Wednesday, April 21, 2010
Philips buys Visicu
AMSTERDAM, Netherlands – Royal Philips Electronics will acquire healthcare IT vendor Visicu in a $430 million deal, Philips announced today.
The purchase is a step towards Philips' goal of expanding its healthcare business. The Dutch firm bought Boca Raton, Fla.-based Emergin, a medical software provider, in early December.
Baltimore-based Visicu supplies medical services and systems for hospitals' intensive care units. The transaction includes $130 million cash representing an enterprise value of $300 million, or $12 per share, of Visicu, Philips said in a release.
"Philips is a market leader in patient monitoring systems in the hospital, so we know the challenges our customers face - rising patient numbers, staff shortages and concerns about patient safety," Steve Rusckowski, chief executive of Philips' Healthcare division, said in a release. "By investing in clinical IT solutions like those offered by Visicu and Emergin, we believe we can offer customers more attractive patient monitoring solutions that improve hospital productivity as well as patient outcomes."
Visicu's signature product is the eICU Program, which tracks ICU patients and provides monitoring of vital information. The tool also sends triggered "Smart Alerts" to clinicians treating the patients.
"Making these investments we believe will drive further growth in our patient monitoring business," Rusckowski added.
"Philips could leverage its extensive sales network for Visicu's products to boost its profitability and revenues," SNS Securities analyst Victor Bareno told Reuters. Bareno noted that Philips is paying an estimated 30 times EBITDA (earnings before interest, tax depreciation and amortization) for Visicu.
The deal is expected to close in the first quarter of 2008.
Hi Group, Attaching an email response I recieved from Dr Zubrow who is director at Christiana Medical Center which has eCare, their version of tele-ICU. Think these are things we can talk about if anyone asks questions about real-life system, or licensing/regulatory problems.
Hello Dr Zubrow,
Thanks for helping! I am a Nurse Practitioner in DC, and an MBA student at Hopkins. I am presenting information on E-ICU tonight and was hoping to use Christiana as an example of its success. Could you give me a little information about your system?
1. How many ICU beds do you have monitored by the eCare system? Up to 61 at Christiana and up to 36 in the Maryland eCare program
2. During which hours is the eCare monitoring vs the Hospital team? The nurses monitor 24/7 and an intensivist is there 7 pm until 7 am Mon.-Friday and 24 hours on weekends and holidays.
3. How do orders and notes become integrated in the medical record of the patient? Is there a shared CPOE/EMR between the two sites? Depends on the site and local IT situation. Some of the notes are electronically integrated into the local medical record, some are printed locally. Orders are placed utilizing the local CPOE if it exists, if not, they are type and printed locally in the individual ICU.
4. Who makes up the eCare staff? Nurses are all Christiana Care employees, the physicians are all casual pool (moonlighters) from a variety of places. Are Christiana personnel taking shifts? Yes, the nurses are sometimes shared staff positions and some of the local intensivists work shifts. Some of the nurses are full time for eCare. Or are they seperate staff from the hospital?
5. Do you provide eCare for beds at other hospitals? Yes, Google Maryland eCare for more information.
6. Are there any licensing or regulatory issues which are problematic if the eCare site is in a different state from the hospital where the patients are located? Yes, real and theoretic. All the Docs and nurses have local State licenses. The Docs must have DEA for each State in addition to licenses. All Docs must be credentialed at each individual hospital. There is the theoretical concern that a malpractice case would end up in federal court because of crossing State lines. I hope not to find out the real answer to that one!
Again, many thanks for any information you can provide. It will be nice to have some specifics about a real case to demonstrate the benefits of the technology.
Kristen Nelson
Hello Dr Zubrow,
Thanks for helping! I am a Nurse Practitioner in DC, and an MBA student at Hopkins. I am presenting information on E-ICU tonight and was hoping to use Christiana as an example of its success. Could you give me a little information about your system?
1. How many ICU beds do you have monitored by the eCare system? Up to 61 at Christiana and up to 36 in the Maryland eCare program
2. During which hours is the eCare monitoring vs the Hospital team? The nurses monitor 24/7 and an intensivist is there 7 pm until 7 am Mon.-Friday and 24 hours on weekends and holidays.
3. How do orders and notes become integrated in the medical record of the patient? Is there a shared CPOE/EMR between the two sites? Depends on the site and local IT situation. Some of the notes are electronically integrated into the local medical record, some are printed locally. Orders are placed utilizing the local CPOE if it exists, if not, they are type and printed locally in the individual ICU.
4. Who makes up the eCare staff? Nurses are all Christiana Care employees, the physicians are all casual pool (moonlighters) from a variety of places. Are Christiana personnel taking shifts? Yes, the nurses are sometimes shared staff positions and some of the local intensivists work shifts. Some of the nurses are full time for eCare. Or are they seperate staff from the hospital?
5. Do you provide eCare for beds at other hospitals? Yes, Google Maryland eCare for more information.
6. Are there any licensing or regulatory issues which are problematic if the eCare site is in a different state from the hospital where the patients are located? Yes, real and theoretic. All the Docs and nurses have local State licenses. The Docs must have DEA for each State in addition to licenses. All Docs must be credentialed at each individual hospital. There is the theoretical concern that a malpractice case would end up in federal court because of crossing State lines. I hope not to find out the real answer to that one!
Again, many thanks for any information you can provide. It will be nice to have some specifics about a real case to demonstrate the benefits of the technology.
Kristen Nelson
Tuesday, April 20, 2010
Updates
Hey team, I've transferred much of the references we had on the blog to the slides, so I think we're done with that, no one needs to spend time on it. I also find some pics on the web to add to the slides, just to liven things up.
Monday, April 19, 2010
Slide 12 - Implementation diagram
During our meeting we discussed slide 12 - implementation diagram of eICU. We didn't come to a conclusion whether to keep this diagram, replace it with another simpler document, or get rid of it all together. What does the group think?
Twitter Names
Hey guys i have tried to locate each and every one of you on Twitter and i think so has David. I keep on getting thousands of people with the same names. So here is an idea why don't we all post our user names on here so we can add the right person. My user name is TZBOSS.
Sunday, April 18, 2010
Today's Meeting 04-18-10
All,
I have reorganized the slides. Please review and check the order and reorganize if necessary. As discussed today lets go through a dry run on Tuesday @ 10:30. Call the conference number Carl set up 218-862-1000, password #137277.
~ Faiza Baluch
challenge section
Hi Pat,
I think the problem or challenge that the E-ICU addresses is the lack of availability of intensivists to provide 24 hour coverage for ICU patients. by monitoring many beds, at different sites with one ICU team--the need for intensivists is lessened, and all the patients have intensivist care around the clock. This is increasingly important, and has become a standard required by safety monitoring groups such as Leapfrog. Another problem it addresses is improved quality of life for the docs who won't be taking overnight call because they have E-ICU monitoring the patients. also hopes to improve early detection of problems like pneumonia by computerized algorithms which detect sublte changes in vital signs which might otherwise be missed. By preventing problems or intervening early--it hopes to shorten ICU time for patients--saving money and improving outcomes. I think you might be focusing more on the problems or challenges of the E-ICU system itself--I thought we were meant to define the healthcare problem that the system addresses.
I think the problem or challenge that the E-ICU addresses is the lack of availability of intensivists to provide 24 hour coverage for ICU patients. by monitoring many beds, at different sites with one ICU team--the need for intensivists is lessened, and all the patients have intensivist care around the clock. This is increasingly important, and has become a standard required by safety monitoring groups such as Leapfrog. Another problem it addresses is improved quality of life for the docs who won't be taking overnight call because they have E-ICU monitoring the patients. also hopes to improve early detection of problems like pneumonia by computerized algorithms which detect sublte changes in vital signs which might otherwise be missed. By preventing problems or intervening early--it hopes to shorten ICU time for patients--saving money and improving outcomes. I think you might be focusing more on the problems or challenges of the E-ICU system itself--I thought we were meant to define the healthcare problem that the system addresses.
Presentation: Challenges & Recommendations
What problems or challenges does it address? (Pat/David)
Challenge #1: Physician Resistance
1) The lack of availability of intensivists to provide 24 hour coverage for ICU patients by monitoring many beds, at different sites with one ICU team--the need for intensivists is lessened, and all the patients have intensivists care around the clock. This is increasingly important, and has become a standard required by safety monitoring groups such as Leapfrog.
2) It is improved quality of life for the doctors who won't be taking overnight call because they have E-ICU monitoring the patients. Also hopes to improve early detection of problems like pneumonia by computerized algorithms which detect subtle changes in vital signs which might otherwise be missed. By preventing problems or intervening early--it hopes to shorten ICU time for patients--saving money and improving outcomes.
3) ICU physician and nurses have to be accustomed with new technology under eICU systems.
4) Physicians tend to be more resistant to eICU intervention than nurses, because there are prevailing concerns about their expertise being questioned, turf conflicts, and a dislike of other physicians caring for their patients. eICU administrators consider this to be an unavoidable challenge that all hospitals must confront.
Challenge #2: Slow to Show Significant Improvement
1) Creating metrics for quality improvement is difficult and many uncontrollable factors influence patient mix and acuity. Consequently, measurable improvements in the quality of ICU care will not be immediately apparent. Administrators can expect to rely on trends toward lower LOS and improved outcomes for several years before determining whether the eICU has significantly improved patient care.
Challenge #3: High Financial Outlay
1) The eICU– whether purchased from VISICU or built independently– requires hospitals have millions of dollars (2M-5M) available to purchase equipment, and software, as well as to fund physician and nurse salaries. Gaining a full return on investment is highly unlikely, so the eICU will become a cost sink. For smaller community hospitals or health systems the expense can prove to be a hurdle difficult to surmount.
2) eICU bed cost up 100, 000 per one unit. An eICU center is a multi-million dollar investment, and except in very limited circumstances, reimbursement is currently unavailable. That said, “soft” returns in terms of physician, nurse, and patient satisfaction, not to mention improved clinical quality, have been substantial.
Challenge #4: Lack of Reimbursement
1) Compounding the financial hurdle is a current lack of reimbursement for eICU services. Hospitals must pay for all eICU operations out of their operating budgets without expecting financial returns from payers. Administrators anticipate that reimbursement is in the pipeline, and the Society for Critical Care Medicine is currently requesting a CPT code dedicated to eICU services, but it is unclear when reimbursement will be determined.
2) Lack of reimbursement from insurance for eICU services.
Challenge #5: Systems Integration
1) Integrating the eICU systems with the existing ICU systems is a challenge.
2) eICU systems can’t work effectively with existing ICU systems.
How will it solve the challenge? (Pat/David)
1) Open Communication Channels
To ensure that physicians and nurses on the floor will implement eICU technologies, administrators and doctors must be open to discussing concerns or problems.
Additionally, clear guidelines about which situations eICU intensivists may intervene in are key to avoiding turf battles and confusion.
2) Collaboration Between eICU, Bedside
Uncooperative physicians and nurses on the floor may actually lower the quality of ICU care, and eICU intensivists who intervene without physician permission can interfere with floor staff’s work. All parties must work together when setting up and implementing the eICU to reach a consensus about the level of care the eICU team will provide.
3) Physician and Nurse Advocates
Physicians and nurses will never universally accept the eICU. However, on units where a strong physician or nurse leader enforces the eICU rules, cooperation between eICU administrators, physician, and nurses is significantly better than on those units with no champion to unify the staff.
4) Financial Security
Hospitals with eICUs must finance them without any support from insurers or additional charges to patients. Consequently, the hospital or health system with significant funds that can be allocated to new technology is more likely to maintain a successful eICU.
5) Clear Division of Tasks
Avoiding confusion between the eICU and the floor is critical to a functional eICU and clearly delineating when and in what situations the eICU physician will take over for the attending physician or nurse. Clarity is a key to maintaining strong communication and collaboration between the eICU and the physicians.
6) Patience
Many early adopters have found identifying significant improvements in quality is difficult to measure when the eICU has been up and running for less than two years. Additionally, physicians and nurses may require a significant amount of time to “win over.”
References:
Koppenheffer, M. (2006). The eICU: Beyond the Hype. Retrieved April 18, 2010 from
Miller, M. & Fifer, S. (2007). Tele-ICUs Interim Findings about Remote Monitoring and
Management of Patients in Intensive Care Units: A FAST Initiative Technology Analysis. Retrieved April 18, 2010 from http://www.healthpolcom.com/Tele-ICU-DiscussionDRAFT-condensed-0707.pdf.
Wednesday, April 14, 2010
Presentation Document
All,
As discussed in class everyone should put their sections in the google document, see link below. Everyone has read/write access.
https://docs.google.com/present/edit?id=0Af_gsL3jK0gdZGdxa3RxOHJfNDFndGQ2ODdjag&hl=en
Group Assignments:
•Pick some facet of Healthcare IT (Kristen)
–Educate us on the technology – (Kristen)
–Visualize drawing (Martin)
•Define the problem statement (Marvin/Pat/David)
–What problems or challenges does it address? (Pat/David)
–How will it solve the challenge? (Pat/David)
–Who are the stakeholders? (Marvin)
–How will it help the stakeholders? (Marvin)
•Describe the benefits (Faiza)
–How does it improve patient care?
–What efficiencies will be realized?
•What vendors provide the solution(s)? (Paul)
•Pick a vendor and perform a cost benefit analysis (Carl/Hans)
–Create your own bounds
All, this is what we decided:
Scenario
- Consultants
- Test Case - beta
- digital hospital - new age Hospital
- don't want to house staff for ICU
- 14 beds, surgical ICU beds
- If it works we will expand to our other locations/ICU centers
Schedule:
- Deadline - Google Powerpoint Sunday @ 4pm
-Conference call - Sunday @ 5:30
- Dry Run: Wednesday @ 5:00
Tuesday, April 13, 2010
Hi Group,
Thinking about Marvin's comment on whether or not this really meets the criteria for HC IT. I think it does, but isn't just one type. Agree we should get the professors approval as we go on. I think because it uses PAC's-type system for radiology, real-time telemetry and vital signs transmission, and two-way communication between the site where the ICU staff are monitoring and site where actual patients are it is considered novel IT. I think we should focus on the gains of having off-site monitoring of patients to save costs and allow one team to monitor patients at multiple sites simultaneously.
Thinking about Marvin's comment on whether or not this really meets the criteria for HC IT. I think it does, but isn't just one type. Agree we should get the professors approval as we go on. I think because it uses PAC's-type system for radiology, real-time telemetry and vital signs transmission, and two-way communication between the site where the ICU staff are monitoring and site where actual patients are it is considered novel IT. I think we should focus on the gains of having off-site monitoring of patients to save costs and allow one team to monitor patients at multiple sites simultaneously.
Monday, April 12, 2010
For attachments
Folks, if you have attachments for a post and don't have a link for it to insert but the actual file, one solution is to upload the file to Google Docs, share the file, and then copy and paste that share link to the blog post.
Abundant sources
Folks, I found a bunch of resources for e-ICU researching through the library and even some from google scholar, but there seems to be something wrong with the saving records feature!! So I'll just copy and paste the biblios here manually. If they look relevant enough, we have plenty of resources to make our presentation. I know its late but I just have to ask though, does this topic count as a "health care information system", as it's more of automated procedure? I think we should just confirm with Professor Ramcharan. Anyway, here are my sources (NOTE: For the sake of time, not all these are cited APA-style. Also, to click into the full-texts and PDFs, must be logged into the JHU library):
- · VISICU homepage (eICU infocenter)
|
Electronic Version via:
| Highwire Press Royal Society of Medicine
|
Electronic Version via:
|
Electronic Version via:
Elsevier SD Freedom Collection
Elsevier ScienceDirect Complete
|
Electronic Version via:
·
|
Electronic Version via:
Highwire Press SAGE Publications
- · Rosenfeld, B.. (2009). eICU: More Data Are Now Available. Health Affairs, 28(6), 1859; author reply 1860. Retrieved April 12, 2010, from ABI/INFORM Global. (Document ID: 1901978461). Full Text - PDF (74 K)
- · Popely, D.. (2009, September). Telemedicine Delivers Healthy Medical and Financial Benefits to ICUs. Healthcare Executive, 24(5), 22-4, 26-8. Retrieved April 12, 2010, from ABI/INFORM Global. (Document ID: 1850912231). Full Text - PDF (5 MB)
- · Geoff Nairn. (2009, May 29). Is there a doctor in the mouse? Financial Times,11. Retrieved April 12, 2010, from ABI/INFORM Global. (Document ID: 1762139821). http://proquest.umi.com.proxy1.library.jhu.edu/pqdweb?did=1762139821&Fmt=3&clientId=5241&RQT=309&VName=PQD
- · Jeppsson, J.. (2009, January). eWellness. Industrial Engineer, 41(1), 52-53. Retrieved April 12, 2010, from ABI/INFORM Global. (Document ID: 1629203241). Full Text - PDF (680 K)
- · Anonymous, . The Critical Link. (2008, March). Health Management Technology, 29(3), 26-27. Retrieved April 12, 2010, from ABI/INFORM Global. (Document ID: 1443529841). Full Text - PDF (189 K)
- · Thomas Hoffman. (2007, June). Saving Lives Via Video. Computerworld, 41(26), 28. Retrieved April 12, 2010, from ABI/INFORM Global. (Document ID: 1297417501). Full Text - PDF (149 K)
- · Linda Stern. (2007, September). Care From Afar :Small hospitals use technology to run remote ICUs.. Newsweek, 150(12), E18. Retrieved April 12, 2010, from ABI/INFORM Global. (Document ID: 1334309031). http://proquest.umi.com.proxy1.library.jhu.edu/pqdweb?did=1334309031&Fmt=3&clientId=5241&RQT=309&VName=PQD
- ·
|
Electronic Version via:
EBSCOhost Business Source Premier
Full text may not be available for some articles
EBSCOhost Health Source Consumer Edition
- · Mary I Cerón. (2007, March). Bringing Virtual Technology to the ICU. Healthcare Executive, 22(2), 40,42. Retrieved April 12, 2010, from ABI/INFORM Global. (Document ID: 1227487391). Full Text - PDF (152 K)
Sunday, April 11, 2010
Next Steps
All,
The research done so far looks great! Lets all try to read the articles shared and in class on wednesday we can discuss gaps in the resarch (specific discusion points the professor is looking for as part of our presentation) and make sure we fill them.
To add from the jhu elibrary, I found an article about a day in the life of eICU clinician team member:
http://www.sciencedirect.com.proxy1.library.jhu.edu/science?_ob=ArticleURL&_udi=B75J0-4TWW9G2-D&_user=75682&_coverDate=12%2F31%2F2008&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000006078&_version=1&_urlVersion=0&_userid=75682&md5=5d5df4f62069b9cff3fcfa192c2f350b
The research done so far looks great! Lets all try to read the articles shared and in class on wednesday we can discuss gaps in the resarch (specific discusion points the professor is looking for as part of our presentation) and make sure we fill them.
To add from the jhu elibrary, I found an article about a day in the life of eICU clinician team member:
http://www.sciencedirect.com.proxy1.library.jhu.edu/science?_ob=ArticleURL&_udi=B75J0-4TWW9G2-D&_user=75682&_coverDate=12%2F31%2F2008&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000006078&_version=1&_urlVersion=0&_userid=75682&md5=5d5df4f62069b9cff3fcfa192c2f350b
Hi group,
Looks like everyone is finding some good articles. Here are some more:
"Clinical and Economic outcomes of eICU. Jan 2010"
http://journals.lww.com/ccmjournal/Abstract/2010/01000/Clinical_and_economic_outcomes_of_the_electronic.2.aspx
Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: an alternative paradigm for intensivist staffinghttp://www.ncbi.nlm.nih.gov/pubmed/14707557
Kristen
Looks like everyone is finding some good articles. Here are some more:
"Clinical and Economic outcomes of eICU. Jan 2010"
http://journals.lww.com/ccmjournal/Abstract/2010/01000/Clinical_and_economic_outcomes_of_the_electronic.2.aspx
Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: an alternative paradigm for intensivist staffinghttp://www.ncbi.nlm.nih.gov/pubmed/14707557
Kristen
Research articles found
Some articles I found yesterday that may be helpful. These are form JHU Library sight:
Three Approaches to ROI, by Dave Carpenter
The Critical Link, Health Management Technology, 29 no3, 26-7, Mr 2008
web site: http://vnweb.hwwilsonwen.com
The Doctor Is (Plugged) In, Timothy J. Mullaney, Business Week, New York, Jun 26, 2006, Iss 3990, pg 56
Building the business case for clinical quality, William J. Ward, Jr, Lynn Spragens, Ken Smithson. Healthcare Financial management, Westchester: Dec 2006, Vol 60, Iss. 12, pg 92, 7 pgs.
Electronic Intensive CAre: A technical solution to the Intensivist Shortage, Elaine D. Seeman, David a. Rosenthal. Academy of Health cAre Case Management Proceedings. Cullowheee: 2004, Vol 1, Iss. 1.
Hope this helps. I will keep looking today for more articles.
Carl Phipps
Three Approaches to ROI, by Dave Carpenter
The Critical Link, Health Management Technology, 29 no3, 26-7, Mr 2008
web site: http://vnweb.hwwilsonwen.com
The Doctor Is (Plugged) In, Timothy J. Mullaney, Business Week, New York, Jun 26, 2006, Iss 3990, pg 56
Building the business case for clinical quality, William J. Ward, Jr, Lynn Spragens, Ken Smithson. Healthcare Financial management, Westchester: Dec 2006, Vol 60, Iss. 12, pg 92, 7 pgs.
Electronic Intensive CAre: A technical solution to the Intensivist Shortage, Elaine D. Seeman, David a. Rosenthal. Academy of Health cAre Case Management Proceedings. Cullowheee: 2004, Vol 1, Iss. 1.
Hope this helps. I will keep looking today for more articles.
Carl Phipps
Friday, April 9, 2010
Some eICU articles
Team:
The below include some eICU articles, please check them out.
"eICU program favorably affects clinic and economic outcomes":
"The eICU: Beyond the Hype":
(6 Critical Success Factors from Early Adopters, 8 opportunities)
"Extending the PA Role With Telemedicine":
"The eICU-It's not just telemedicine":
(I have a PDF file, how can I upload it here?)
Thursday, April 8, 2010
An important link.
Hi Team,
I find a link, that have articles and case study. Please let take a look at it:
http://www.intouchhealth.com/apps_criticalcare.html?gclid=CP2SpLKM-KACFdk55QodwT3dxw
I find a link, that have articles and case study. Please let take a look at it:
http://www.intouchhealth.com/apps_criticalcare.html?gclid=CP2SpLKM-KACFdk55QodwT3dxw
INOVA Tested eICU's Capabilities
Group,
This is an interesting article because it shows that major health providers like Inova are considering eICU technology. Here's a link to couple articles:
http://www.healthcareitnews.com/news/eicu-helps-inova-health-improve-response-large-scale-emergency-drill
http://www.icumedicine.com/cmss_files/attachmentlibrary/The%20Advisory%20Board%20eICU%20Considerations_2005_Nov.pdf
Let me know if these links don't work.
This is an interesting article because it shows that major health providers like Inova are considering eICU technology. Here's a link to couple articles:
http://www.healthcareitnews.com/news/eicu-helps-inova-health-improve-response-large-scale-emergency-drill
http://www.icumedicine.com/cmss_files/attachmentlibrary/The%20Advisory%20Board%20eICU%20Considerations_2005_Nov.pdf
Let me know if these links don't work.
Critical Care Beyond the Bedside: The Collaborative Effort of the eICU Team
Hi Team,
Here is a link for eicu article, what is so interesting about it, is that this technology was develop by two johns hopkins intensive physician: http://www.nursezone.com/nursing-news-events/devices-and-technology/Critical-Care-Beyond-the-Bedside-The-Collaborative-Effort-of-the-eICU-Team_24170.aspx.
David
Here is a link for eicu article, what is so interesting about it, is that this technology was develop by two johns hopkins intensive physician: http://www.nursezone.com/nursing-news-events/devices-and-technology/Critical-Care-Beyond-the-Bedside-The-Collaborative-Effort-of-the-eICU-Team_24170.aspx.
David
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