Forbes: VISICU dragging Medicine into the Information Age The E-Gang: Medical Marvels September 2nd, 2002 by Robert Langerth In this Golden Age of biology, scientists have unleashed a cornucopia of potent new drugs, designer diagnostics and precision imaging systems. Yet in information technology, medicine relies on the equivalent of an old Commodore 64. Doctors too often track patients the old-fashioned way, with pencil and paper. Change is afoot. This year's E-Gang, our annual focus on high-tech innovators, profiles eight visionaries who are dragging medicine into the information age. Intensive care specialists Brian Rosenfeld and Michael Breslow had a radical idea five years ago. They hoped to offset a desperate shortage of critical care physicians. Only 13% of the nation's 7,500 ICUs have full-time specialists. The two doctors proposed using a sophisticated remote monitoring system to let one doctor care for patients in several separate ICUs at once. They wanted to slash the high death rates among hospitals' sickest patients--even though the docs would be far from patients' bedsides. The two doctors persuaded officials at the Johns Hopkins School of Medicine, where they worked, to try a crude experiment. With two other ICU doctors, they set up videoconferencing equipment at an ICU at Hopkins' sister hospital across town in Baltimore. They sent the video feeds, along with real-time patient vital sign data, to computers in the doctors' homes. For four months they took turns watching patients from home for 24-hour shifts. The results were astonishing: Deaths declined by 50%. "We weren't making esoteric diagnoses in the middle of the night," says Rosenfeld. "Catching a lot of little things added up." Inspired, the doctors quit their hospital jobs in 1998 to found closely held Visicu in Baltimore to commercialize the concept. Visicu designed an "eICU®" that, rather than replace on-site staff, provides another set of expert eyes to watch over patients 24 hours a day. An eICU® manned by one doctor and a couple of nurses costs $2 million to $3 million to set up, about $2 million a year to run, and can monitor 50 to 100 beds in multiple ICUs. One monitor in the eICU® functions like a Bloomberg terminal for patient data, displaying readings on blood-oxygen levels and other data; a click of the mouse switches from one patient to another. Proprietary software continuously monitors vital signs and pops up "smart alerts" when patients start to deviate beyond their established stable ranges. High-resolution cameras at bedsides let the remote team visually examine patients. Visicu's first customer, Norfolk-based Sentara Healthcare, uses its eICU® to monitor 55 beds in three hospitals. Sentara says the system saves 90 lives a year, while also saving millions of dollars by avoiding pricey complications (insurers usually pay a flat "case rate" for ICU patients). These days Visicu can hardly keep up with the calls from hospitals. The New York-Presbyterian Hospital system recently signed up; Executive Vice President Michael Berman says he was floored during a site visit when he saw Sentara's eICU® team spot a heart rhythm problem before nurses by the bedside noticed. If used widely, the system could have a big impact. Studies show that staffing all ICUs with such specialists could save up to 50,000 lives a year. Even well-staffed hospitals could benefit from eICU® during overnight hours when specialists go home. "Patients don't get sick only during the day," Rosenfeld says. "Around-the-clock care should be the standard of care." Related File FORBESInterview.doc