Remote Proactive Physiologic Monitoring in the ICU

Abstract

Critical care is undergoing a sea change as intensivist access is inadequate to meet current and future demand for specialist services, while the amount of data involved in critical care plans continues to increase markedly. Heralded by similar changes in nonmedical industries due to increased digital computing power and secure data storage capability, healthcare (and critical care in particular) is rapidly becoming influenced by the rise of remote proactive physiologic monitoring (RPM) technologies that provide enhanced remote specialist access and clinical decision support through a variety of hardware devices and analytic software platforms. While still relatively early in development, RPM technologies are already radically changing the landscape of critical care delivery through individual use cases as well as collective, integrated platforms. Centralized monitoring tele-ICU systems are enterprise-level, end-to-end platforms offering improved clinical outcomes through use of robust clinical information systems that allow early recognition of disease and proactive intervention. Downsides include a high investment of resources and extended time to implementation. Decentralized tele-ICU systems are versatile and relatively inexpensive systems that mirror the bedside experience at the expense of an integrated analytics platform. Artificial intelligence, data science, and related disciplines continue to provide advances in predictive analytics by leveraging the power of machine learning algorithms such that critical care delivery through RPM technologies has made an “Internet of ICU Things” a realistic possibility. Institutions looking to utilize RPM technologies and/or a full tele-ICU program should be keenly aware of impacts upon remote and bedside clinicians and seek to integrate such technologies with legacy systems and minimize interdepartmental technology variations. A strong emphasis on interoperability and compatibility within new and existing technologies and together with clinical operations and workflows is crucial for success.