length of stay, mortality, and costs. However, the specific elements of tele-ICU that make a difference are not clear.

A number of devices are being used in inpatient setting as well as in skilled nursing facilities. Telemedicine reduces avoidable visits to emergency departments for skilled nursing patients. Some rural skilled nursing facilities exist in communities that do not have physicians, and getting physicians there urgently can be a challenge. Recent studies show strong evidence of clinical benefit and savings with increased use of telehealth in nursing homes, and that families and nursing home personnel were very positive about the use of telepsychiatry for geropsychiatric care.

Looking toward the future, telesurgery has been used on a small scale. Future challenges and opportunities include determination of the key beneficial elements of tele-ICU and how it can be tailored to smaller hospitals. In terms of development, a lot of the expansion of hospital-based telemedicine has been with for-profit companies offering stroke and ICU care to hospitals that can afford those models. How can we build incentives to expand those models, so either private companies or public institutions can afford to offer these services in rural communities? Also, as payers stop paying for readmissions, there may be more incentives for the use of telemedicine in skilled nursing facilities. Finally, telementoring and telerobotic surgery may increase as a method to capitalize on experts’ technical skills and knowledge.

CONCLUDING REMARKS

Nesbitt concluded that advanced telecommunication and information technologies have a role to play in transforming the health care system. Evidence-based models facilitated by these technologies can improve access to and quality of health care across the geographic and economic spectrum. To date, we have been attempting to layer these technologies onto a health care system that does not have the necessary incentives. However, the passage of ACA and other policy changes can help facilitate this transformation. Overall, more research is required to develop appropriate quality standards in all these areas of care.



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