Monday, November 28, 2005

Sorry Mr. Smith, No Nurse is Available - But We Have a Camera Watching You...

Amazing article in the Chicago Tribune Business Section on cool new defibrillators that keep tabs of heart devices (Remotes keep tab on heart devices - Wireless tracking offers piece of mind," Chicago Tribune 11/28/05, Business Section, Section 4, Page 1). Cool stuff. But buried deeper in the article is information about NEW technology offered by a Chicago Firm called nPhase LLC, a firm that specializes in machine-to-machine communications, run by Steve Pazol, its chief executive.

"Insurance companies looking to reduce costs are driving this trend, Pazol said. 'They want to reduce hospital stays and increase home care,' he said. 'If you can have one person monitoring 100 pieces of equipment spread all over instead of 10 in a concentrated area, you get a huge cost savings.'
An example of such networking is underway in Joliet (IL) where Provena Health has specialists -- called intensivists -- who monitor patients in the intensive care units of six Provena hospitals in Illinois.
Digital cameras and microphones enable these specialists to see and hear the patients as well as gain access to equipment that monitors their heart rates, blood pressure and so on."

Now we are reassured by Dr. James Cowan, Medical Director for Provena's "enhanced intensive-care unit."

"Intensive care nurses are still on the scene to assist the patients, and the technology doesn't replace any personnel, said Dr. Cowan. We have one physician and three nurses looking at 120 patients."

Imagine: there you are, lying on a ventillator, and mucous plugs your breathing tube, but you don't know this because you're "asleep" from the sedation you've been given. Sally the nurse is changing the person's bedpan in the room next to yours and a sensor trips telling the "Wonder Monitors" that you might be in trouble. Oops, there are five other patients with simultaneous problems equally as grave, sounding alarms. "Which call to make first?," they think.... "we'll notify hospital Z first, then Y, then X (you're at X). But Sally can't get there right away....

Great system. Instead of training more intensivists, we're gonna substitute a "Command Center". And don't me started on the FALSE POSITIVE rates - alarms are MADE to beep MORE OFTEN to assure they don't miss problems (improves sensitivity to problems at the expense of specificity). All those calls to the ICU, more nurses on the phone, and fewer doctors and nurses TOUCHING and caring for patients...

Most ominous:

"But there aren't enough doctors trained as intensivists. So this technology helps us meet that need," Cowan said.

So what do we do? Get a computer. Forget the doctor. Why train more intensivists? Does anyone see the writing on the wall?

Let's see who's going to line up in favor of this technology. All the Big Boys: hospital administrators, insurance associations, Quality Assurance specialists....

We need to be keenly aware of our new "health care choices" when selecting insurers... Fun times are ahead...

-Wes

2 comments:

Shelby said...

Wow, this is really scary. I just don't see how this is beneficial to patient care. That's exactly what we need is one more barrier between patient and medical personnel (*dripping sarcasm*). I shudder at what's going to come with this technology. I see patient deaths and lawsuits in the future--unfortunately.

DrWes said...

Part of my concern is that the medical literature reporting the value of this technology is in fact being written by physicians with financial interests in its promotion. Take the company VISICU, for instance (see http://www.visicu.com). The studies referenced ALOT by the medical community citing the benefits of remote monitoring are authored by two intensivists on that company's board, Drs. Rosenfeld and Breslow. (Can you say conflict of interest?) And yet TONS of hospital systems are turning to this model to circumvent the real need: training more intensivists, critical care nurses and pharmacists.

Somehow, I really don't see the families of a critically-ill individual tolerating the "big brother" approach in a time of crisis with their loved one... but beware, the party line is "it's safer." Really? Seems more intensivists would be the SAFEST option. The real secret party line, I'm afraid, is.... "it's cheeper."

--Wes