The Georgia Health Policy Center recently spoke to Robert Sapien, M.D., principal investigator for the New Mexico EMS for Children and Child Ready Program at University of New Mexico, and Katherine Schafer, the Child Ready program manager, about the health system’s participation in the Federal Office of Rural Health Policy’s Telehealth Network Grant Program.
Grantee Profile: University of New Mexico (Albuquerque, N.M.)
The Child Ready Program provides regionalized pediatric emergency care in tribal and rural areas of New Mexico. This grant will enable the Child Ready Program to expand its Virtual Pediatric Emergency Department Telehealth Network to include seven level III trauma centers in the state as originating sites. Additionally, the expansion will add pediatric emergency care coordinators at the new telehealth sites, as well as at existing emergency departments within the network.
What is an early learning that you would share with an organization launching a similar tele-emergency services program?
Katherine: One of the struggles is the infrastructure at our university. Based on our experience, some key questions you should ask are: What do you have to work with not just at the beginning, but to sustain the program? Who is going to be doing what components? How is it maintained and where is it moving? From the beginning, you have to know where your alliances are within your own institution, and then, setting up regular communication so that you continue to build on those relationships and keep your program at the forefront.
Evaluation is absolutely crucial. You need to be able to demonstrate the importance of your program. Even for your internal department, it is important to show why our providers need to be available to take these consults. Why should we make it part of their regular routine in the emergency department? And how do we make it important to the hospital? We have to have the numbers, the transfers that we’ve saved, the patient costs saved. As you are building the billing and you are looking at sustainability, how is it going to bring profit to your hospital? How does it bring recognition to your community, to your state?
Robert: We have really been building from the bottom up. As Katherine alluded to, we didn’t have the infrastructure or full support of leadership in the institution. We have been building the program hoping to then convince them to support this. Some programs have the full support from the top and have built their programs top-down. But, either way, keep trying, because sometimes a ‘no’ is a soft no, or sometimes a no is really, ‘I don’t understand.’ Keep helping to educate those in leadership.
What programmatic adaptations did you have to make to your program in light of COVID-19?
Robert: Behavioral health emergencies in children have just exploded over the last 10 years. We are fortunate at University of New Mexico to have a psychiatric consultation service that would come to the pediatric emergency department to evaluate the children. However, because of COVID-19 and the desire to decrease the exposure to our subspecialists, the psychiatrists asked to use telehealth. So our emergency department became an originating site and the psychiatric services, three blocks away, became the distant site. We kind of switched roles and brought in our cart, into our own pediatric emergency department because of COVID-19.
What will your organization be doing more of or differently to emerge stronger from the pandemic?
Katherine: COVID has really taken away some of the hesitation to use telehealth because now there are no other alternatives. It is really making it a day-to-day thing because people are doing it with their primary care providers. We are going to come out stronger because we are going to have better partnerships — more people are looking to do things like this. It is a lot easier for us to reach more people because now people are more comfortable with online learning platforms like Zoom. So this will help with future practice.
Robert: From a clinical perspective, we are approaching the winter months with other viruses, like the respiratory syncytial virus and bronchiolitis that we see every year, plus the pandemic. We are a pediatric-based program and pediatric resources are so limited in our state, plus many of the pediatric clinical areas in our hospital have already been converted to adult areas, which further decreases our pediatric capability. So, by helping and supporting the originating sites to be more comfortable keeping those children by using telehealth and doing those consultations, we will be shifting and redistributing resources so that critical adults still get the care they need here and we can support the outlying facilities to take care of the children.