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Gaurav Kumar, MD; Peter Cram, MD, MBA
Author and Funding Information

From the Lakeshore Chest Center (Dr Kumar), Portage, IN; and the Division of General Medicine (Dr Cram), Iowa City VA Medical Center, University of Iowa.

Correspondence to: Guarav Kumar, MD, Lakeshore Chest Center, 3156 Willowcreek Rd, Portage, IN 46385; e-mail: gaurav-kumar@uiowa.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(4):1184-1185. doi:10.1378/chest.12-2709
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To the Editor:

We appreciate Dr Gorman’s interest in our analysis of the cost of telemedicine programs in ICUs (tele-ICUs).1 We agree that institutions must weigh the costs and benefits of implementing and operating a tele-ICU within their own health system. We also believe that greater access to truly transparent data about the costs and benefits of tele-ICU is critical if hospital administrators, third-party payers, and health-care policy leadership are to make sound decisions about whether to invest in this promising new technology.2

The review of the existing literature revealed strikingly few truly rigorous studies describing the costs of tele-ICU. Tele-ICUs may yield cost savings and cost avoidance through an array of mechanisms, but to assert these outcomes on isolated surrogate values results in savings that remain largely speculative. Furthermore, although the cost savings proposed by Dr Gorman may seem possible, data from organizations such as Advanced ICU Care and the New England Healthcare Institute/Massachusetts Technology Collaborative have yet to be published in their entirety in peer-reviewed sources, making it difficult to fully evaluate the methods and assumptions at work. As for tele-ICU effectiveness, there are certainly some data suggesting that tele-ICUs may have a marked impact on mortality, but other studies suggest far more modest effects.3,4

In the current era of fiscal austerity, new technologies will—now more than ever—need to be both clinically effective and cost effective. Without rigorous investigation, including the margins, responsible decision making could not be possible. If future studies support tele-ICUs in both these aspects, the technology could be truly transformative.

References

Kumar G, Falk DM, Bonello RS, Kahn JM, Perencevich E, Cram P. The costs of critical care telemedicine programs: a systematic review and analysis. Chest. 2013;143(1):19-29. [PubMed]
 
McCambridge MM, Tracy JA, Sample GA. Point: should tele-ICU services be eligible for professional fee billing? Yes. Tele-ICUs and the triple aim. Chest. 2011;140(4):847-849. [CrossRef] [PubMed]
 
Lilly CM, Cody S, Zhao H, et al. Hospital mortality, length of stay, and preventable complication among critically ill patient before and after tele-ICU reengineering of critical care processes. JAMA. 2011;305(2):2175-2183. [CrossRef] [PubMed]
 
Young LB, Chan PS, Lu X, Nallamothu BK, Sasson C, Cram PM. Impact of telemedicine intensive care unit coverage on patient outcomes: a systematic review and meta-analysis. Arch Intern Med. 2011;171(6):498-506. [CrossRef] [PubMed]
 

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References

Kumar G, Falk DM, Bonello RS, Kahn JM, Perencevich E, Cram P. The costs of critical care telemedicine programs: a systematic review and analysis. Chest. 2013;143(1):19-29. [PubMed]
 
McCambridge MM, Tracy JA, Sample GA. Point: should tele-ICU services be eligible for professional fee billing? Yes. Tele-ICUs and the triple aim. Chest. 2011;140(4):847-849. [CrossRef] [PubMed]
 
Lilly CM, Cody S, Zhao H, et al. Hospital mortality, length of stay, and preventable complication among critically ill patient before and after tele-ICU reengineering of critical care processes. JAMA. 2011;305(2):2175-2183. [CrossRef] [PubMed]
 
Young LB, Chan PS, Lu X, Nallamothu BK, Sasson C, Cram PM. Impact of telemedicine intensive care unit coverage on patient outcomes: a systematic review and meta-analysis. Arch Intern Med. 2011;171(6):498-506. [CrossRef] [PubMed]
 
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