The crew from Lehigh Valley presented their experience creating a telemedicine system called aICU (advanced ICU). John Sokalsky lead off, describing how their aICU concept leverages intensivists and critical care nurses in a remote location to serve more ICU patients. The system improves outcomes and reduces costs - always good things. This system integrated their CPOE, meds administration, real-time documentation charting and medical device data via a critical care information system, and finally a camera/digital video system. The strategic initiative was to create and implement an off-site “tele-intensivist” program. This program provides round-the-clock intensivist coverage of critical care units throughout their health care system. Results showed improved patient outcomes and reduced overall costs by managing changes in patient conditions quickly and effectively.
The project was lead by Stephen Matchett, MD, Chair, and Project Sponsor, and included the following team members:
- I/S Applications and Administration
- Clinical Services Administration and leadership
- Respiratory Therapy
- Administrative Planning
- Clinical Engineering
- Others invited on as needed basis
The Lehigh Valley system is based on an application from iMDsoft. Device drivers for legacy devices (or devices that do not include connectivity) use serial device drivers written by iMDsoft. Patient context for devices with serial interfaces was done by bed location. [This works fine for an ICU implementation where patients rarely move - connectivity on devices connected to lower acuity patients should establish patient context in the device.] Data was received from devices with built in connectivity (via integrated network support) via HL7 from the device vendor's HL7 server.
They use HP OpenView to monitor device connectivity as far as the Lantronix terminal server for serial-based devices. Devices with network connections can be monitored by OpenView up to the medical device vendor's server. The links between the device and the next step (term server or device vendor's server) is not visible to IT for monitoring. They usually get warning from biomedical engineering when new devices or firm ware upgrades, and test in advance of deployment.
An interesting part of their description of the project includes a test environment. During deployment, this environment was a “simulated ICU" that includes back to back TNICU/MICU beds in test, and four additional beds at remote ends of the ICU. Beds were added until the first twenty eight ICU beds were online. This required continuous coordination with Facilities and Bed Management. As the first 28 bed unit prepared to go live, additional units were subsequently wired & placed in test. This approach offered the following advantages: facilitation of training by department prior to "go live," and identification and correction of system, device and workflow issues. Once fully deployed, they use spare devices (they're usually available) to create a test environment as needed.
Surprisingly, they've had problems with some vendors getting the data required to develop a serial port device driver.
Christina Roberts, on the IT side, talked about the nursing and clinical engineering relationship. At Lehigh Valley, the IT department facilitates the coordination between nursing and biomedical engineering. The IT department takes calls 24x7 and provides tier 1 support for the aICU (and other clinical information systems). Depending on the problem, they will call biomedical engineering.