. Nursing Economics, 29(5), 265-277.