Reducing cost burden for critical care with Tele ICUs

Way back in 1999, when we started our critical care journey, there was only one department in the whole of North India. However, critical care has made a major impact across the country; more so after COVID, because many people were primarily looking for two things at that time: ICUs and critical care doctors; that's when they actually got to know what a critical care expert is.

Today, ICUs are coming at a very fast pace in the private as well as the government sector. However, the number of critical care physicians is actually extremely short. Since it's a small and oung doctors since everybody cannot do a fellowship in critical care. Hence, for somebody in deeper parts of the country, we have our own simulation-based training vertical, where we have already trained about 10,000 doctors and nurses in the last five years. In the basics of critical care medicine at this point of time, we are close to monitoring experience of 1,000 ICU beds with the teleICUs. We are a team of critical care specialists, physicians, technicians, nurses and paramedics staff, who are continuously monitoring patients in India and abroad. We can manage emergencies as well as the ward patients as that's the beauty of telemedicine - it's critical care sans barriers.

Disease burden in India

India contributes to 18 percent of the worldwide mortality. We are the trauma capital of the world, the diabetes capital of the world - primary artery disease that's much more in India than anywhere worldwide, and heart disease in India occurred 10 years earlier as compared to the population in Europe and America. As we are advancing and ageing, we are living more with comorbidities, but are also learning more with complications. Post-Independence, the average lifespan of an Indian was 47 years. Today, it is 73 years. So, if people are living till 73 years of age, they will live with more heart diseases, more diabetes, more infections and more problems. That's how a lot of morbidity in the world is contributed by India.Prior to the COVID-19 pandemic, we spent only one percent of the Gross Domestic Product (GDP) towards our healthcare investment. Post-COVID, it has actually gone to 2.3-2.4 percent, but is still much less. During COVID, we were faced with an unprecedented massive load of patients. A lot of patients required ventilators, and there was a huge shortage of ICU beds, but the governments and the private sector actually started making ICU beds at a rapid pace, which came up as a huge relief.

Challenges and opportunities

Skilled manpower in the form of trained doctors and nurses is the biggest challenge in critical care. Digitalization and innovations like teleICUs can go a long way in solving many such problems. In ICUs, an intensivist relies a lot on life-saving alarms and early warning signals. Through digitalization and teleICUs, a remotely situated critical care specialist can monitor and give junior doctors and nurses a lot of advice in managing critical care patients. This not only improves the quality of care but has also been proven to decrease mortality. I can envisage that most of the critical care units in tier-II and tier-III cities will be managing their patients via digitalization or teleICUs in the near future.

A connected workflow helps analyze and prioritize patients faster, which eliminates pressure on busy clinicians and emergency medical personnel, in order to reduce the risk for patients and saving their lives. Tele-ICU has an off-site command centre where a critical care team communicates with patients in distant ICUs using real-time audio-visual and electronic means, and exchanges health information. This is the cost-effective remote way to provide services to all types of locations. It makes it possible for patients and critical care specialists in the ICU to be face to face within minutes, and for administrations to receive medical attention easily and quickly. Tele-ICU programmes have command centers that are staffed with critical care nurses and intensivists who treat patients electronically either with the help of audio connections or video conferences.

This allows healthcare professionals to get patient data in real-time and resolve issues as soon as possible. Tele-ICU has become a way to augment Limited resources are used to save lives every day through teleICU, providing patients with flexible and round-the-clock access to critical care specialists. In addition to consultation and acute patient management, daily rounds involve intensivists guiding activities and plans for teleICU patients. Intensivists are experienced in determining the criticality of patients' conditions, greatly aided by access to vital information provided by current technology using teleICU equipment. This significantly reduces ICU complications.Years back, when telemedicine wasn't available, people from remote areas struggled as they had to travel far for medical treatment. Now, with telemedicine, patients can stay in peripheral sites and receive treatment there. Tele-ICU solutions have the potential to reduce healthcare costs significantly for those in need. Consequently, hospitals can generate more revenue by monitoring critically ill patients with a network of remote intensivists and critical care teams. Thus, telemedicine not only allows doctors to reach more patients but also saves hospital costs, resulting in better patient care.