Advocate Health Care, one of the largest accountable care organizations in the country, has been using telemedicine technology in its hospitals’ intensive care units and emergency rooms to deliver on the goals of population health, including to improve care and reduce costs. The innovative tele-ICU supports organizations, especially those with limited clinician resources, most especially in the evenings and on weekends.

Technology optimizes the workflows through which the organization can deliver evidence-based medicine to patients, said Michael Ries, MD, medical director of critical care and the eICU at Advocate Health Care. Ries spoke today at the 2016 HIMSS and Healthcare IT News Pop Health Forum in Chicago during a session entitled “Tele-ICU Drives Clinical and Financial Success at Advocate.”

“A tele-ICU can improve clinical outcomes and reap financial benefits for a large health system,” Ries said. “But it’s not the technology that achieves the benefits, it’s how you use the technology you have that garners the improvements.”

Advocate’s tele-ICU relies on a variety of evidence-based protocols to enhance and improve care, and the telemedicine technology helps caregivers in real time maintain compliance with these protocols.

“We had to create an electronic tool to enable this,” Ries said. “EHRs are wonderful tools, but progress notes are just what is happening to a patient at one point in time. So we created an electronic tool to give us a fluid assessment of what is happening over time. We get a report sheet, and whenever there is an entry, you can see the time and date has changed, and we use the report sheet to create an electronic checklist.”

So, for example, there are six components to an ICU ventilator bundle. Twice a day, tele-ICU nurses run through the bundle checklist, and if there is an omission, they get a tele-ICU physician to complete an order.

“We first started looking at our ventilator length of stay for our ventilator patients,” said Cindy Welsh, RN, vice president of adult critical care and medical professional affairs at Advocate Health Care, who co-presented at the forum with Ries. “Overall, we pretty quickly reduced our ventilator ratio, which means we have patients off the ventilators very quickly. Most of our hospitals have managed to be below targets for ventilator days, and that comes back to communication and diligence around rounding and which patients are eligible to be deactivated off of ventilators.”

Welsh said the tele-ICU has reaped significant improvements and a few million dollars in savings.

“In 2015 compared with 2014, we had 352 fewer ICU days, which saved $300,000, and 331 fewer ventilator days, which saved $400,000, and we continue to strive for improvements year over year,” she said.

 More articles from the Pop Health Forum 2016 in Chicago: 
⇒ Triple Aim alone will never bend the cost curve
⇒ Secrets to engagement: Start with the patient and work backward
⇒ Healthcare providers chasing bright, shiny population health objects, expert says
⇒ Reality check: Population health on today's IT
⇒ Population health is here, but can the care delivery system keep up? 

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

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