Inside a Virtual Nursery - Beth Israel Deaconess Medical Center's project - Company Operations

Health Management Technology, June, 2001 by John Halamka

Telemedicine project combines videoconferencing, high-speed Internet connectivity and database software to link hospitalized infants with their parents.

One of life's most joyous events is the birth of a new baby. But when that baby is premature, with the health complications typical of early delivery, the medical and emotional challenges are enormous.

One of the toughest is to provide parents of sick infants with as much support and information as possible while their babies fight to survive in a hospital Neonatal Intensive Care Unit (NICU). Another is to cut the time the infant must spend in the NICU so he or she can go home as soon as is medically safe.

Physicians and technologists at Boston-based Beth Israel Deaconess Medical Center have joined forces to build a virtual Web nursery that accomplishes both goals while cutting healthcare costs by millions annually for these high-risk babies.

Beth Israel Deaconess is part of the CareGroup Healthcare System. With revenues of $1.2 billion annually, CareGroup is the second largest integrated delivery system in the northeastern U.S. CareGroup is comprised of six hospitals and serves more than 800,000 patients.

The Web nursery project, called Baby CareLink, began in 1996 with a three-year $2.8 million grant from the National Library of Medicine of the National Institutes of Health. Dr. Charles Safran, former director of the informatics and advanced technology group at the Beth Israel Deaconess Center for Clinical Computing, and Dr. James Gray, director of newborn services at Beth Israel Deaconess, kicked off the initiative with input from a series of structured focus groups with 40 NICU families. The team combined the information they gained on needs and stresses these families faced while caring for a child in the NICU with input gathered from the multidisciplinary NICU clinicians and clinical computing center technologists to develop the Baby CareLink system.

Baby CareLink combines multiple technologies--PCs, videoconferencing, high-speed Internet connectivity and high performance database software--to provide bidirectional communication between families and their premature babies, as well as the NICU healthcare professionals.

It runs on an IT infrastructure that includes Windows NT as the main operating platform for Microsoft Exchange 5.5 mail servers, Internet Information Server 4.0 Web Servers and the post-relational CACHE database from Cambridge, MA-based InterSystems Corporation. CACHE is the underlying database technology for the CareGroup healthcare network. It provides a unified database and delivers the performance and scalability needed to provide accurate clinical information quickly and easily.

The Baby CareLink technology platform also incorporates several levels of security to ensure compliance with online security standards. This enables the system to observe rigorous privacy and confidentiality practices.

How the Nursery Works

With Baby CareLink, parents can videoconference from home to monitor their babies, schedule visits and find medical information about their child's condition. Each baby is provided with its own secure Web page, providing a 24-hour connection between parents and baby. From their homes, parents can monitor their babies at any time, schedule visits, videoconference with NICU personnel and check on the latest available information and updates via daily reports, doctor's notes and a baby growth chart. They can also research 500 newborn-related subject areas stored in a massive database containing clinical content and resources such as baby care and safety reference material including instructions as basic as how to give a newborn a bath.

Baby CareLink also provides parents with information to expedite and streamline the hospital discharge process. The bidirectional videoconferencing stays in place even after the baby goes home, enabling NICU personnel to monitor the baby's condition and progress, and parents to ask questions on an as-needed basis once they've taken over full-time care of the baby.

The Baby CareLink pilot project included 58 families, with 28 participating actively and the remainder acting as a control group for comparison. Each of the 28 participants received free high-speed phone lines, computers, videoconferencing equipment and the training needed to utilize the system.

Return on Investment

The three-year pilot project is viewed as a major success. Baby CareLink provides a nurturing environment where parents, even though remote from the NICU, can actively participate in decisions surrounding their baby's care. As communication between parents and clinicians improves, quality of care also improves. Being so closely involved with the NICU gives an extra boost of confidence to the parent about overall care of the premature infant and the improved communication and customized education.

As a result, Beth Israel Deaconess, already a Center of Excellence (a designation of the U.S. Department of Health and Human Services), has seen a 75 percent reduction in reports of quality-of-care problems. The number of respondents answering positively to the question "was there a problem with your child's care?" was cut from 13 percent to 3 percent for respondents using Baby CareLink.