JMIR Publications

ABSTRACT

Background:

Many intensive care units (ICUs) utilize telemedicine in response to an expanding critical care patient population, off-hours coverage, and intensivist shortages, particularly in rural facilities. Advances in digital health technologies, among other reasons, have led to integration of active, well-networked critical care telemedicine systems across the United States, which in turn, provides the ability to generate large-scale remote monitoring data from critically-ill patients.

Objective:

The objective of this study was to explore opportunities and challenges of utilizing multisite, multimodal data acquired through critical care telemedicine. Using a publicly-available teleICU database, we illustrate the quality and potential uses of remote monitoring data, including cohort discovery for secondary research.

Methods:

Exploratory analyses was performed on the eICU Collaborative Research Database that includes de-identified clinical data collected from adult patients admitted to ICUs from 2014 – 2015. Patient and ICU characteristics, top admission diagnoses, and predictions from clinical scoring systems were extracted and analyzed. Additionally, a case study on respiratory failure patients was conducted to demonstrate research prospects using teleICU data.

Results:

The eICU database spans 200+ hospitals and 139,000+ ICU patients across the United States with wide-ranging clinical data and diagnoses. While mixed medical-surgical ICU was the most common critical care setting, patients with cardiovascular conditions accounted for more than 20% of ICU stays and those with neurological or respiratory illness accounted for nearly 15% of ICU unit stays. The case study on respiratory failure patients showed that cohort discovery using the eICU database can be highly specific, albeit potentially limiting in terms of data provenance and sparsity for certain types of clinical questions.

Conclusions:

Large-scale remote monitoring data sources such as the eICU database has a strong potential to advance the role of critical care telemedicine by serving as a testbed for secondary research as well as for developing and testing tools, including predictive and prescriptive analytical solutions and decision support systems. The resulting tools will also inform coordination of care for critically-ill patients, intensivist coverage, and the overall process of critical care telemedicine.