This message was posted to The PICU list on July 1, 1998

It seems that it is time to announce the existence of the Virtual PICU.

This announcement is prompted by what appears to be a widespread recognition of the need for a comprehensive database for PICU use, as has been clear over the PICU list these last several days.

In response to this, and many other informatics needs in the pediatric critical care world, several of us got together a month or so ago in St Louis for a two day symposium to explore ways to develop informatics support to meet the needs of pediatric critical care medicine into the next century. We recognize that much excellent work already has been and is being done by many pediatric intensivists around the country. We think that it would be beneficial to provide support, develop standards, encourage organization and coordination and facilitate communication among the many people interested in this area so that we don't have to all 'go it alone.'

The symposium attendees were: Dana Braner at Portland Children's Hospital. Joe DiCarlo at Stanford. Barry Markovitz at Children's Hospital St. Louis. Carl Weigle at Milwaukee Children's. Judy Verger from Children's Hospital of Philadelphia. Jim Fackler from Johns Hopkins Hospital. Steve Pon from Cornell. Adrienne Randolph from Boston Children's. Randall Wetzel at CHLA. Doug Wilson from U.Va. (in absentia). Tom Green from Northwestern has since joined the group.

This group is intent on organizing a 'Virtual PICU' with the following vision and aims.

Vision

We will create a common information space for the international community of care givers providing critical care for children.

Every critically ill child will have access to the Virtual PICU that will provide ready access to the essential information required to optimize their outcome.

Mission

Aim #1. To further develop the technology and expertise now within cost effective reach to allow inter-institutional data sharing for the creation of extended knowledge bases. This data sharing will provide the infrastructure for randomized clinical trials (national studies) and also improve the quality of inferences from anecdotal data (conclusions based on individual patient cases).

Aim #2. To provide the best comprehensive training for practitioners of critical care medicine, at a level completely unknown before now. Shared protocols, curricula, lecture courses, and distance learning by recognized experts will be made available over the Internet for critical care givers. Development of a national CBC conference database, as well as real time on-line CPC's, an evidence based journal (club) and multimedia educational initiatives will be directed at improving educational levels and efficiency in pediatric critical care.

Aim #3. To improve quality. Decreasing variation is a primary means of assuring quality, and applying standards for continuous quality control requires adequate, accurate data of the critical care delivery process. Real-time, automated data gathering with analysis of severity of illness and outcomes and defined therapeutic protocols are essential to improve therapy, cost efficiency, and outcomes in the practice of critical care medicine.

Aim # 4. To develop pediatric critical care telemedicine. This will enhance pediatric care everywhere. It is not possible to provide a pediatric intensivist for every institution that cares for children. It is possible, with an integrated critical care network, for pediatric practitioners in areas where intensivists do not exist to have access to the virtual PICU. Medicine will be brought to the bedside of critically ill children over an Internet accessible communications network.

As part of this process we have recognized and are developing, in collaboration with PCCSG, a common database structure with a common semantic architecture to which data can be mapped. In keeping with this structure, local database support would be available. We are committed to providing a usable common format database for individual PICU use. Many individuals and individual PICU's already have databases and/or are developing their own. Commercial versions are available. It is obviously desirable in the long run to have a common format and semantic architecture and assure that our databases in the future can communicate and share data.

We intend this development to be inclusive and collaborative and therefore we welcome comments, assistance and cooperation from interested colleagues. The goal is to produce, at the lowest possible cost, a common database structure for practitioners of pediatric critical care that will be available to us all.

Randall C. Wetzel, M.D.
Professor of Pediatrics and Anesthesiology
The Anne O'M. Wilson Professor of Critical Care Medicine
Director, Critical Care Medicine
Childrens Hospital Los Angeles
USC School of Medicine
Director, The Laura P. and Leland K. Whittier Virtual Pediatric ICU
e-mail:rwetzel@chla.usc.edu
phone: 323-669-2557
fax: 323-664-0728
4650 Sunset Blvd. MS # 12
Los Angeles, California 90027-6062