More research needed on e-ICU benefits

Interoperability is a big issue regarding the integration of the health care system. This is based on the notion that the quality of the information will be affected because hospitals, general practitioners and pharmacies are all using different operating systems for their databases that can not be easily integrated to allow easy data flow across all sectors. For these hospitals to gain the full benefits of these systems, interoperability needs to be addressed and a solution needs to be found because quality of the data is very important. When dealing with Telemedicine that relies on up to date technology systems that increase efficiency for the health care clinician, the data needs to be 100% accurate. If the data available in these systems have errors in it, then medical error can occur in which a patient may be harmed as a result. This article below shows reasons behind why interoperability must become a priority because it will make the health care system increasingly efficient.
Brailer, D. J. (2005). Interoperability: The Key To The Future Health Care System. Health affairs.Vol 24; Supp/1, pg. W5-19-W5-21

 
Interoperability has substantially improved telemedicine in countries such as Denmark. Although interoperability is crucial to enhance 'quality' of care, it comes with several challenges of which funding (-resources) and patient privacy are very important.
Successful implementation of interoperability within systems involves considerable financial costs, but the resources are scarce (Stokes, 2005). Also, the cost-bearers- the practitioners and health care workers- do not derive as much benefit as the consumer – the patients (Ackerman, 2006) - [this statement may be more relevant to US than NZ]
Confidentiality is a major problem because interoperability and EHRs make detailed patient information easily accessible. For example, thousands of medical records held by the University of Michigan Medical centre which included vast amounts of personal information such as names and job status were posted on public sites for two months (Washington Post, 1999). A more recent example is that of a health care employee who accessed personal information about a cancer patient and obtained a credit card on their name and charged $9000+ in personal purchases.
These issues are applicable in New Zealand as well, and we also face another challenge which is “acceptability” by patients and practitioners (Kerr, 2004).
Thus, where interoperability has the potential to improve telemedicine, it has risks as well which need to be addressed side by in order to ‘truly’ enhance care.
Karolyn, Kerr (2004) accessed from http://www.hinz.org.nz/journal/2004/03/The-Electronic-Health-Record-in-New-Zealand---Part-1/892
References in the second and third paragraph were cited in
Laura Dunlop, Electronic Health Records: Interoperability Challenges Patients’ Right to Privacy , 3 Shidler J. L. Com. & Tech. 16 (Apr. 6, 2007), at http://www.lctjournal.washington.edu/Vol3/a016Dunlop.html

The aforementioned barrier of interoperability isn't the only barrier though, what about the upfront opportunity costs as well as the ongoing operating costs or staff costs and reimbursements/funding. Do you think that these can be weighed against the benefits for remote areas (or as often mentioned, the military), for improving patient safety and clinical quality?
Is this a case that the complaints about having few studies into the effectiveness of eICU is simply a matter of needing units to be established in the first place?  

 The dilemma you outline is interesting Sam. The upfront costs just for establishing an eICU system for rural populations is estimated to be between $2-$5 million American, which is between $2.7-$6.7 million New Zealand. That's a big financial risk considering how little is known about the effectiveness of eICUs. 
Franzini and Thomas (2008) suggest it's hard to estimate the cost effectiveness of such units because of difficulties designing valid studies to assess any potential benefits. We can't randomly choose hospitals to install these systems and each eICU will serve different populations with different needs, so generalising results across hospitals is near imposisble. Perhaps most importantly, the effectiveness of eICUs should be compared to other methods of quality improvement which are less dependent on new technological infrastructure that most hospitals do not have access to. 
Franzini, L., & Thomas, M. (2008). Costs and effectiveness of tele-ICUs in reducing morbidity and mortality in intensive care units. Journal of Medical Economics, 11, 165-169. 

Thank you I.Walker, I was not aware that establishing an eICU was so expensive. However, is this the only barrier to adopting an eICU approach? I am aware that is the only major barrier and in that sense I think that the benefits from adopting eICU will only pay for itself in the long run.
The key advantage is the immediate ability to respond to emergencies. The eICU is like a second set of eyes and allows whoever is monitoring the patient to have all the information at his/her fingertips to make the necessary decisions. The eICU almost becomes part of the team looking after the said patient.
I mean, sure we need to do more studies on how cost-effective eICU is but I think the current studies heavily favour adopting an eICU approach. Is the financial risk that big when the potential benefits from adopting such an approach could save so many lives?
R. Berenson Does Telemonitoring of patients - the eICU - improve intensive care? 2009

 
Others have raised several issues regarding the use of telemedicine in the IC setting.  I acknowledge that there are substantial costs in implementing the system as well as the problem of ‘interoperability’. 
But what needs to be focused upon is, whether or not these new technologies are actually providing any clinical benefit for the patients as they were set out to do.
 This article outlines the ‘remote care program’ use across multiple iC units in a hospital in the US. Lending an extra hand in monitoring and  managing  ICU patients, with supporting software, data displays and physician note and order writing, computer based application tools, all from a centralized off site facility (eICU). Results shows that mortality was lower for patients under this ‘e-monitoring’ as well as lower length of stay (higher hospital revenues).
 As Fred_feki stressed above, that even though there are financial burden (as with any new technologies) .. what about the positive outcomes??
why delay implementing something that might save people lives even if there are certain costs and conditions which can be overcome if the system is implemented properly.  
And as this article shows, there are clinical and financial benefits; Telemedicine in this type of setting has the capacity to to allow mass monitoring of patients within units, and through this provides a greater benefit to overall health care within the hospital. 
 Breslow MJ, Rosenfeld BA, Doerfler M, Burke G, Yates G, Stone DJ, Tomaszewicz P, Hochman R, Ploche. 2004. Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: an alternative paradigm for intensivist staffing. Crit Care Med , 32:31–38