Trans-border ICU

Physicians and nurses in a Delaware command center will monitor intensive care unit (ICU) patients in six Maryland hospitals as part of the Maryland eCare initiative. From the Washington Post:

The program, funded with a $3 million grant, "allows us to provide the same high level of care at 2 in the morning as we provide at 2 in the afternoon," said Maryland eCare Director Marc T. Zubrow, director of critical care medicine at Wilmington's Christiana Care Health System, where the critical care doctors will be based. "It's about crisis prevention rather than crisis response."A video camera and computer terminal positioned in a patient's room will send vital signs, test results and information about patient responsiveness to Wilmington, where a doctor and several nurses will view the data and photographs on high-resolution computer monitors.If command center staff members see the patient's health deteriorating, they can communicate with nurses to provide medicine or additional tests...The technology, known as eICU, was developed by Baltimore-based Visicu, a medical technology company, and is used in about 200 hospitals throughout the country.

This initiative is interesting in its own right, because it's extending the telemedicine concept beyond its typical bounds. However, the implications are potentially quite profound:

• If people are comfortable with the idea of monitoring ICU patients from 50 or 100 miles away, they should be equally comfortable with a distance of 5000 or 10,000 miles. The communications links are just as good to Asia as they are to Delaware, so why not have doctors and nurses there monitoring the ICU? Actually, it could be better. When it's 2 am in Maryland (and Delaware) it's 2 pm in Singapore and Manila, when people are wide awake. What's more, labor costs are a lot lower. At this point the barriers are more regulatory in nature than anything else.
• The concept could and should be extended to the emergency department as well. We increasingly hear that specialists, such as neurologists, are refusing to take call in emergency departments. With modern communications technology much of what a neurologist does could be done remotely. At a minimum it could cut down on the number of in-person staff needed.
• Younger physicians are increasingly seeking to limit their total number of hours at work. (The Wall Street Journal wrote about it today.) That's a change from the medicine-is-everything attitude of earlier generations and it's exacerbating the shortage of staff. On average, female physicians want to work fewer hours than men, especially those that want to have kids. Perhaps there's an opportunity to tap into some underutilized resources by providing telemedicine work for stay-at-home moms and dads.

Radiology has paved the way with the "nighthawk" concept, and while there are definite advantages to in-person care, more specialties than one might initially expect can conduct at least some of their patient care activities remotely.