The Tele-ICU: Formative or Out-of-Date or Both? Practice Models and Future Directions

Abstract

The tele-ICU concept is almost one-half century old and commercially operational for nearly two decades. The initial “driver” for the development was the critical care physician shortage with the tele-ICU providing a mechanism to “leverage” physicians over greater geography and numbers of patients. Subsequently, the tele-ICU model has become very well established and functional. This chapter reviews the history, process, and functional models and more recent evolutionary changes. But, the health environment is changing dramatically. Staffing models are now transitioning to include more advanced care providers with recent use of extremely remote staff to “turn night into day.” The supply of critical care capable physicians and advanced care providers is changing such that the shortage may disappear in less than a decade. Reimbursement for tele-ICU critical care time has not evolved, while federal and commercial payment plans have changed dramatically. Virtual hospitals are developing which include tele-ICU services with a broad array of supplemental services. Educational programs taking advantage of telemedicine technology have arrived. Perhaps it is time to reconsider whether free standing tele-ICUs should continue or evolve into horizontally or vertically scaled programs, addressing the “population health” goals while providing a broader range of services including outreach care provider education along the model of Project ECHO.