Premature birth affects 1 in every 10 babies born in the U.S. and is the largest contributor to infant mortality nationally and abroad. Its incidence is on the rise—the U.S. preterm birth rate rose for the fourth straight year in 2018. Facing the challenge of treating this growing population—along with other critically ill infants—Children's Health in Dallas developed a comprehensive TeleNICU program.
Among the benefits of bringing telemedicine into the NICU: greater patient access to high-level care at a fraction of the cost. "It's great for the families because they don't have to leave their home and still have the confidence that they have the support of a Level IV NICU if they need it," says Rashmin Savani, M.D., M.B., Ch.B., division director of neonatal-perinatal medicine at Children's Health and professor of pediatrics at the University of Texas Southwestern in Dallas. "We're basically just the push of a button away from providing that consultation."
3 keys to success
The Children's Health TeleNICU recently marked six years since its launch and now provides telemedicine services for nine remote NICU locations across north Texas. Before the system could go live, Children's Health spent two years researching—and eventually working through—a maze of medical, legal, compliance and technology challenges.
Benefitting from a wealth of knowledge and experience amassed over the course of those eight years, Savani and his team identified three key components they say are crucial for building or improving a program that brings telemedicine into the NICU:
- Collaboration. To address the myriad of complex problems inherent with this endeavor, Children's Health established a multi-disciplinary committee to work through issues including HIPAA compliance, physician credentialing, enabling remote access to patient EMRs and securing patient data.
- Laying the foundation. Finding the right software is the bedrock on which the program will be built—it must meet the performance, privacy and security standards that suit a hospital's specific needs.
- Proper tools. Precision, high-tech tools are necessary for distant neonatologists to conduct thorough virtual exams and provide real-time input to clinicians. For Children's Health, they include digital otoscopes and stethoscopes, high-resolution cameras and a video laryngoscope. "We spent an enormous amount of time making sure we had all the peripheral devices we needed, and that's made our program very successful," Savani says.
Savani adds it's "absolutely critical" to assess your own needs and make deliberate decisions—don't rush into building a program that brings telemedicine into the NICU. "We were very eager to start the program," Savani says. "But when we looked at everything we needed to take care of, we knew it would be better to be comprehensive rather than quick."
Benefits beyond patient care
Of course, the focus of the TeleNICU program is the infant population in its care. TeleNICU care enables the entire care team—on both ends of the connection—to put the patient's needs first. Primary among those benefits is keeping patients close to home. Children's Health's TeleNICU has conducted more than 200 virtual exams on infants with a variety of diagnoses. As a result, about half of those patients were able to remain in their home hospital Level II and III NICUs instead of transferring to Children's Health.
But the remote hospital partners also benefit by having access to the expertise of the Children's Health clinicians. Savani says his team uses the technology to provide clinical lectures and simulations to instill best practices for complicated procedures. "We can provide education; the outside facilities want us to help them with protocols and procedures," Savani says. "The teaching part of it is important for us."
Looking ahead and abroad
Savani says Children's Health constantly evaluates the TeleNICU program to identify areas of improvement. Meanwhile, he's excited for the program to continue evolving.
"Our next horizon is to look internationally and identify units that we can help in the third world," Savani says. "There are opportunities for us to develop that. We're in the process of figuring out how we can provide neonatal telemedicine care globally."
