Goal # 1. Extended databases

To develop the technology and expertise now within cost effective reach to allow inter-institutional data sharing for the creation of extended, multi center (distributed) knowledge bases.

These can be available to either improve the quality of inferences from anecdotal data or to demolish many of the barriers to formal randomized control trials. This data sharing is the infrastructure of prospective randomized clinical trials.

Goal # 2. Education and distance learning

To provide the best fellowship and other medical practitioners training for practitioners of critical care medicine.

Shared protocols, curricula, lectures, courses and demonstrations by recognized national experts can be made available over the Internet to all.

For example, every week in this country there are at least fifty top rate clinical pathological conferences in pediatric intensive care. First rate practitioners provide in depth knowledge and discussion for two or three fellows in a localized environment. These are never shared. Development of a national CPC data base, as well as real time on-line CPC's will begin to decrease variability and elevate the quality of critical care.

Internet accessible audio visual demonstrations in areas such as statistics, experimental design, ventilator management, neuro-resuscitation, etc, can be made widely available. The cutting edge practice of academic centers would become immediately available throughout the community. The cost of each one of these presentations would be prohibitive for local institutions. A national cooperative effort for dispersal of this knowledge throughout the country would be possible.

Access to medical knowledge data bases and literature searches of the National Library of Medicine can be brought to the bedside of critically ill children over an Internet accessible communications network. These data can be reviewed and commented upon by leading intensivists. Practitioners of critical care medicine who are unable to keep up with the literature or unable to be present at leading academic centers, can feel a part of the national critical care practice. The educational opportunities are limitless as every ICU becomes part of the virtual ICU.

Goal # 3. Quality Enhancement

To improve quality.

Decreasing variation in large numbers of products is a major technique for assuring quality. Applying industrial standards for continuous quality control requires adequate, accurate data of the delivery process in critical care.

Real-time, on-line, automated data gathering with analysis of outcomes, severity of illness analysis, and defined therapeutic protocols are necessary to ascertain variation. This will provide a clue to improve therapy, improve cost efficiency and almost certainly improves outcomes in the practice of critical care medicine.

This requires a shared data base overseen by a nationally organized group to constantly insure accuracy and reliance of the data acquisition in the virtual ICU.

Goal # 4. Telemedicine and improved access to pediatric critical care services

To develop critical care telemedicine to enhance critical care.

It is not possible to provide a pediatric intensivist in every institution that cares for children in the United States. It is possible, with an integrated critical care network, for pediatric practitioners in areas where intensivists do not exist, to have access to a virtual pediatric ICU.

Real-time transmission of patient data combined with bedside explanation from the physician attending the child in locations remote from pediatric critical care units can enhance the care delivery at the bedside of that child in their community, in a cost efficient manner. The medical decisions of the need for critical care and its level can be determined and managed by practitioners expert with the integration of informatics and critical care medicine based at academic centers.

In addition, continuous quality improvement, (item three above), can be used to not only test this hypothesis but to continually improve care in these units. The same critical care management strategies available at the premier academic ICUs can be available at every child's bedside.