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