The video camera scans the room showing a fragile woman lying in the ICU bed in Guam. The Tripler Army Medical Center doctors talk about how sick she is as they zoom in with the camera and scan the bags hanging on the IV Pole. After much discussion with the Internal Medicine physician at Naval Hospital Guam, the Tripler intensivists make several well-received recommendations to the Guam doctor. He immediately goes into action ordering some of the recommended procedures. The woman is in the virtual hands of quality specialists more than 3000 miles away from her in Hawaii. Tripler's eICU solution is doing its job of pushing levels of quality health care to the forward edge of the battlefield.
"This system is HIPAA-compliant and FDA-approved", stated a smiling Col. Dr. Benjamin Berg, Tripler's Residency Director of Internal Medicine and Medical Director of the eICU solution at Tripler. "Basically, it is one big telephone line called a T-1 line that allows us this unprecedented access to improve the quality of care we can provide."
"The eICU solution allows telecommunications technology to improve patient care and overcome geographic barriers by linking patients to experts in military medicine", stated Dr. Stanley M. Saiki, Jr., M.D., director of Pacific Telehealth & Technology Hui, a DoD/VA joint venture. "Research projects of this kind demonstrate how such advances can benefit military and civilian patients in remote, isolated settings."
Tripler is the sixth medical centre in the United States to install the eICU solution, the first military hospital to conduct patient-care activities, and the first one to hook up with another hospital more than 3000 miles away. Guam, a territory of the United States, does not have any intensivists. In the past, the only option for primary-care physicians or other specialists on Guam was to contact Tripler specialists for advice and recommendations via phone and e-mail.
"This is so much better", Col. Dr. Berg stated. "We can see and speak with the patients if we need to, we can speak directly with the doctors and nurses, and also have the patients' labs and other information we need to make a differential diagnosis right at our fingertips."
Col. Dr. Berg and other specialists use the equipment, which consists of computer monitors, microphones and video cameras, to see and hear what is happening with patients more than 3000 miles away. Grand Consult rounds take place at noon Hawaii time, which is 8 a.m. tomorrow on Guam. "It enhances the quality of the interaction and brings a more robust quality of health care to the people of Guam", he stated.
"The system is great", stated Navy Lt. Dr. David J. Krause, U.S. Naval Hospital, Guam. "At first, I didn't know quite what to expect. I thought it would be more of an intern/attending physician relationship but it is a very collegial relationship. I am treating critically ill patients having the knowledge we can talk to intensivists at Tripler", Lt. Dr. Krause stated. "We've already seen it has improved patient care. I have found it helpful to have critical care assistance available in this format."
The prime contractor in this project is TREX Enterprises Hawaiian Operations, according to Donald A. Hudson, Pacific Telehealth & Technology Hui's project manager of the electronic ICU initiative. "From my perspective, the Hui focus is facilitating collaboration between DoD and private enterprise to develop and implement innovative solutions for extending the reach of critical-care expertise", Mr. Hudson stated.
There is a big push in Quality Assurance (QA) to have intensivists available for critically ill patients, according to Col. Dr. Berg. "The QA concept is to push the expertise further forward and that is exactly what Tripler staff is doing. There are not enough intensivists in the world to be present in every ICU area."
Col. Dr. Berg assisted one internist in Guam through a Right Heart Catheterisation by talking him through the procedure as he watched the doctor on the computer screen. U.S. Naval Hospital, Guam takes care of active-duty and their families, Veterans, and civilian emergencies. As Tripler moves forward with this technology, more specialists will become involved. For example, patients with head traumas and bleeds would have a Tripler neurosurgeon present to offer options and recommendations to the doctors in Guam.
"We are going to be able to provide the same level of care across the medical system no matter where we are physically", Col. Dr. Berg stated, "and that improves patient outcomes. It is a win-win situation for physicians and patients alike."
VISICU Inc., a privately held company founded in 1998 by two intensivist physicians, is headquartered in Baltimore, Maryland. The eICU solution enables hospitals to standardise ICU care across multiple hospitals and leverage scarce intensivist talent. From a centralised eICU, intensivists and nurses monitor and care for ICU patients through a high-fidelity telemedicine network, that has been likened to air traffic control.
Proprietary software is used to proactively manage patient care and electronically connect the patient to the doctor, 24 x 7. A Cap-Gemini E&Y study of the eICU system proved the clinical and financial benefits and the eICU solution is currently the only technology solution that enables hospitals to meet the Leapfrog Group's ICU patient care safety standards. VISICU won the 2001 Healthcare Informatics and Technology Award and in 2002 the eICU was recognised as one of the Top 100 technical innovations by InfoWorld magazine. More news on VISICU can be found in the VMW June 2003 article Saint Luke's Health System invests in VISICU's eICU patient safety solution.