Jeremy Pamplin, MD, FCCM
Director, Telemedicine and Advanced Technology Research Center
n/a
Fort Detrick, MD
Disclosure information not submitted.
Christopher Colombo, MD, MA, FCCM
Associate Professor
The Geneva Foundation
Gig Harbor, Washington
Disclosure information not submitted.
.jpg "J. Christopher Farmer, MD, MCCM photo")
J. Christopher Farmer, MD, MCCM
President, Trajectory Group
Mayo Clinic
Rochester, Minnesota
Disclosure information not submitted.
Benjamin Scott, MD
Associate Professor of Anesthesiology and Critical Care
University of Colorado
Aurora, CO
Disclosure information not submitted.
Title: Development and Lessons Learned: Year One of the National Emergency Tele-Critical Care Network
Introduction: The U.S. healthcare system remains vulnerable to crisis and troubled by resource inequities. Uneven distribution and scarcity of critical care (CC) clinicians is one example: COVID19 overwhelmed many hospitals with critically ill patients forcing some clinicians to provide care beyond their normal scope of practice and level of comfort.
Methods: The National Emergency Tele-Critical Care Network (NETCCN) was developed to address this problem by providing on-demand access to CC experts. NETCCN was funded by the Coronavirus, Aid, Relief, and Economic Security (CARES) Act; as a collaboration between the U.S. Army’s Telemedicine and Advanced Technology Research Center (TATRC), the Department of Health and Human Services Assistant Secretary for Preparedness and Response (HHS ASPR), and the Society of Critical Care Medicine (SCCM). NETCCN focused on rapid development and deployment of technology platforms that were simple and user-friendly, cyber-secure, and HIPAA compliant, and only required a cellular connected mobile device. This federally funded resource allowed local non-CC caregivers to consult with CC experts.
Results: NETCCN has deployed to six states/territories, eight hospitals and cared for hundreds of patients in locations unfamiliar with managing critically-ill patients. While limited in scope, the NETCCN experience highlights key challenges and successes to address or sustain moving forward. Fear commonly prevented wider acceptance and use of NETCCN support. Clinicians fear judgment when asking questions; hospital administrators fear violating laws or disrupting “normal” practice patterns; and provider groups fear loss of market share. Despite laws that permit expedience during disaster conditions, major policy barriers, particularly local credentialing and privileging processes, hinder the use of tele-CC consultation solutions. Finally, lack of consistent federal, state, and local telehealth policies, especially for in-patient and e-consult services, caused confusion and prevented wider deployment of NETCCN.
Conclusions: A federal capability that provides telemedicine support to hospitals or communities in crisis as part of a disaster response system is feasible, but policy barriers and cultural expectations impede rapid adoption.