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ICU – Clinical decision support and telemedicine may save money

par Lauren Dubinsky, Senior Reporter | December 19, 2016
Health IT
From the December 2016 issue of HealthCare Business News magazine

Implementing an EMR is a costly and cumbersome process, but the decision support tools are only a small fraction of the overall expense. In addition, the return on investment is high. If you prevent medical errors or identify a patient with sepsis early, that avoids prolonged ICU stays on the ventilator, which essentially pays for the decision support tool, says Frassica.

Another option
Philips is not the only company that offers these tools. The clinical information systems company iMDsoft offers an ICU decision support tool called MetaVision. A study conducted at Paul Brousse Hospital in France that was published in June 2014 found that MetaVision reduces the length of stay in the ICU by 20 percent. “We need decision support to help us make the right decisions at the right time,” Frassica says. “Decision support will never replace the physician or the nurse at the bedside, but it will make us better clinicians and [we’ll be able] to follow guidelines in a more reproducible way.”

Are tele-ICUs cost-effective?
A University of California-Davis study published in Critical Care Medicine in January found that telemedicine in the ICU is cost-effective. Tele-ICUs allow clinicians to remotely monitor critically ill patients from a central station. “Tele-ICUs partially compensate for the absence of on-site intensivist expertise [physician, nurse, pharmacist], and offer additional clinical surveillance and support as a ‘second set of eyes,’” says Byung-Kwang Yoo, lead author of the study and associate professor of public health sciences at the university. Tele-ICUs can cost between $70,000 and $92,000 per bed in the first year, and between $34,000 and $53,000 per bed in subsequent annual operating costs, according to the study.

Yoo and his team applied mathematical modeling to costs and benefits on data gathered from multiple tele-ICU studies. The health benefits were calculated in quality adjusted life years (QALYs), which takes into account quality and length of life. The researchers concluded that a tele-ICU would be cost-effective if the incremental telemedicine-related costs to extend a year of life for one patient were less than $100,000 per QALY. “It is straightforward to judge that the tele-ICU is costworthy if it is reducing both cost-perpatient and mortality in [the] ICU,” says Yoo.

James Laskaris, clinical analyst at MD Buyline, says that the starting salary for an intensivist is $200,000 per year. He adds that not many 100- or 200-bed hospitals can afford to have three or four intensivists on staff. The study also found that ICUs with fewer resources and less access to critical care health providers would most likely benefit the most from a tele-ICU. “Our model assumed that [those ICUs] had a higher ICU mortality before introducing tele-ICU,” says Yoo. “Our model also assumed that these ICUs will have a greater magnitude of mortality reduction after introducing tele-ICU.”

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