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This is the Becker's Healthcare Podcast,

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Thanks for listening.
Now here's the episode.

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This is Chris Sosa with the
Becker's Healthcare Podcast.

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I'm thrilled today to be
joined by Dr. Mark Bergeron,

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medical director for digital
health transformation,

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and medical director for the neonatal
virtual care program at Children's

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Minnesota. Dr. Bergon, thank you
so much for joining us today.

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Yeah, thanks for having
me. I appreciate it.

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Could you please introduce yourself and
tell us a bit about your background?

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Absolutely. So, uh, like you
said, I, my name is Mark Bergeron.

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I'm a practicing neonatologist
at Children's Minnesota,

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and then I wear the dual hats as
medical director for digital health

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transformation, um, for our entire
healthcare system. But then, uh,

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in the neonatology department,

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I am medical director for our
neonatal virtual care program.

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Excellent. Could you please
outline that virtual care program,

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including how it increases access to
particular critical care patients in rural

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and regional hospitals and communities?

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Yes, absolutely. First, just a little
bit about Children's Minnesota, um,

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and specifically our neonatology
program. Um, we are truly a,

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a regional resource for families
throughout, um, the upper Midwest.

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Um, we have a team that's 500 doctors,
surgeons, nurse practitioners,

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rehab specialists, you
name it. And then, uh,

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based both on the size of our team and
the volume of patients that we take care

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of. We're one of the largest neonatal
programs, uh, in the country.

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And certainly we are in Minnesota. Um,

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we take care of more than 3000 babies
a year, and so we do this a lot. Um,

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our virtual care program, gosh,

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started back in 2018 as a pilot
with one of our rural hospitals, um,

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that sends us a fair number of
babies and they had a, a need, um,

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for kind of a virtual partnership
for stabilizing babies.

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They had a single pediatrician who was
concerned being fresh outta practice,

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that, uh, he, uh,

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was gonna find himself in a situation
he'll always have at the middle of the

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night where he was gonna want
some kind of expert backup. Uh,

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and so we approached us about, uh,
could we do a virtual care program? Um,

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and we said, yes, absolutely.

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And so we went through the process of
designing the program with his hospital

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and, uh, did a year long pilot.

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And the program today is
much larger than that,

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but looks exactly the same as it did
as in design as it did back then.

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Um, and basically, you know,

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a a provider in a rural setting recognizes
that he is got a baby in front of him

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that needs critical care, um,

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and we are there in a virtual sense
in the room to walk that provider

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through the initial steps of, uh,
preparation for resuscitation,

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the actual act of resuscitation,
and then, you know,

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streamlining that process of moving
that baby from the rural setting

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into the twin cities to our,
one of our ICUs if needed. Um,

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and doing that in a kind
of a streamlined fashion.

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Dr. Bergon,

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how has the program evolved since it
launched to serve patients throughout the

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upper Midwest? So.

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When we launched the program in 2018,

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we designed it with a single
site as a pilot, and, um,

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really we designed it with
a local pediatrician, uh,

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asking for virtual care services to
support him in his practice because he was

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concerned that he would run into
a situation that he pot, uh,

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potentially wasn't, uh, comfortable
managing particularly, uh, uh,

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in a rural hospital. It doesn't have
as many resources as a, as a, um,

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large pediatric medical center would. Um,

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so in that first year with that
one site, we did 10 consults. Um,

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and then throughout the
year, up to present day,

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we've added about two to three new
hospital, uh, partners, uh, each year.

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So now we're doing about
80, uh, consults a year.

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We'll probably surpass that this
year just because we've added, um,

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additional sites. So we're up
to 14 sites, um, as a, you know,

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as of today and then probably
two to three more, uh,

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hospitals will get partnered
with us by the end of the year.

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I'm glad you mentioned the size of the
program and how it's growing. Well,

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how do you see the need for services
like this growing as hospitals find it

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increasingly difficult to recruit
providers with unilateral experience?

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Yeah, so as Becker's and many
others have reported, um,

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in the last year or so,

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recruitment and retention for all
types of professions in healthcare is,

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um, is problematic. Within
pediatrics, it's no different,

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and it seems it's in the specialized
field of neonatology. Um,

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there is a definite need for neonatal
expertise the further you get away

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from a major metropolitan
area. I see the need growing.

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The way medical education works
now in the United States, uh,

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is different than it was 20 years
ago when I went through training.

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You did repeated months of training
as a resident in the N I C U,

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and that has been whittled down to, you
know, just a few weeks, um, for most,

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uh, residency programs.

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So we have recent graduates that
are coming out with not a lot of

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confidence in being able to resuscitate,

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resuscitate a newborn that they might
have coming out of a training program,

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you know, 10 or 20 years ago.

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And I see that's where the role of our
program really comes, uh, into, uh,

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its importance that we can go to
these regional sites and say, Hey,

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we recognize there's gonna be some times
where you need a neonatal expert, uh,

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virtually, um, to back up the skills
that your onsite provider has.

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And we're ready to do
that at a moment's notice.

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And that's really been the success
and the experience of our program,

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is that we build these relationships
with these rural providers and make them

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feel more confident in what they can
accomplish and stabilizing an infant.

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Certainly those stabilizations and the
resuscitations that you just mentioned

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are key. There's the
cornerstone to this program.

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What else do you think about this program
helps streamline transfers from the

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hospital to the N ICUs.

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So it used to be that you would, you know,

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you'd be talking on the phone about
the baby that's, that you can't see,

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and you'd be relying very heavily on the,

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the experience and the perceptions
of the provider that's on site,

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and that's variable depending
on their comfort level, uh,

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and experience with an infant. Today I
see the infant at the same time they do,

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and I have a, uh, my experience
and that, and my partners,

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we have an earlier recognition of an
infant that probably needs to come to us

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rather than having the
situation described to us.

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We see it and we recognize and we should
probably mobilize our transport team

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now. Um, and so first of all,
it's that earlier recognition,

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and then once our transport
team gets on site,

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I can describe to them in the
moments before they arrive and,

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and while they're on route,

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here's what's going on in that delivery
room or in that newborn nursery,

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this is the status of the infant,
here's what the chest x-ray looks like.

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I've seen all the, the
first labs and everything,

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and so it was like I was in the room
for them so that when they arrive,

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there's not as many surprises and
they're pretty well informed about what,

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what they're going into, what, what
type of baby they're picking up.

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And so I would say that the accuracy
of the transfer of information, uh,

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and the timeliness of the transfer of the
patient are really what's changed with

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this technology.

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Dr. Bergon,

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another thing I would like to ask
you is what do our listeners in the

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neonatology space need to know about
the effective programs like this?

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In addition,

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how can it build bridges to rural
and regional hospitals within their

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communities?

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Well,

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our experience has been that it's really
tightened the referral relationships

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between those partner
hospitals and our, our center.

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So we've always been a great resource
to the hospitals that are distant to us.

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Um,

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they could always pick up the phone day
or night and ask us a question about a

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baby, describe a situation, and
know that we're gonna give them, uh,

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great information and guidance,
transfer the baby when necessary. Um,

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with this technology, I
would tell your listeners,

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it enables us to virtually be in the
room and make the decisions with them in

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real time with much, much better
understanding of what the situation is.

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Just because our eyes,

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the eyes of our neonatal experts is
on the patient and we're giving good

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guidance, um,

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and that guidance is better informed
just by the experience of seeing and

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hearing the activity in the room. Um,

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I think your listeners
would appreciate, uh, that

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much of the work goes into this
program through simulation before the

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partner sites would go live.

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And so there's an incredible amount
of team building that goes. Our,

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our simulation days is all day. We
hit all shifts. And so our team,

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uh, gets to build, uh, a nice, uh,

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kind of team sense of, um, you
know, management with these,

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uh, simulated situations so that, you
know, when we actually do it in real life,

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it's more, uh, high functioning
because we've simulated the situations.

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Instead of just knowing the doctor's
name and voice over the phone,

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we actually know them now across a, a
camera and we can recognize their face,

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they see us, we see them, it's
a much more, um, you know,

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team feeling and they
feel more, um, you know,

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bound to us as a, a referral system, um,

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for their high acuity needs. So it's
a great two-way relationship, um,

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strengthened by a program like this.

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Dr. Bergon, lastly,

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where do you see this program ending up
five years from now, 10 years from now,

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however far in the future
you would like to project?

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So kind of future state,
obviously a bigger network.

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We always want to add more
partners. Um, and then kind of the,

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the types of patients that we take
care of. It's, uh, it's inception.

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We were looking at those babies that
had never left the hospital before.

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Really those, you know, deliver
room management, uh, situations.

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Um, we've expanded in the last year
to any infant up to a month of age.

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So the neonatal service now extends into
anywhere where a newborn might present

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itself. So that includes like the
emergency department coming in.

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They can now get us,
uh, uh, virtually, uh,

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involved in a consult in
the ed, for instance. Uh,

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we'll grow the program next year to go
take care of all critically ill children

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in our partner sites, and we'll
add that service, uh, gradually,

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and that will partner with our
pediatric critical care specialists,

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so it won't be just a neonatal program
anymore. Um, and then, you know,

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that's, this is all on the front end, uh,

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a patient that as they enter
the healthcare system, um,

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I think the opportunity to look at
virtual care for neonatology, uh,

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like daily rounding in rural hospitals
that don't have neonatology coverage is

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something that, you know, we will
look at in the future. Post nicu,

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discharge care, um, rounding in the home.

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Those are all things that we're
very interested in exploring. Um,

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and we do a little bit of, um,

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a program with early discharge for very
healthy preterm infants leaving our

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nursery that maybe, uh,

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aren't fully orally feeding
yet and have a feeding tube in,

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and we're managing them at home
day, doing virtual rounds daily, um,

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for a select number of patients.

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And I think that's what the future looks
like with virtual care in neonatology.

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Dr. Baron all sounds very exciting and
it's very impressive how this program has

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grown in seemingly such a short time.

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Thank you so much for
sharing your insights today,

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and I look forward to
connecting with you soon.

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Hey, thanks for the opportunity.
It was great to talk to you today.

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