Electronic Intensive Care Unit More patients and better outcomes?

by David Orenstein free-lance writer

A common lament about information technology is that automation displaces workers. In Houston, however, the Memorial Hermann Healthcare System has made a major technology investment to compensate for a lack of available workers. The short-staffed system is deploying a sophisticated telemedicine system so that the few intensivists it has managed to hire can closely watch acute care beds in several hospitals around the clock.

Patients under the constant supervision of intensivists have better outcomes—lower mortality and shorter length of stay—than patients who are not, says Dr Liza Weavind, medical director of Memorial Hermann’s electronic intensive care unit. “Unfortunately, there are very few intensivists,” Dr Weavind says. The best way to use those highly specialized physicians is to have them monitoring patients from a well-wired, mission control-style room in Memorial Hermann’s central office. “If I were an intensivist at bedside, I could look after, at the maximum, 20 patients in one hospital. With eICU, I can look after 100 patients in three hospitals.”

In the eICU, a team of physicians and critical care nurses can see all the monitors and other information they would see at a patient’s bedside. They also have “Smart Alert” software that can analyze the data and warn them if a patient’s numbers start a worrisome trend. When an intensivist doesn’t like what’s on the bank of monitors at his workstation, he can spring in to action. He can turn on a camera to visually examine the patient, talk to nurses at the patient’s bedside and assist them in addressing the patient’s needs, and contact the patient’s primary physician for consultation, all while allowing the nurse to continue giving care without distraction.

The eICU is well-integrated into Memorial Hermann’s other patient systems. Intensivists have access to patient lab results, as well as patient images such as X-rays, CT scans, and ultrasounds.

Memorial Hermann signed the deal to buy the system from Baltimore-based VISICU Inc in 2003. The system was scheduled to have reached 100 beds in three hospitals by February, about a year after installation began. By full deployment, scheduled for the end of 2006, the eICU will monitor all 276 acute care beds in the hospital system. Memorial Hermann claims to have the only system of this kind in Texas.

The cost of the eICU—the hardware, software, and network installation—will reach about $6.5 million, Dr Weavind estimates. This does not include the system’s operating costs, the staff’s salaries, or the training required for the eICU staff and the on-site care providers. Neither physicians nor patients are charged for the system. Instead, Memorial Hermann pays for it as a “patient safety initiative,” Dr Weavind says.

The system has been well worth the cost, based on the “remarkably impressive” anecdotal evidence in the system’s first year, she says. The system seems to be preventing emerging problems from becoming complicated, costly, and even tragic.

For example, Dr Weavind cites how the system has helped physicians diagnose cases of Heparin-induced thrombocytopenia syndrome. The eICU software can display trends in platelet counts graphically, making it easier to see precipitous drops than by looking at rows of numbers. If the platelets drop, physicians have a means to establish an early diagnosis, especially because the software “knows” whether a patient experiencing a platelet drop is taking Heparin. In one case, a patient did not have to lose the limb because the eICU allowed for quick intervention.

Saving an arm—regardless of the cost—is always a good outcome, but it also is good business. “Insurance companies are very wary and looking into secondary adverse events that occur with patients in the ICUs,” Dr Weavind says. “One of the roles of the eICU is to constantly monitor our critically ill patients in an attempt to prevent or ameliorate these adverse events.” That’s worth a try.

The author of this monthly column, David Orenstein, is a technology and business writer in Silicon Valley. To learn more about a technology topic in Computing Care, email him at davealli@comcast.net.