Tele-Treatments

The Boston Globe
November 19, 2007

WORCESTER - On a recent Saturday night, Dr. Craig Lilly studied a wall of video screens monitoring the heart rates, urine output, and breaths per minute of fragile patients in the intensive care unit.  One patient was clearly in trouble.

Franklin Sisler, a retired Air Force master sergeant, was suffering from an aggressive infection in his left knee that had reached his lungs.  A blue line tracking Sisler's kidney function was climbing, a warning that his organs were failing, and Lilly decided he needed an operation right away.

He advised a junior doctor to give Sisler more fluid and antibiotics immediately, call in an infectious disease expert, and make sure Sisler got the next available surgery slot to clean out his knee.  "It might make the difference between him walking out of the hospital or not," Lilly told a colleague.

Lilly is an intensive care specialist, but he was seated not in the intensive care unit, and for that matter, not even in Sisler's hospital.  Rather, he was working out of a low-rise office building in downtown Worcester - 3 miles from where Sisler lay at UMass Memorial Medical Center.  From this carpeted, flourescent-lit support center, called an "eICU," Lilly  and his nurse practitioner Joanne  Lewis were suprevising the care of 109 of UMass Memorial's sickest patients, scattered among eight ICUs at three of the system's hospitals.  They are part of a new program that aims to cope with the soaring number of ICU patients, a problem exacerbated by a shortage of intensive care specialists.

There are 20 percent more ICU beds nationwide now than there were 10 years ago, and too few doctors trained to care for the patients filling them.  The vast majority of hospitals do not have an ICU specialist working at night or on weekends, despite studies showing that when intensive care doctors manage or help manage ICU patients, the patients' chances of dying in the hospital  decrease by 30 percent.

... The emergence of eICUs shows that so-called "telemedicine" has reached a point  where specialists trust it enough to make real-time treatment decisions for the sickest patients.

"This is a technology that enables us to practice better medicine," said Wendy Everett, president of the New England Healthcare Institute, a nonprofit research organization in Cambridge that wants to expand eICUs across the state and plans to study whether the improve survival rates for patients and reduce medical costs. 

Link to Full Article: http://www.boston.com/business/globe/articles/2007/11/19/tele_treatment/