Reach Out and Heal a Heart: Tele-ICU and Low Virtualization Care Processes

Telehealth offers significant potential to improve healthcare delivery, but its benefits are context-driven. It shows clear advantages in consumer-facing, high-virtualization settings and uncertain impacts in high-stakes, tightly coupled processes like Intensive Care Unit (ICU) care. Prior IS research has examined high-virtualization telehealth, such as mental health. In these settings, patients are active agents, and self-efficacy drives outcomes. Less attention was given in the ICU context, where continuous monitoring, rapid decision-making, and coordination are critical.<br><br>In this paper, we examine tele-ICU, a telehealth technology designed to support ICU care. We use acute myocardial infarction (AMI) as a context to study a low-virtualizable care process. The AMI care process mostly begins with ICUs and requires rapid monitoring, coordination, and reliance on specialized staff. AMI care contributes significantly to hospital readmissions, targeted under the Medicare Hospital Readmission Reduction Program, underscoring their importance.<br><br>The shortage of cardiac care staff has increased interest in tele-ICU, which can extend expertise across hospitals. However, the comprehensive role of intensivists in the ICU may also affect the impact of tele-ICUs.&nbsp;These countervailing forces motivate our investigation. Drawing on process virtualization theory and the sociotechnical systems perspective, we develop hypotheses about the direct and interaction effects of tele-ICU, health information interchange, and closed-model cardiac intensivist use on AMI outcomes. Using panel data and a control-function approach, we find no direct effects of tele-ICU. We find strong complementarity between tele-ICU and health information interchange, and separately, between tele-ICU and intensivist staffing. Effects vary by organizational level—hospital, joint-venture, or system—highlighting ICU coordination challenges.<br><br>Our study contributes theoretically by extending process virtualization theory with a sociotechnical perspective to low-virtualization care processes. It helps guide hospital administrators on when tele-ICU can improve the ICU care process. It contributes policy-wise by informing telehealth investment, integration, and post-pandemic efforts to enhance complex care.