Adoption of ICU telemedicine in the United States

Abstract

Objective: ICU telemedicine is a novel approach for providing critical care services from a distance. We sought to study the extent of use and patterns of adoption of this technology in U.S. ICUs.

Design: Retrospective study combining a systematic listing of ICU telemedicine installations with hospital characteristic data from the Centers for Medicare and Medicaid Services. We examined adoption over time and compared hospital characteristics between facilities that have adopted ICU telemedicine and those that have not.

Setting: U.S. ICUs.

Setting: U.S. hospitals from 2002 to 2010.

Interventions: None.

Measurements and main results: The number of hospitals using ICU telemedicine increased from 16 (0.4% of total) to 213 (4.6% of total) between 2003 and 2010. The number of ICU beds covered by telemedicine increased from 598 (0.9% of total) to 5,799 (7.9% of total). The average annual rate of ICU bed coverage growth was 101% per year in the first four study years but slowed to 8.1% per year over the last four study years (p < 0.001 for difference in linear trend). Compared with non-adopting hospitals, hospitals adopting ICU telemedicine were more likely to be large (percentage with > 400 beds: 11.1% vs 3.7%, p < 0.001), teaching (percentage with resident coverage: 31.4% vs 21.9%, p = 0.003), and urban (percentage located in metropolitan statistical areas with more than 1 million residents: 45.3% vs 30.1%, p < 0.001).

Conclusions: ICU telemedicine adoption was initially rapid but recently slowed. Efforts are needed to uncover the barriers to future growth, particularly regarding the optimal strategy for using this technology most effectively and efficiently.

Figure 1

Utilization of intensive care unit (ICU) telemedicine by year expressed as percentages of all United States hospitals (panel A) and percentages of United States ICU beds (panel B).

Figure 2

Geographic distribution of intensive care unit (ICU) telemedicine. The circles indicate hospitals with ICU telemedicine, with the size of the markers proportional to the number of intensive care beds for each hospitals. The markers are overlaid onto Dartmouth Atlas hospital referral regions, which are shaded according to the proportion of covered ICU beds in the region.