TeleNICU: Insider Tips on Building – or Improving – Virtual Care
In a state where it takes nearly 14 hours to drive from top to bottom, transferring every neonate to the Level IV NICU at Children’s Health℠, Children’s Medical Center Dallas wouldn’t just be inefficient – it would be nearly impossible.
That’s why Children’s Health and UT Southwestern developed one of the nation’s most comprehensive TeleNICU programs. Along the way, we solved thorny compliance and legal problems, built our own telemedicine platform and created a model that makes it affordable for partner hospitals to get input from our specialists.
"It's a win for families because it keeps them closer to home, and it's a win for the health care system because it lowers costs and lets smaller hospitals keep more neonates at their facility," says Rashmin Savani, MBChB, Division Director of Neonatal-Perinatal Medicine at Children’s Health and Professor of Pediatrics at UT Southwestern. “We think our experience building such a unique program could be useful for other centers who want to build a similar TeleNICU program or improve an existing one.”
Step One: Collaborate with Experts
We spent two years developing privacy safeguards, custom software and tackling other key challenges before launching our TeleNICU. Our first step was to create a working group that met weekly. The group collaborated with medical, legal, compliance and technology experts, and we devised ways to:
- Efficiently gain parental consent for virtual care
- Ensure compliance with HIPAA, the Centers for Medicare & Medicaid Services and the Texas Medical Board
- Establish an efficient process to get physicians credentialed at the hospitals where they would be consulting
- Enable remote access to patients’ electronic medical records
- Establish a secure way to transfer medical data, such as X-rays, ECHO and EEG
The next step was finding software that would meet our performance, privacy and security standards. After testing several programs, we opted to build our own platform, which gave us full control over the end product.
Using State-of-the-Art Tools for Remote Exams
Virtual evaluation is only as good as the technology it relies on, so we sought out the most advanced telemedicine hardware. Our mobile carts include digital otoscopes and stethoscopes, high-resolution cameras and a video laryngoscope. This enables the neonatologists here to conduct thorough exams from afar, and we can even give real-time input on things like how a distant team should intubate an infant.
“It means we can help outside providers pinpoint a baby’s condition and find ways to keep them stable,” Dr. Savani says.
Helping Referring Hospitals Keep Their Patients
We launched our TeleNICU in late 2013 with one partner site. We now have eight partners and are planning to add more in 2019.
We have virtually examined more than 170 neonates so far with diagnoses as varied as difficulty with ventilator management to an evaluation of gut inflammation to a possible genetic disorder. About half of the patients have been able to stay in their home hospitals. This has saved tens of thousands of dollars – without sacrificing patient care – by keeping patients in Level II and III NICUs. It is also better for patients and families who are able to stay closer to home.
Each partner gains access to our team in return for a fee. But just because our TeleNICU is advanced doesn’t mean it’s expensive for partner hospitals. Their costs – a one-time equipment purchase and a monthly service fee – are quickly recouped. The average cost of a Level II/III NICU stay is $76,000. If a hospital retains just one neonate, they will have covered the costs of one year’s worth of TeleNICU fees, including the equipment.
Putting Patients First
At the end of the day, telemedicine is about patient-centered care.
“TeleNICU enables our team, our partner physicians and even the parents to put the needs of the infant first,” Dr. Savani says. “Our principal goal is doing what’s in the best interest of the baby, and we make every decision based on that.”
Our TeleNICU is just one component of the Fetal Neonatal Program at Children’s Health and UT Southwestern. Our world-renowned experts have established specialized teams for complex conditions, a cooling program, a multidisciplinary FETAL Program and the Thrive Clinic, which encompasses the full spectrum of life from fetus to 5 years of age. That’s why U.S. News & World Report ranked Children’s Health among the top 25 fetal neonatal programs of 2018-19.
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