With the evolving regulatory, technological, and fiscal landscape of the healthcare industry, healthcare providers, hospital systems, insurers, and legislators must work together to improve care, reduce costs, and serve an increasingly geographically dispersed patient population.
With that in mind, Children's Health System of Texas set out to make the world a smaller place through the creation and deployment of a telemedicine program to serve pediatric patients located outside of the health system's metro area.
At Children's Health, our organization's goal has always been to bring the highest quality of pediatric care to children in the right place and at the right time. Through the development of a pediatric telemedicine program, we are reducing unnecessary transfers while facilitating appropriate transfers in need of our tertiary and quaternary services. Our pediatric telemedicine program enhances family centered care and is standardizing pediatric care through shared protocols and best practices. Children's Health launched their telemedicine program with the TeleNICU service. TeleNICU was a first in Texas, and designed to help the most fragile patient, the neonate. Through this innovative modality, connecting hospitals from around the state and across the country can request telemedicine consults with Children's Level IV NICU.
We can do more
Children's Health has a history rooted in community outreach and partnerships. Children's builds relationships and works with adult hospitals to assist them in the care of their pediatric patients. Pediatric patients enter adult hospitals in one of two ways; they are birthed at those locations and spend time in the nursery/NICU or they enter through the emergency department. With a relentless desire to do more for community hospitals, Children's set out knowing that leveraging pediatric specialists and clinical staff was a must. We knew that virtual connectivity would become the most viable answer.
In the fall of 2013, Children's Health System of Texas launched the state's first ever Neonatal-specific Telemedicine program (TeleNICU). It has transformed care delivery to the most fragile neonatal patients located in remote hospitals within the state of Texas. TeleNICU enables real-time collaboration between remote hospitals and the Children's Health Level IV NICU (with world-renowned UT Southwestern neonatologists) using high-tech telemedicine equipment. The TeleNICU service helps to "bend the cost curve" by enabling newborns to be treated close to home, allowing participating hospitals to safely retain patients when appropriate (preventing unnecessary, costly patient transfers). Keeping newborns with their families in their home communities was always the driving force.
TeleNICU enables Level IV Neonatologists to be virtually present in the remote examination using specialized equipment designed for patient examination and collaboration with a remote site. To conduct an exam with a remote location, the Neonatologist at the Level IV NICU is able to connect to the remote location from a telemedicine studio located at Children's Medical Center Dallas, the health system's flagship hospital (or the physician's home via a home-based telemedicine station). The remote location is equipped with a Telemedicine cart, which has the same patient examination and collaboration equipment. Once the two sites are connected, Neonatologists are able to conduct complete interactive examinations of the neonatal patient. The Level IV physician can listen to the patient's heartbeat, lung, and bowel sounds and see the patient through the high-resolution camera and scope equipment. This allows the care team to collaborate to determine the best course of treatment. If they choose, parents can be involved in the consult. They are encouraged to ask questions and participate in their baby's care. Trusted relationships are established. Collaboration occurs. The very best care for the patient is at the core.
Telemedicine provides patients in remote hospitals and facilities with 24/7 access to the pediatric system's Level IV neonatal intensive care unit (NICU) and the expertise of a team of Neonatologists and supporting sub specialists, who care for the babies at Children's Medical Center's NICU. Enhanced care is possible since the program allows the neonate to remain in their home nursery or NICU and receive consults remotely. However, if a patient's condition warrants transfer to a Level IV facility, we believe that outcomes will be more positive due to the earlier interventional care and collaboration between physicians.
Reviewing the outcomes on TeleNICU
Of the TeleNICU consults completed September 2013 through November 2015, 40 percent were retained in the home hospital, while the remainder required transfer for higher tertiary care. Historically, all neonates may have required a transfer. Beyond revenue, the program frees up highly acute care resources, ensuring availability to those who really need it.
TeleNICU has enhanced the family experience by involving the parent in the consult. To date, 100% of parents verbalized appreciation for being included in the consult and encouraged to collaborate in their baby's treatment plan.
The TeleNICU service helps to standardize care through shared protocols and education. TeleNICU customer hospitals can choose from an array of education offerings and those courses are then deployed over the video connection at a time designated by the connecting hospital. In this way, breadth and depth of care for this patient population is enhanced.
Lessons to share
We are often asked about costs to build and deploy a telemedicine service. One of the most challenging steps was covering expenses. Our participation in the Delivery System Reform Incentive Payment initiative was paramount in funding the startup of our services. In addition, we established a service fee for connection, rather than being solely dependent on billing the patient's insurance. By defraying costs amongst connecting sites, the service fee was minimal to each individual site, allowing for program sustainability. The TeleNICU service has proven itself to be a success. We would encourage adoption of this technology and new care delivery model, in order to improve access to subspecialists that are not readily available in all communities, thus improving the quality of care made available to a child.
With an eye on the future
The healthcare industry seeks cost effective, quality delivery models that improve care, retain revenue, and enhance family satisfaction. The TeleNICU program is innovative in its use of technology. Also important, is a sustainable business model irrespective of grant funding. With certainty, the telemedicine program is repeatable in other areas of specialty. Children's Health launched their second hospital based telemedicine service, TeleER, in August of 2015. In addition, Children's Health has a robust primary care telemedicine application currently in schools throughout North Texas. Growth plans include expansion of the services to include more connection sites to our ICU telemedicine services and to further develop other non-emergent telemedicine subspecialties to enhance the availability of world-class care to pediatric patients in remote locations. The U.S. Department of Health and Human Services validates that telemedicine can effectively link distant sites to more resource-rich sites of care. In addition, the HRSA also states that telemedicine has the potential to improve pediatric care by increasing access to pediatric specialists and services. With that in mind, Children's Health has developed non urgent, ambulatory telemedicine for Plastic and Craniofacial Surgery, Dermatology, and Neurodevelopment.
Per American Academy of Pediatrics, June 2004 Technical Report, certain pediatric services seem well adapted to telemedicine, including the following; Radiology, Mental Health, Dermatology, Cardiology, Emergency Medicine, School Health, Hospital Care and Family Communication, Patient Education, Pathology, and Child Abuse. Couple this with the fact that the market for telemedicine is expected to grow at a rate of more than 50% a year—ballooning from $240 million in 2013 to $1.9 billion by 2018, according to IHS, a data and analytics firm. Hospital leaders and physicians will benefit from aligning themselves with this new way of practicing medicine. Telemedicine is no longer a vision for the future, but rather a current modality that is removing healthcare disparity between communities, expanding regional footprint for those that offer it and demonstrating high quality, cost effective care.
A zip code should not be the determining factor in the type of health care that is available. Regardless of the community or availability to specialists, healthcare leaders can work together to leverage resources and improve access to care. Children's Health is proud to be a leader in the ever expanding world of pediatric telemedicine.
About the Author:
Laura Swaney has more than 18 years of leadership experience in healthcare and education. Laura currently serves as the Vice President of Hospital Outreach and Physician Engagement for Children's Health in Dallas, Texas and maintains responsibilities for physician and hospital outreach services and business development.
www.childrens.com
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