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Ga. hospitals experiment with telemedicine to ease critical care shortage

While a handful of U.S. healthcare systems have ventured into using technology to treat patients who are abroad, a group of hospitals around Atlanta is taking a different route.

They are using video conferencing and remote monitoring of vital signs to treat intensive care patients in Georgia hospitals, from Australia.

The experiment comes as hospital officials are increasingly interested in using telemedicine to move away from having doctors in the same room, or even in the same country, as their patients.

A third of more than 100 hospital officials and other healthcare executives said in a 2017 report by law firm Foley & Lardner LLP's telemedicine practice that they were interested in providing telemedicine care abroad, and 80% of them said they wanted to start in the next three years.

The interest was partly due to spotty reimbursement for telemedicine in the U.S., the report said. In comparison, wealthy patients in China and the Middle East are willing to pay in cash to get a second opinion from a U.S. specialist or have their radiology results analyzed.

Saving money for healthcare systems

More broadly, hospitals are increasingly turning to telemedicine as a way to provide greater convenience to patients while saving money.

Healthcare facilities can save money by having a specialist in one location monitor the vital signs of intensive care patients at several facilities, Karsten Russell-Wood, head of global marketing for Philips Patient Care Analytics, told S&P Global Market Intelligence.

It saves the cost of having to transport patients from one location to another, or having in-house specialists at each of the hospitals, said Russell-Wood, whose company provides telemedicine technology to Emory Healthcare Inc. and several other healthcare systems.

In Atlanta, Timothy Buchman, founding director of Emory Healthcare's critical care center, said in an interview that he was trying to deal with a different problem through the technology — the looming shortage in critical care staff.

According to a 2013 study on Critical Care Medicine, just less than half of intensive care units, or ICUs, in the U.S. have an intensivist — physicians who specialize in critical care. Often, no intensivist physicians are on duty at night and on weekends.

And the situation is only going to get worse as more Baby Boomers age and develop serious health conditions, according to a 2006 report from the Department of Health and Human Services' Health Resources and Services Administration.

The report estimated that the nation would have only about 1,500 critical care specialists in 2020, less than half of the 4,300 needed.

Meanwhile, nurses, including those in intensive care units, are also expected to be in short supply. A 2013 survey by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers found that 55% of registered nurses are 50 years or older.

"Nurses with a great deal of expertise will be replaced by new novice nurses," Cheryl Hiddleson, director of the Emory Electronic Intensive Care Unit, said in an interview.

The trends would only exacerbate a shortage of experienced ICU staff at night and over weekends.

Turning night into day

A solution, said Buchman and Hiddleson, would be to have a specialist remotely monitor patients and by video conferencing supervise young ICU residents and nurses at Emory University Hospital in Atlanta and four other hospitals.

However, they could not find enough senior staff willing to work overnight.

"Somehow, we had to turn night into day," Buchman said.

SNL Image

Emory Healthcare's Tim Buchman monitors critical
care patients in Atlanta, from Perth in Australia.

Source: Emory Healthcare Inc.


In 2016, Emory Healthcare did just that.

They began sending an experienced doctor and a nurse on rotation to Sydney, where it is day when it is night in Atlanta.

After moving the program from Sydney to Perth in 2018, the Emory Healthcare staff has been communicating from an office at Royal Perth Hospital with doctors and patients back in Georgia on television monitors, and keeping track of critical patients on a panel showing their electrocardiography, blood pressure, and pulse oximeter.

Another panel shows alerts based on algorithms that track changes in blood pressure, and heart and respiratory rates.

Australia: a dream destination

Finding doctors and nurses for the eight- to 16-week rotation was easy.

"Many Americans dream about visiting Australia anyway," Buchman said.

SNL Image

Western Australia Health Minister Roger Cook from
Perth talks to critical care nurse Katie Casey in Atlanta.

Source: Emory Healthcare Inc.

Russell-Wood does not know if other hospital systems will follow Emory Healthcare's lead in dealing with the shortage in critical care staff by treating U.S. patients from abroad.

Internationally, there have been efforts like a venture announced in February 2017 between Cleveland Clinic and the telemedicine company Vigilint to provide travelers around the clock access to doctors by phone.

However, the Foley & Lardner study cautioned that hospitals that want to start offering telemedicine internationally face "the formidable and complex tangle of law and regulations governing telemedicine technology around the world."

Buchman said their approach avoided medical licensing questions by using Emory Healthcare staff.

U.S. regulators were not concerned because Emory Healthcare staff are treating their own patients.

"The Australian regulators said as long as we are not taking care of Australian patients, we don't care," Buchman said.

But domestically, Russell-Wood sees the program as an example of how hospitals are increasingly attracted by the cost savings offered by treating patients at several intensive care units from one location.

According to a Phillips Patient Care Analytics estimate, the number of U.S. critical care beds served by telemedicine has grown to 15,000 in 2017 from 598 in 2002.