title: Critical care telemedicine: evolution and state of the art.
abstract: OBJECTIVE
  To review the growth and current penetration of ICU telemedicine programs, association with outcomes, studies of their impact on medical education, associations with medicolegal risks, identify program revenue sources and costs, regulatory aspects, and the ICU telemedicine research agenda.
  
  
  METHODS
  Review of the published medical literature, governmental documents, and opinions of experts from the Society of Critical Care Medicine ICU Telemedicine Committee.
  
  
  RESULTS
  Formal ICU telemedicine programs now support 11% of nonfederal hospital critically ill adult patients. There is increasingly robust evidence of association with lower ICU (0.79; 95% CI, 0.65-0.96) and hospital mortality (0.83; 95% CI, 0.73-0.94) and shorter ICU (-0.62 d; 95% CI, -1.21 to -0.04 d) and hospital (-1.26 d; 95% CI, -2.49 to -0.03 d) length of stay. Physicians in training report experiences with telemedicine intensivists that are positive and increased patient safety. Early studies suggest that implementation of ICU telemedicine programs has been associated with lower numbers of malpractice claims and costs. The requirements for Medicare reimbursement and states with legislation addressing providing professional services by telemedicine are detailed.
  
  
  CONCLUSIONS
  The inclusion of an ICU telemedicine program as a major part of their critical care delivery paradigm has been implemented for 11% of critically ill U.S. adults as a solution for the problem of access to adult critical care services. Implementation of an ICU telemedicine program is one practical way to increase access and reduce mortality as well as length of stay. ICU telemedicine research including comparative effectiveness studies is urgently needed.
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA., Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Craig M
authors: CM
authors: Lilly
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Marc T
authors: MT
authors: Zubrow
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Kenneth M
authors: KM
authors: Kempner
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: H Neal
authors: HN
authors: Reynolds
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Sanjay
authors: S
authors: Subramanian
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Evert A
authors: EA
authors: Eriksson
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Crystal L
authors: CL
authors: Jenkins
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Teresa A
authors: TA
authors: Rincon
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Benjamin A
authors: BA
authors: Kohl
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Robert H
authors: RH
authors: Groves
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Elizabeth R
authors: ER
authors: Cowboy
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Kamana E
authors: KE
authors: Mbekeani
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Center, Worcester, MA, USA.
authors: Mark J
authors: MJ
authors: McDonald
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Ceneter, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Dominick A
authors: DA
authors: Rascona
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Michael H
authors: MH
authors: Ries
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Herbert J
authors: HJ
authors: Rogove
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Ahmed E
authors: AE
authors: Badr
authors: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Center, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA.
authors: Isabelle C
authors: IC
authors: Kopec
mesh_terms: D000328:Adult; D003422:Critical Care / Q000458:organization & administration*; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D016730:Program Development; D015397:Program Evaluation; D011787:Quality of Health Care; D017216:Telemedicine / Q000458:organization & administration*; D014481:United States