Using electronic medical record notes to measure ICU telemedicine utilization

• Published in: Journal of the American Medical Informatics Association : JAMIA Vol. 24; no. 5; pp. 969 - 974
• Main Authors: O’Shea, Amy MJ, Vaughan Sarrazin, Mary, Nassar, Boulos, Cram, Peter, Johnson, Lynelle, Bonello, Robert, Panos, Ralph J, Reisinger, Heather S
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-09-2017
• Subjects: Case Reports; Electronic Health Records; Hospitals, Veterans; Humans; Intensive Care Units - organization & administration; Midwestern United States; Organizational Case Studies; Telemedicine - utilization; critical care; telemedicine; United States Department of Veterans Affairs; veterans; intensive care units
• ISSN: 1067-5027; 1527-974X
• DOI: 10.1093/jamia/ocx029

Abstract
Given the complexity of high-acuity health care, designing an effective clinical note template can be beneficial to both document patient care and clarify how telemedicine is used. We characterized documented interactions via a standardized note template between bedside intensive care unit (ICU) providers and teleintensivists in 2 Veterans Health Administration ICU telemedicine support centers. All ICUs linked to support centers and providing care from October 2012 through September 2014 were considered. Interactions were assessed based on initiation site, bedside initiator, contact type, and patient care change. Of 14 511 ICU admissions with teleintensivist access, teleintensivist interaction was documented in 21.6% (N = 3136). In particular, contacts were primarily initiated by bedside staff (74.4%), use increased over time, and of contacts resulting in changes in patient care, most were initiated by a bedside nurse (84.3%). Given this variation, future research necessitates inclusion of utilization in evaluation of Tele-ICU and patient outcomes.