In 2013, Children’s Health and UT Southwestern developed Texas’ first and one of the nation’s most comprehensive TeleNICU programs. The program connects neonatologists at Level 2 or Level 3 NICUs with UT Southwestern neonatologists and 150 clinical and surgical subspecialists at Children’s Health. Dr. Jawahar Jagarapu discusses his research on the benefits of this program, from extending care to cost savings.
Visit childrens.com/teleNICU to learn more.
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Benefits of the TeleNICU Program
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Learn more about Dr. Jagarapu
Jawahar Jagarapu, MD, FAAP
Jawahar Jagarapu, M.D., FAAP, is a neonatologist at Children’s Health and Assistant Professor of pediatrics in the Neonatology division at UT Southwestern. Dr. Jagarapu has a significant interest in improving the quality of newborn care and he believes telemedicine plays a major role in enhancing newborn and pediatric care in the future. He is actively involved in the TeleNICU initiative at Children’s Health that is designed to promote newborn care in rural Texas. Dr. Jagarapu’s research interests include studying applications of telehealth in neonatal care and measuring the quality of care and economic impacts of the programs in telehealth.Learn more about Dr. Jagarapu
Transcription:
Benefits of the TeleNICU Program
Hal Altman, MD (Host): Welcome to Pediatric Insights, advances, and innovations with Children's Health, where we explore the latest in pediatric care and research. Today, we'll examine the application of neonatal telemedicine with our guest, Dr. Jawahar Jagarapu, who is a neonatologist at Children’s Health and Assistant Professor of Pediatrics at UT Southwestern.
I'm your host, Dr. Hal Altman. In 2013 Children's Health and UT Southwestern developed Texas' first and one of the nation's most comprehensive Tele NICU programs. The program connects neonatologists at a level two or level three NICU with UT Southwestern Neonatologists along with 150 clinical and surgical sub-specialists at Children's Health. Dr. Jagarapu recently published research on the benefits of this program and is here to speak with us about his findings. Dr. Jagarapu, it's a pleasure to welcome you to the podcast.
Jawahar Jagarapu, MD, FAAP (Guest): Thank you so much, Dr. Altman, and it's an absolute pleasure to be on this podcast and the ability to share our program and benefits.
Host: We certainly look forward to tapping into your expertise. advances in medical communication technology have helped to bring digital medicine into the mainstream. Your program with Children's Health has been at the forefront of a neonatal application of this virtual care model. Can you start by sharing the history and vision behind the Tele NICU program at Children's Health?
Dr. Jagarapu: Sure. And the program itself is called Tele NICU. It's telemedicine neonatal intensive care unit. And as you mentioned earlier, it was started in 2013 and no date at the time I started in 2015, but the program was established by a unique collaboration between Children's Health and UT Southwestern Medical Center.
And Dr. Savani, our division chief was instrumental in setting up this program. And whenever I had a chat with him the, the main vision behind the program, whether we can leverage technology to keep newborns, you know, closer to where they live and provide the highest level of care. And Children's Medical Center is a level four neonatal intensive care unit. There are level one to four, level four is the highest level of care.
And there is only around 20 of these kind and on the state of Texas, which is one of the second largest states in the United States. And there are over 200 neonatal facilities in the state. And yes, it's like one level four unit for every 12 to 13 neonatal facilities.
So, the initial vision was whether we could leverage this technology to connect to these lower level intensive care units and safely provide the care. Historically it was whenever they needed babies needed higher level of care, they used to just transfer to the Children's Medical Center.
Given the explosion in technology and whether we can use this to leverage and to see whether we can safely keep the babies closer to where they live and that'll help the health systems locally and also help the parents to be with their children. Also to improve the collaboration between these health systems who are referral facilities.
Host: So, can you bring us into sort ofthe nuts and bolts, the specifically how the tele NICU program works?
Dr. Jagarapu: Sure. And usually it's a the telemedicine program is connected. So we are the level four NICU is connected to at around nine hospitals in the north Texas region. And these nurseries or the lower level NICU's are anywhere between 50 miles to up to 500 miles from the Children's Medical Center.
And typically whenever the referring providers need any consultations on babies who are very sick and they might need higher level of care, they connect to the telemedicine platform to the to the level four center at the Children's Medical Center. So there is this process for technology which was put in place throughout the years.
So whenever there is a consult needed and it's a 24/7 service. So anytime of the night, there is a physician on call at Children's to take the telemedicine calls. And if the consult is needed urgently, we are able to connect with the lower level NICUs within 15 minutes. And sometimes, you know, the referring physicians are even because of the parental requests, sometimes they would like to schedule the call for the next day where the parents can be there during the time of the call. And in those cases is, are more like scheduled consults. So once the consult is initiated from the referral center, we prepare a time and date, if it is emergent where it will be within 15 to 30 minutes, we are able to log on to the telemedicine platform anywhere where we are like to the computer we have at home, through the studio at the Children's Medical Center, there is a teleNICU studio, and we are able to connect. It's like a direct audio video transmission between the referring provider and the accepting provider at the Children's Medical Center.
The technology itself is a fascinating to me and offers a seamless communication of audio and video and the referring sites, the NICUs in the communities have these carts, the telemedicine carts, which have cameras which are high definition cameras.
And they're also equipped with some equipment like stethoscopes to examine the heart and lungs, otoscopes to even look into ears and the dermatoscopes, which are to examine the skin of the infants. So very sophisticated technology and other cool thing is where you can even manipulate those cameras from our end and so that you can zoom in on the babies to examine closely.
So it's virtually being at the bedside of the baby, using technology. So that's the most fascinating part of the technology.
Host: Fascinating and very impressive. So doctor, can you share with us what you feel some of the benefits of the program are starting with patients and families and extending to community providers, nurseries and third-party payers?
Dr. Jagarapu: Thank you. So the biggest benefits for the patients and families are the ability to stay locally within their health systems and safely obtain the care, the highest level of care and where, when babies are born, it's a time for moms and the family members as well. Separating the babies at the time of birth to transfer to some other centers, it's always very stressful and parents have to take time off from their work to travel to the higher level of, higher level center. So it becomes very stressful. Using telemedicine or the tele NICU, we are able to provide the same highest level of care using technology. And we are able to safely keep these babies within their local health systems.
It's a huge win for the families and they always love it whenever they have use telemedicine and you know, stay at the local health systems. And for the local health systems or the referring sites, the biggest advantages are keeping the babies within the ri health systems and having a 24/7 kind of service of a specialist service for consultation and that actually increases trust in the, in the local health systems from the families, you know, and their providers as well. At the same time it also promotes collaboration between the health systems and between the referring hospitals and then in the quaternary centers.
And in terms of for the payers, I think the biggest benefits are by avoiding transfers of these babies to higher level centers, there is huge cost savings within the because of the avoided transfer, just in the transport costs alone, even before not taking into equation, other things like loss of pay and everything for the parents because of loss of work. And also sometimes when infants are cared in higher level centers, like a quaternary center; the charges are much, much higher. And compared to a lower level care in the lower level nursery. So the payers are benefiting a lot because of, you know, avoided transport costs and, you know, decreased police charges. And overall it's benefiting the health systems, you know, less
healthcare dollars being spent with the use of technology.
Host: Thank you very much for that. It sounds like everybody involved in the program turns out to be a winner. In 2021, you published a study called Tele NICU, Extending the Reach of Level Four Care and Optimizing the Triage of Patient Transfers. What are some of the highlights of your study?
Dr. Jagarapu: Yeah. So the program has been there. And look at this program has been there for almost nine years coming up to nine years this year. And so we through this study, we actually explored the tele NICU program, the aims of the teleNICU program were achieved really, or whether the program was effective over this period.
And we conducted a study to look at all the consultations over a period of five years. And we found that there were more than a hundred consultations, which were provided during this time. And we were able to in more than half of the cases, almost 54% of the cases, we are able to keep these babies locally in their own health systems, in the referring hospitals using telemedicine.
If, if you say like, if there was no telemedicine or teleNICU program, all these babies might have been transferred to the highest level center or the Children's Medical Center for further care, because in the past it used to be just a telephone call discussion between the referring provider and the higher level provider. And eventually the transfer would have happened to the Children's Medical Center. So that was one of the biggest findings of this. And there were a couple of other programs in the nation, which have showed similar findings but less transfer rates.
The other aspect of the program we looked at was the patient and the family satisfaction. And every time we have performed this consultation, the families are really, really happy with the way and the process happened and had, they felt that there was someone at the higher level centers who are kind of providing the care for them. And they are very, very happy with the whole process and it truly kind of reflects the family centered care, which is provided in the, in the NICU.
And the third important thing, which we found that was, we actually calculated the cost savings for the health systems, especially in avoided transport costs and just, just with avoiding transport costs, the health system, the healthcare dollars around up to a million dollars were saved in just avoided transport costs. So that the healthcare cost savings using technology. It does not even take into account other things like benefits for the local health systems by keeping the revenue within the local health systems. So overall I think it benefited communities with high clinical level of care and effectiveness, and then also saved healthcare systems cost savings.
Host: Well, congratulations that that's a very impressive summary and I'm sure you look forward to more years of better outcomes. So, Dr. Jagarapu in closing, is there anything else that you'd like to share with providers about the tele NICU program at Children's Health?
Dr. Jagarapu: Sure. And, one thing that's happened over these years is in, especially over the last three years, I think we were still dripping with the COVID-19 pandemic, but having this program in place even prior to COVID-19 actually, you know, leveraged our health systems, put us in a unique place where we were able to actually utilize the telemedicine in more effective ways, communicating with the families.
We actually embarked more in providing virtual rounds and then also we are using telemedicine in the transport of newborn care and other consultations, like, you know, mothers with complex fetal problems. We are able to provide fetal consultations using telemedicine. So, we leverage technology in all aspects of, you know, improving newborn care and the program being the first and the unique program in the state of Texas.
And the benefits of these programs showcased from the study some of the other centers actually approached us, you know, in terms of how we implement these programs and I'd like to thank the leaders behind the vision and of this program and the unique collaboration between Children's Health and UT Southwestern Medical Center, along with efforts of, you know, virtual health technology team who has provided the technology behind it and also the 24/7 technology support. So it takes a team of technology clinical service providers with other teams like compliance teams and regulatory teams, to achieve success in these kinds of programs. And hopefully our program will inspire many other programs across the nation to provide similar services and improve newborn care.
Host: Very much so. Well, thank you Dr. Jagarapu and to our audience for participating in today's Pediatric Insights, advances in innovations in neonatal telemedicine with Children's Health. Providers can gain more information about the tele NICU program at Children's Health by visiting the website at www.children's.com/telenicu.
For updates on the latest on pediatric medical advances, breakthroughs and research, please follow us on your social channels. You are warmly invited to subscribe, rate, and review this podcast and to all other podcasts from Children's Health. Goodbye, and thanks again for listening to Pediatric Insights, advances, and innovations with Children's Health.
Benefits of the TeleNICU Program
Hal Altman, MD (Host): Welcome to Pediatric Insights, advances, and innovations with Children's Health, where we explore the latest in pediatric care and research. Today, we'll examine the application of neonatal telemedicine with our guest, Dr. Jawahar Jagarapu, who is a neonatologist at Children’s Health and Assistant Professor of Pediatrics at UT Southwestern.
I'm your host, Dr. Hal Altman. In 2013 Children's Health and UT Southwestern developed Texas' first and one of the nation's most comprehensive Tele NICU programs. The program connects neonatologists at a level two or level three NICU with UT Southwestern Neonatologists along with 150 clinical and surgical sub-specialists at Children's Health. Dr. Jagarapu recently published research on the benefits of this program and is here to speak with us about his findings. Dr. Jagarapu, it's a pleasure to welcome you to the podcast.
Jawahar Jagarapu, MD, FAAP (Guest): Thank you so much, Dr. Altman, and it's an absolute pleasure to be on this podcast and the ability to share our program and benefits.
Host: We certainly look forward to tapping into your expertise. advances in medical communication technology have helped to bring digital medicine into the mainstream. Your program with Children's Health has been at the forefront of a neonatal application of this virtual care model. Can you start by sharing the history and vision behind the Tele NICU program at Children's Health?
Dr. Jagarapu: Sure. And the program itself is called Tele NICU. It's telemedicine neonatal intensive care unit. And as you mentioned earlier, it was started in 2013 and no date at the time I started in 2015, but the program was established by a unique collaboration between Children's Health and UT Southwestern Medical Center.
And Dr. Savani, our division chief was instrumental in setting up this program. And whenever I had a chat with him the, the main vision behind the program, whether we can leverage technology to keep newborns, you know, closer to where they live and provide the highest level of care. And Children's Medical Center is a level four neonatal intensive care unit. There are level one to four, level four is the highest level of care.
And there is only around 20 of these kind and on the state of Texas, which is one of the second largest states in the United States. And there are over 200 neonatal facilities in the state. And yes, it's like one level four unit for every 12 to 13 neonatal facilities.
So, the initial vision was whether we could leverage this technology to connect to these lower level intensive care units and safely provide the care. Historically it was whenever they needed babies needed higher level of care, they used to just transfer to the Children's Medical Center.
Given the explosion in technology and whether we can use this to leverage and to see whether we can safely keep the babies closer to where they live and that'll help the health systems locally and also help the parents to be with their children. Also to improve the collaboration between these health systems who are referral facilities.
Host: So, can you bring us into sort ofthe nuts and bolts, the specifically how the tele NICU program works?
Dr. Jagarapu: Sure. And usually it's a the telemedicine program is connected. So we are the level four NICU is connected to at around nine hospitals in the north Texas region. And these nurseries or the lower level NICU's are anywhere between 50 miles to up to 500 miles from the Children's Medical Center.
And typically whenever the referring providers need any consultations on babies who are very sick and they might need higher level of care, they connect to the telemedicine platform to the to the level four center at the Children's Medical Center. So there is this process for technology which was put in place throughout the years.
So whenever there is a consult needed and it's a 24/7 service. So anytime of the night, there is a physician on call at Children's to take the telemedicine calls. And if the consult is needed urgently, we are able to connect with the lower level NICUs within 15 minutes. And sometimes, you know, the referring physicians are even because of the parental requests, sometimes they would like to schedule the call for the next day where the parents can be there during the time of the call. And in those cases is, are more like scheduled consults. So once the consult is initiated from the referral center, we prepare a time and date, if it is emergent where it will be within 15 to 30 minutes, we are able to log on to the telemedicine platform anywhere where we are like to the computer we have at home, through the studio at the Children's Medical Center, there is a teleNICU studio, and we are able to connect. It's like a direct audio video transmission between the referring provider and the accepting provider at the Children's Medical Center.
The technology itself is a fascinating to me and offers a seamless communication of audio and video and the referring sites, the NICUs in the communities have these carts, the telemedicine carts, which have cameras which are high definition cameras.
And they're also equipped with some equipment like stethoscopes to examine the heart and lungs, otoscopes to even look into ears and the dermatoscopes, which are to examine the skin of the infants. So very sophisticated technology and other cool thing is where you can even manipulate those cameras from our end and so that you can zoom in on the babies to examine closely.
So it's virtually being at the bedside of the baby, using technology. So that's the most fascinating part of the technology.
Host: Fascinating and very impressive. So doctor, can you share with us what you feel some of the benefits of the program are starting with patients and families and extending to community providers, nurseries and third-party payers?
Dr. Jagarapu: Thank you. So the biggest benefits for the patients and families are the ability to stay locally within their health systems and safely obtain the care, the highest level of care and where, when babies are born, it's a time for moms and the family members as well. Separating the babies at the time of birth to transfer to some other centers, it's always very stressful and parents have to take time off from their work to travel to the higher level of, higher level center. So it becomes very stressful. Using telemedicine or the tele NICU, we are able to provide the same highest level of care using technology. And we are able to safely keep these babies within their local health systems.
It's a huge win for the families and they always love it whenever they have use telemedicine and you know, stay at the local health systems. And for the local health systems or the referring sites, the biggest advantages are keeping the babies within the ri health systems and having a 24/7 kind of service of a specialist service for consultation and that actually increases trust in the, in the local health systems from the families, you know, and their providers as well. At the same time it also promotes collaboration between the health systems and between the referring hospitals and then in the quaternary centers.
And in terms of for the payers, I think the biggest benefits are by avoiding transfers of these babies to higher level centers, there is huge cost savings within the because of the avoided transfer, just in the transport costs alone, even before not taking into equation, other things like loss of pay and everything for the parents because of loss of work. And also sometimes when infants are cared in higher level centers, like a quaternary center; the charges are much, much higher. And compared to a lower level care in the lower level nursery. So the payers are benefiting a lot because of, you know, avoided transport costs and, you know, decreased police charges. And overall it's benefiting the health systems, you know, less
healthcare dollars being spent with the use of technology.
Host: Thank you very much for that. It sounds like everybody involved in the program turns out to be a winner. In 2021, you published a study called Tele NICU, Extending the Reach of Level Four Care and Optimizing the Triage of Patient Transfers. What are some of the highlights of your study?
Dr. Jagarapu: Yeah. So the program has been there. And look at this program has been there for almost nine years coming up to nine years this year. And so we through this study, we actually explored the tele NICU program, the aims of the teleNICU program were achieved really, or whether the program was effective over this period.
And we conducted a study to look at all the consultations over a period of five years. And we found that there were more than a hundred consultations, which were provided during this time. And we were able to in more than half of the cases, almost 54% of the cases, we are able to keep these babies locally in their own health systems, in the referring hospitals using telemedicine.
If, if you say like, if there was no telemedicine or teleNICU program, all these babies might have been transferred to the highest level center or the Children's Medical Center for further care, because in the past it used to be just a telephone call discussion between the referring provider and the higher level provider. And eventually the transfer would have happened to the Children's Medical Center. So that was one of the biggest findings of this. And there were a couple of other programs in the nation, which have showed similar findings but less transfer rates.
The other aspect of the program we looked at was the patient and the family satisfaction. And every time we have performed this consultation, the families are really, really happy with the way and the process happened and had, they felt that there was someone at the higher level centers who are kind of providing the care for them. And they are very, very happy with the whole process and it truly kind of reflects the family centered care, which is provided in the, in the NICU.
And the third important thing, which we found that was, we actually calculated the cost savings for the health systems, especially in avoided transport costs and just, just with avoiding transport costs, the health system, the healthcare dollars around up to a million dollars were saved in just avoided transport costs. So that the healthcare cost savings using technology. It does not even take into account other things like benefits for the local health systems by keeping the revenue within the local health systems. So overall I think it benefited communities with high clinical level of care and effectiveness, and then also saved healthcare systems cost savings.
Host: Well, congratulations that that's a very impressive summary and I'm sure you look forward to more years of better outcomes. So, Dr. Jagarapu in closing, is there anything else that you'd like to share with providers about the tele NICU program at Children's Health?
Dr. Jagarapu: Sure. And, one thing that's happened over these years is in, especially over the last three years, I think we were still dripping with the COVID-19 pandemic, but having this program in place even prior to COVID-19 actually, you know, leveraged our health systems, put us in a unique place where we were able to actually utilize the telemedicine in more effective ways, communicating with the families.
We actually embarked more in providing virtual rounds and then also we are using telemedicine in the transport of newborn care and other consultations, like, you know, mothers with complex fetal problems. We are able to provide fetal consultations using telemedicine. So, we leverage technology in all aspects of, you know, improving newborn care and the program being the first and the unique program in the state of Texas.
And the benefits of these programs showcased from the study some of the other centers actually approached us, you know, in terms of how we implement these programs and I'd like to thank the leaders behind the vision and of this program and the unique collaboration between Children's Health and UT Southwestern Medical Center, along with efforts of, you know, virtual health technology team who has provided the technology behind it and also the 24/7 technology support. So it takes a team of technology clinical service providers with other teams like compliance teams and regulatory teams, to achieve success in these kinds of programs. And hopefully our program will inspire many other programs across the nation to provide similar services and improve newborn care.
Host: Very much so. Well, thank you Dr. Jagarapu and to our audience for participating in today's Pediatric Insights, advances in innovations in neonatal telemedicine with Children's Health. Providers can gain more information about the tele NICU program at Children's Health by visiting the website at www.children's.com/telenicu.
For updates on the latest on pediatric medical advances, breakthroughs and research, please follow us on your social channels. You are warmly invited to subscribe, rate, and review this podcast and to all other podcasts from Children's Health. Goodbye, and thanks again for listening to Pediatric Insights, advances, and innovations with Children's Health.