B6| Saturday/Sunday, March 28 - 29, 2020 **** THE WALL STREET JOURNAL.
beds,” says Saurabh Chandra, med-
ical director of telehealth services
at Northwell. Advanced tele-ICU
systems make the monitoring of
such numbers possible because
they include software that alerts
physicians when patients’ vital
signs cross into dangerous terri-
tory, he adds.
But these devices can take time
to install even under normal con-
ditions. Facing a flood of new pa-
tients, Northwell doctors are get-
ting creative with tech they
already have on hand. In Decem-
ber, Northwell ordered a batch of
35 movable carts with videoconfer-
encing capability from American
Well, which are scheduled to ar-
rive in early April.
These carts were intended to be
used in any department in any ofto the risk of infection, says Timo-
thy Buchman, medical director of
Emory’s electronic ICU service.
“In situations where require-
ments and demands are changing
rapidly, the ability to move from
one room to the next, or one hos-
pital to the next, literally at the
speed of light, allows us to make
the most efficient allocation of
what are increasingly scarce hu-
man resources,” Dr. Buchman says.
Northwell has a telehealth com-
mand center in Syosset, N.Y., from
which teams of critical-care physi-
cians and nurses are already moni-
toring more than 130 beds, of
which 116 are occupied by Covid-19
patients, says Kara Benneche, di-
rector of clinical operations of
telehealth services at Northwell.
Physicians and nurses at North-
well’s Syosset center sit at banks
of six to eight monitors, connected
to video-conferencing systems that
allow them to interact with pa-
tients and any health professionals
in the patients’ rooms.
“That’s the beauty of tele-ICU:
One person sitting in a tele-ICU
centercantakecareof50to100Northwell’s hospitals and other fa-
cilities. But many are being pressed
into service in a variety of roles ne-
cessitated by the pandemic, includ-
ing connecting to ICU beds. Physi-
cians can access the carts’ cameras
remotely from a computer.
This system can also save doc-
tors and nurses who are on site
from having to enter patients’
rooms, says Ms. Benneche. Remote
practitioners using these systems
can’t do anything in patients’
rooms that requires their hands—
such as adjusting an IV or a ventila-
tor. But they can check patients’
overall condition, and use the sys-
tem’s cameras to zoom in on bed-
side monitoring equipment, allow-
ing them to check vital signs just as
they would if they were in the
room. Every time they do this, itHow to Monitor a Patient You Can’t Touch
Facing a deluge of Covid-19 patients, more hospitals leverage remote technology; checking vital signs from afar
KEYWORDS|CHRISTOPHER MIMS
At Northwell Health’s telehealth
center in Syosset, N.Y., teams of
critical-care physicians and
nurses monitor more than 130
beds, including more than 100
Covid-19 patients. Kami Sisco,
above, and Rochelle Heath and
Romana Amjad, at left, follow
patients from afar at the center.EXCHANGE
As American cities
face a surge of coro-
navirus patients who
will require lifesaving
care, they are also
facing a rapidly dwin-
dling supply of avail-
able intensive-care-unit beds. Physi-
cians and nurses at many of the
country’s largest hospital systems
are leveraging a decades-old tech-
nology in new ways—at times cou-
pling it with cheap, readily available
gadgets—to expand their ability to
care for and monitor patients.
Generally known as “tele-ICU,”
this two-way bedside video is sort
of like FaceTime or Zoom. The dif-
ference is that it typically adds a
host of other technologies to vid-
eoconferencing, in order to con-
nect critically ill patients in hospi-
tal ICU beds with teams of doctors
and nurses who specialize in deliv-
ering care to the sickest, even
when those teams are miles or
even whole states away.
The technologies include high-
definition cameras with pan, tilt
and zoom abilities, so they can
home in on anything in the hospi-
tal room, from the patient’s face to
the instruments at bedside. They
also include direct connections to
instruments like heart-rate and
blood-pressure monitors. These
traditionally expensive systems
also connect remote specialists to
the doctors and nurses at patients’
bedsides, often at smaller hospi-
tals and in rural locations.
But to treat waves of patients
struggling with Covid-19, doctors
and technicians are also appropri-
ating less expensive remote-moni-
toring tech to their arsenal of ex-
isting tele-ICU systems. It’s the
difference between spending tens
of thousands of dollars a bed on
top-of-the-line tech that could take
weeks to be delivered and installed,
and switching to systems that in-
clude commercial tablets and can
be installed at patients’ bedsides
immediately.
If things get really
bad, medical providers
could enlist the help of
store-bought tablets
and laptops, as they
have in hurricanes and
other past disasters.
In the sheer number
of patients whom doc-
tors believe could ben-
efit from tele-ICU, cor-
onavirus presents a
trial far beyond any
that such technology
has been put through
before. The result is an
example of rapid inno-
vation—even disrup-
tion—in action, as pro-
fessionals are forced to
improvise using only
the gear at hand. By
their own accounts, be-
yond finding it merely
serviceable, they are
developing and sharing
new methods in real time. It’s a
medical hackathon in which lives
are at stake and the papers analyz-
ing what worked best may have to
wait until after the catastrophe
has passed.
It may be a taste of the medical
innovation to come, as the entire
world is forced to find ways to
grapple with an accelerating pan-
demic.
The health professionals at
Northwell Health, which includes
23 hospitals and 72,000 employees
across New York state, are rapidly
increasing the number of tele-ICU
beds from 170 to 420, and say they
could accommodate far more.
(New York state has desperately
tried to add to its 3,000 ICU beds;
Gov. Andrew Cuomo has warned it
might need 40,000.)
In Seattle, another coronavirus
hot spot, the hospital system Swed-
ish is leveraging a variety of tele-
health technologies, partly to keep
health-care workers from being ex-
posed to coronavirus and to keep
patients at home when possible.
But of all of the programs to ad-
dress shortages of health-care pro-
viders at Swedish, “I think the
tele-ICU capacity is the most im-
portant one at this time,” says
Elizabeth Meade, the medical di-
rector of pediatric quality and
safety at Swedish.
The point of tele-ICU isn’t to
replace staff on premise, but to
supplement them while also keep-
ing the scarce supply of trained
intensivists physically removed
from patients to minimize their
risks of infection.
Four hospitals in Atlanta’s Emory
Healthcare system are using tele-
ICU technology to support staff.
One example is easing the burden
of monitoring stable patients when
on-premise staff must intubate a
Covid-19 patient, a procedure that
requires extra people and effort due
Kara Benneche, at left, says North-
well’s staff can zoom in on bedside
equipment to check patients’ vital
signs. At right, Dr. Shreyas Ravi-
shankar advises a nurse. Below,
Richard Budke monitors patients.saves them 10 to 15 minutes of suit-
ing up in protective gear, she adds.
One challenge for the coronavi-
rus patients is the isolation, with
loved ones not allowed in. But
while tele-ICU can also mean less
human contact, nurses are on the
other hand more readily available
in at least one way: Patients who
are able can touch a button at any
time to talk to them, something
they do frequently just to cope
with loneliness, says Ms. Benneche.
SOC Telemed, which provides
telemedicine technology to more
than 600 hospitals across the U.S.,
will add 100 hospitals to its plat-
forms in the next 45 days on ac-
count of the pandemic, says Jason
Hallock, the company’s chief medi-cal officer. About one in seven ICU
beds in the U.S. already have tele-
ICU capability, he adds.
In 2018, SOC Telemed equipped
Onslow Memorial Hospital in Jack-
sonville, N.C., with telemedicine
capabilities, including tele-ICU, in
just 18 hours when flooding from
Hurricane Michael cut off the hos-
pital from outside help. Using a
telemedicine cart Onslow staff al-
ready had on hand, “we took care
of anyone from a newborn baby to
someone in their late 90s,” says
Dr. Hallock.
Tele-ICU is only one part of
what must be a much broader re-
sponse to the coronavirus pan-
demic, emphasizes Eric Toner, a
scholar with the Johns Hopkins
Center for Health Security and au-
thor of a report on the ultimate
impact of coronavirus on the U.S.
“I think [tele-ICU and related]
strategies can improve our capac-
ity to have trained people provide
care, but I think they’re limited,”
he adds.
One thing the tele-ICU cannot
do is remove existing barriers de-
termining which doctors can pitch
in at any given hospital, notes Dr.
Hallock. It can take 120 days for a
physician to become authorized to
work at a hospital. While “emer-gency privileges” can speed this
process, for now the technology of
allowing remote care is running
far ahead of the system’s ability to
absorb physicians who could con-
sult through it. Another issue is
that states traditionally do not al-
low doctors to practice medicine
without a license specific to that
state, limiting the ability of out-of-
state doctors to help. These aren’t
insuperable barriers—Emory
Healthcare has previously set up a
tele-ICU facility in Australia so
health professionals there could
cover the night shift at Emory’s
ICU units in the U.S.—but they
take time to overcome.
Martin Doerfler, a Northwell
senior vice president in charge of
telemedicine, says he is preparing
his hospitals both for the initial
peak of the virus, as well as what
could be an even bigger peak
come November, should coronavi-
rus become seasonal like the com-
mon flu.
If it comes to that, teams of
doctors at Northwell might have to
connect to any tablet or mobile
device through a web app, from
their central tele-ICU center and
remote centers it has set up at
each of its hospitals. This option
would be limited, lacking the pan
and zoom capabilities of dedicated
cameras, while offering only basic
two-way communication between
a remote physician and a patient
or bedside nurse.
“I’m practicing now for hun-
dreds—or thousands—of cases and
hopefully not tens of thousands,”
says Dr. Doerfler.‘That’s the beauty:
One person sitting in a
tele-ICU center can take
care of 50 to 100 beds.’RYAN LOWRY FOR THE WALL STREET JOURNAL(5)