National emergency tele-critical care in a pandemic: Barriers and solutions

Jeremy C. Pamplin*, Brooke Gray, Matthew T. Quinn, Jeanette R. Little, Christopher J. Colombo, Sanjay Subramanian, Joseph C. Farmer, Michael Ries, Benjamin Scott, Donna Lee Armaignac, Richard Bakalar, Paul Biddinger, Tehnaz Boyle, Mike Breslow, Tim Buchman, Christine Calouro, Perren Cobb, Chris Colombo, Ryan Costantino, Ben DaxonRay Dizon, Martin Doerfler, Kyle Enfield, Sonia Everhart, Bruce Gipe, Matthew Goede, Sai Haranath, Kirk Hendler, Tiffany Ingham, Marcin James, Christina Kordik, Mei Kwong, Keith Lamb, Krys Laudanski, Chris Palmer, Jeremy Pamplin, Peter Pappas, Subhash Patel, Mike Ries, Herb Rogove, Brian Rosenfeld, Ben Scott, Ash Seth, Jaspal Singh, Sanjay Subramanian, Samuel Taylor, Dan Adams, Dustin Ashton, Srini Attili, Laura Baker, Stacie Barczak, Sara Azimi-Bolourian, Cat Bonanni, T. J. Brown, Richard Catherina, Brant Chee, Rob Chewning, Charlie Chung, Roger Coleman, Christopher Colombo, Cleveland Cooke, Mabel Cooper, Laura Cosentino, Amy Cotter, Steve Dain, Joe Daniels, Lee Depalo, Mark Dertzbaugh, Eric Deussing, Matthew Dinmore, Hong Lin Du, Joel Duerkson, Beverly Adams Everly, Chris Farmer, Troy Finnigan, Rhonda Fischer, Nate Fischer, Brian Foote, Carol Fraser, Richmund Fries, Darrin Frye, Cubby Gardner, Jimmy Gaudeaen, Matt Goede, Julian Goldman, Colin Gorman, Jennifer Ray-Gorrie, Ollie Gray, Bobbie Greenman, Sean Griffin, Jason Gumaer, Richele Harms, Robert Henschel, Bianca Herlory, Im Hill, Rahel Hintza, Sean Hipp, Alice Isenberg, James Beach, Arun Janardhanan, Katie Johansen, Til Jolly, Michelle Kimball, Thomas Kirsch, Josh Kneff, Oren Kodish, Nathan Krull, Joseph Lamana, Lisa Lindgren, Jeanette Little, Debbie Locke, Carl Manemeit, Gregg Mattes, Mary Lowe Mayhugh, Robin McEntire, Fran McVeigh, Ashley Mehra, Andrew Midzak, Tom Moore, Jarone Lee, Tim Nicholes, Mark Noble, Rich Osolease, Terry Bobryk-Ozaki, Dina Passman, Holly Pavliscsak, Richard Perrin, Kathleen M. Perrino, Travis Polk, Elaine Por, Matthew Quinn, Shantaram Rangappa, Tracy Rausch, Mary Reidy, Michael Reinemann, Richard Hunt, Jan Rizzuto, Carol Rogers, Ronald Yeaw, Sharon Rosser, Amanda Sachtelben, Jose Salinas, Patricia Schmidt, Seila Selimovic, Deramus Smart, Christopher Steele, Jeff Stephenson, Kyle Stirling, Michael Talley, Tibor Tuzson, Rosi Urbine, Justin Valovich, Tabitha Waldrop, Sandy Weininger, David Wild

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


The COVID-19 pandemic caused tremendous disruption to the U.S. healthcare system and nearly crippled some hospitals during large patient surges. Limited ICU beds across the country further exacerbated these challenges. Telemedicine, specifically tele-critical care (TCC), can expand a hospital's clinical capabilities through remote expertise and increase capacity by offloading some monitoring to remote teams. Unfortunately, the rapid deployment of telemedicine, especially TCC, is constrained by multiple barriers. In the summer of 2020, to support the National Emergency Tele-Critical Care Network (NETCCN) deployment, more than 50 national leaders in applying telemedicine technologies to critical care assembled to provide their opinions about barriers to NETCCN implementation and strategies to overcome them. Through consensus, these experts developed white papers that formed the basis of this article. Herein, the authors share their experience and propose multiple solutions to barriers presented by laws, local policies and cultures, and individual perspectives according to a minimum, better, best paradigm for TCC delivery in the setting of a national disaster. Cross-state licensure and local privileging of virtual experts were identified as the most significant barriers to rapid deployment of services, whereas refining the model of TCC to achieve the best outcomes and defining the best financial model is the most significant for long-Term success. Ultimately, we conclude that a rapidly deployable national telemedicine response system is achievable.

Original languageEnglish
Pages (from-to)E1091
JournalCritical Care Explorations
Issue number5
StatePublished - 13 May 2024
Externally publishedYes


  • Critical care
  • Delivery of healthcare
  • Health resources
  • Pandemic
  • Rural health
  • Telemedicine


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