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This is Chris Sosa with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr. Mark Bergeron,
medical director for digital health transformation,
and medical director for the neonatal virtual care program at Children's
Minnesota. Dr. Bergon, thank you so much for joining us today.
Yeah, thanks for having me. I appreciate it.
Could you please introduce yourself and tell us a bit about your background?
Absolutely. So, uh, like you said, I, my name is Mark Bergeron.
I'm a practicing neonatologist at Children's Minnesota,
and then I wear the dual hats as medical director for digital health
transformation, um, for our entire healthcare system. But then, uh,
in the neonatology department,
I am medical director for our neonatal virtual care program.
Excellent. Could you please outline that virtual care program,
including how it increases access to particular critical care patients in rural
and regional hospitals and communities?
Yes, absolutely. First, just a little bit about Children's Minnesota, um,
and specifically our neonatology program. Um, we are truly a,
a regional resource for families throughout, um, the upper Midwest.
Um, we have a team that's 500 doctors, surgeons, nurse practitioners,
rehab specialists, you name it. And then, uh,
based both on the size of our team and the volume of patients that we take care
of. We're one of the largest neonatal programs, uh, in the country.
And certainly we are in Minnesota. Um,
we take care of more than 3000 babies a year, and so we do this a lot. Um,
our virtual care program, gosh,
started back in 2018 as a pilot with one of our rural hospitals, um,
that sends us a fair number of babies and they had a, a need, um,
for kind of a virtual partnership for stabilizing babies.
They had a single pediatrician who was concerned being fresh outta practice,
that, uh, he, uh,
was gonna find himself in a situation he'll always have at the middle of the
night where he was gonna want some kind of expert backup. Uh,
and so we approached us about, uh, could we do a virtual care program? Um,
and we said, yes, absolutely.
And so we went through the process of designing the program with his hospital
and, uh, did a year long pilot.
And the program today is much larger than that,
but looks exactly the same as it did as in design as it did back then.
Um, and basically, you know,
a a provider in a rural setting recognizes that he is got a baby in front of him
that needs critical care, um,
and we are there in a virtual sense in the room to walk that provider
through the initial steps of, uh, preparation for resuscitation,
the actual act of resuscitation, and then, you know,
streamlining that process of moving that baby from the rural setting
into the twin cities to our, one of our ICUs if needed. Um,
and doing that in a kind of a streamlined fashion.
Dr. Bergon,
how has the program evolved since it launched to serve patients throughout the
upper Midwest? So.
When we launched the program in 2018,
we designed it with a single site as a pilot, and, um,
really we designed it with a local pediatrician, uh,
asking for virtual care services to support him in his practice because he was
concerned that he would run into a situation that he pot, uh,
potentially wasn't, uh, comfortable managing particularly, uh, uh,
in a rural hospital. It doesn't have as many resources as a, as a, um,
large pediatric medical center would. Um,
so in that first year with that one site, we did 10 consults. Um,
and then throughout the year, up to present day,
we've added about two to three new hospital, uh, partners, uh, each year.
So now we're doing about 80, uh, consults a year.
We'll probably surpass that this year just because we've added, um,
additional sites. So we're up to 14 sites, um, as a, you know,
as of today and then probably two to three more, uh,
hospitals will get partnered with us by the end of the year.
I'm glad you mentioned the size of the program and how it's growing. Well,
how do you see the need for services like this growing as hospitals find it
increasingly difficult to recruit providers with unilateral experience?
Yeah, so as Becker's and many others have reported, um,
in the last year or so,
recruitment and retention for all types of professions in healthcare is,
um, is problematic. Within pediatrics, it's no different,
and it seems it's in the specialized field of neonatology. Um,
there is a definite need for neonatal expertise the further you get away
from a major metropolitan area. I see the need growing.
The way medical education works now in the United States, uh,
is different than it was 20 years ago when I went through training.
You did repeated months of training as a resident in the N I C U,
and that has been whittled down to, you know, just a few weeks, um, for most,
uh, residency programs.
So we have recent graduates that are coming out with not a lot of
confidence in being able to resuscitate,
resuscitate a newborn that they might have coming out of a training program,
you know, 10 or 20 years ago.
And I see that's where the role of our program really comes, uh, into, uh,
its importance that we can go to these regional sites and say, Hey,
we recognize there's gonna be some times where you need a neonatal expert, uh,
virtually, um, to back up the skills that your onsite provider has.
And we're ready to do that at a moment's notice.
And that's really been the success and the experience of our program,
is that we build these relationships with these rural providers and make them
feel more confident in what they can accomplish and stabilizing an infant.
Certainly those stabilizations and the resuscitations that you just mentioned
are key. There's the cornerstone to this program.
What else do you think about this program helps streamline transfers from the
hospital to the N ICUs.
So it used to be that you would, you know,
you'd be talking on the phone about the baby that's, that you can't see,
and you'd be relying very heavily on the,
the experience and the perceptions of the provider that's on site,
and that's variable depending on their comfort level, uh,
and experience with an infant. Today I see the infant at the same time they do,
and I have a, uh, my experience and that, and my partners,
we have an earlier recognition of an infant that probably needs to come to us
rather than having the situation described to us.
We see it and we recognize and we should probably mobilize our transport team
now. Um, and so first of all, it's that earlier recognition,
and then once our transport team gets on site,
I can describe to them in the moments before they arrive and,
and while they're on route,
here's what's going on in that delivery room or in that newborn nursery,
this is the status of the infant, here's what the chest x-ray looks like.
I've seen all the, the first labs and everything,
and so it was like I was in the room for them so that when they arrive,
there's not as many surprises and they're pretty well informed about what,
what they're going into, what, what type of baby they're picking up.
And so I would say that the accuracy of the transfer of information, uh,
and the timeliness of the transfer of the patient are really what's changed with
this technology.
Dr. Bergon,
another thing I would like to ask you is what do our listeners in the
neonatology space need to know about the effective programs like this?
In addition,
how can it build bridges to rural and regional hospitals within their
communities?
Well,
our experience has been that it's really tightened the referral relationships
between those partner hospitals and our, our center.
So we've always been a great resource to the hospitals that are distant to us.
Um,
they could always pick up the phone day or night and ask us a question about a
baby, describe a situation, and know that we're gonna give them, uh,
great information and guidance, transfer the baby when necessary. Um,
with this technology, I would tell your listeners,
it enables us to virtually be in the room and make the decisions with them in
real time with much, much better understanding of what the situation is.
Just because our eyes,
the eyes of our neonatal experts is on the patient and we're giving good
guidance, um,
and that guidance is better informed just by the experience of seeing and
hearing the activity in the room. Um,
I think your listeners would appreciate, uh, that
much of the work goes into this program through simulation before the
partner sites would go live.
And so there's an incredible amount of team building that goes. Our,
our simulation days is all day. We hit all shifts. And so our team,
uh, gets to build, uh, a nice, uh,
kind of team sense of, um, you know, management with these,
uh, simulated situations so that, you know, when we actually do it in real life,
it's more, uh, high functioning because we've simulated the situations.
Instead of just knowing the doctor's name and voice over the phone,
we actually know them now across a, a camera and we can recognize their face,
they see us, we see them, it's a much more, um, you know,
team feeling and they feel more, um, you know,
bound to us as a, a referral system, um,
for their high acuity needs. So it's a great two-way relationship, um,
strengthened by a program like this.
Dr. Bergon, lastly,
where do you see this program ending up five years from now, 10 years from now,
however far in the future you would like to project?
So kind of future state, obviously a bigger network.
We always want to add more partners. Um, and then kind of the,
the types of patients that we take care of. It's, uh, it's inception.
We were looking at those babies that had never left the hospital before.
Really those, you know, deliver room management, uh, situations.
Um, we've expanded in the last year to any infant up to a month of age.
So the neonatal service now extends into anywhere where a newborn might present
itself. So that includes like the emergency department coming in.
They can now get us, uh, uh, virtually, uh,
involved in a consult in the ed, for instance. Uh,
we'll grow the program next year to go take care of all critically ill children
in our partner sites, and we'll add that service, uh, gradually,
and that will partner with our pediatric critical care specialists,
so it won't be just a neonatal program anymore. Um, and then, you know,
that's, this is all on the front end, uh,
a patient that as they enter the healthcare system, um,
I think the opportunity to look at virtual care for neonatology, uh,
like daily rounding in rural hospitals that don't have neonatology coverage is
something that, you know, we will look at in the future. Post nicu,
discharge care, um, rounding in the home.
Those are all things that we're very interested in exploring. Um,
and we do a little bit of, um,
a program with early discharge for very healthy preterm infants leaving our
nursery that maybe, uh,
aren't fully orally feeding yet and have a feeding tube in,
and we're managing them at home day, doing virtual rounds daily, um,
for a select number of patients.
And I think that's what the future looks like with virtual care in neonatology.
Dr. Baron all sounds very exciting and it's very impressive how this program has
grown in seemingly such a short time.
Thank you so much for sharing your insights today,
and I look forward to connecting with you soon.
Hey, thanks for the opportunity. It was great to talk to you today.
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