Advocate Health Care, Oak Brook, Ill., established its eICU telemedicine program in 2003. Eight years later, it's still tweaking the program—and still working to assert the program's value to clinical staff.
The continual evolution of information technology—and, of more importance, IT's use in a clinical setting—was a major theme in “Achieving Clinical Value in the ICU with Strategic IT Utilization,” a presentation from Advocate executives Dr. Michael Ries and Cindy Welsh.
“All we hear about is IT,” said Ries, Advocate's medical director of adult critical care and eICU and an assistant professor of medicine at Chicago's Rush University. But “you cannot bring it in and expect it to change your organization.”
Advocate encountered push-back from some physicians and nurses as well as interoperability issues in implementing its eICU, through which remotely located board-certified critical-care physicians aid on-site intensive-care unit doctors and nurses in monitoring patients 24 hours a day, seven days a week.
The single most important factor for buy-in from doctors is perceived usefulness of a technology, Ries said, and some of the doctors and nurses who work at Advocate facilities not only doubted the value of adding a layer of remote monitoring to ICU patient care but also expressed some resentment at involving additional staff in the clinical decisionmaking process.
“When it comes to clinical decision support, now you're taking away something that puts that physician, that nurse on a pedestal,” Ries said. Doctors and nurses derive prestige from their experience and training, and older physicians and nurses in particular have a difficult time allowing for someone who is not on-site and who may have less experience offering treatment suggestions based on the patient diagnostic images and vital signs that he or she is monitoring.
In reality, “we're not taking anything away; we're just giving them more time to do what they do best,” Ries said. “As one physician said, (through the program) we sort of cover their backs.”
