Craig Lilly, MD: How Tele-ICUs are Revolutionizing Intensive Care

For Craig Lilly, MD, FCCP, Director and Founder of the ICU Telemedicine Program at the University of Massachusetts, telemedicine is more than just a trend in medicine - it's one of the most potent tools available to health systems and patients alike. Lilly sat with MD Magazine at the 2017 CHEST Annual Meeting in Toronto, Ontario, to explain how telemedicine has expanded his ICU's capabilities and reach, how it's saved time and money, and how it's poised to usher in a new era of efficiency.

Lilly:

These tools are evolving today and it's a really exciting time to be engaged in medicine in general, and telemedicine in particular.

I really believe that patients like the idea of having apps, having information, being able to get their provider at a time that's convenient to both folks, and there's a lot of ways that these strategies can eliminate waste.

If you just reflect on any practice, even an outpatient practice, how much of the time is really wasted? Is the time that the patient is traveling to the appointment — is that really well-used time? And why do you have a waiting room, at all? Is that a good use of your time? Is it a good use of the patient's time?

There's a lot of information that the patient could be sharing with you electronically, and not only would you be able to appreciate it and apply your clinical judgement to it, but it would allow you to benefit from clinical decision support tools to help provide families with realistic expectations.

How many times have you been in an exam room with a patient who wasn't prepared? They need a blood test, they need an X-ray, and it wasn't done ahead of time. Isn't it better to have a patient who's fully prepared when you do that interaction? It really is a technology that removes geographic barriers, temporal time barriers, to get what the patients need and want when they need it, and patients desire it.

I think it provides wonderful opportunities to help families after ICU discharge to get their loved ones back on their feet, to make sure they're eating right, and doing the things they need to do to reestablish their barriers, their microbiomes, and to get their functional status back to where it was before.

I think that the next barrier is really in post-ICU care. Once you've built this incredible database about the critically ill patient, why not use it to support their post-acute care needs?

The things that the ICU is doing, the ICU telemedicine team can help them do it more efficiently, more of it, and serve more patients. The better functioning your ICU is, the easier it is to expand its imprint, or footprint, with telemedicine support.

When you have great people, they can do more. They can take care of more patients. You don't have to have your patients in the ICU as long and generally you get better results.

What was fascinating about the intervention was that where we saw the greatest improvements within the longest stay, most difficult patients — those patients became less rare and didn't stay as long, primarily because their complications were less frequent, and when they did occur, they were managed more effectively.

It's really a matter of having a lot of information, being able to identify patients that can benefit from your expertise, and then getting in and figuring out what can and can't be done for them, and doing the things that you can sooner than you would if you didn't have those resources.

The bedside intensivists, they love this intervention. It's more help. They can't be everywhere all the time. They can't be awake 24/7. When they leave the ICU, they can now turn their service over to a colleague who can carry out their plans and only get them engaged when they really need to.

The ICU telemedicine programs are just another set of helpers for the best bedside doctors. The better critical care you can give, the better you're going to be able to work with an offsite helper, or an ICU telemedicine team, to give great care.