2. Statements, opinions and results of studies contained in the program are those of the presenters/authors and do not reflect the policy or position of the Board of Regents of the University of Oklahoma (“OU”) nor does OU provide any warranty as to their accuracy or reliability. Every reasonable effort has been made to faithfully reproduce the presentations and material as submitted. However, no responsibility is assumed by OU for any claims, injury and/or damage to persons or property from any cause, including negligence or otherwise, or from any use or operation of any methods, products, instruments or ideas contained in the material herein. Disclaimer

3. Background Comanche Co. Memorial Hospital – Lawton, Ok Comanche Co. Memorial Hospital – Lawton, Ok 3 rd largest city outside metropolitan areas 3 rd largest city outside metropolitan areas Regional care for 12 county area in Southwest Oklahoma Regional care for 12 county area in Southwest Oklahoma Approximately 1250 babies delivered annually Approximately 1250 babies delivered annually ~400 babies delivered annually that are preterm or late preterm (32-36 weeks Gestation) in the 12 county area ~400 babies delivered annually that are preterm or late preterm (32-36 weeks Gestation) in the 12 county area ~7 pediatricians in the area (4 with privileges at CCMH) ~7 pediatricians in the area (4 with privileges at CCMH) Increasing need for on call coverage of nurseries Increasing need for on call coverage of nurseries

4. Need Growing need for neonatal support Growing need for neonatal support American Academy of Pediatrics revised Guidelines for Neonatal Care American Academy of Pediatrics revised Guidelines for Neonatal Care September 2012 September 2012

5. Collaboration Existing relationship with CCMH and OUHSC/Children’s Hospital Existing relationship with CCMH and OUHSC/Children’s Hospital OU Neonatology Section OU Neonatology Section 19 Board eligible or board certified neonatologists 19 Board eligible or board certified neonatologists 30 Neonatal Nurse Practitioners 30 Neonatal Nurse Practitioners OU Telemedicine OU Telemedicine 20+ yrs experience in Telemedicine service delivery 20+ yrs experience in Telemedicine service delivery Previous telemedicine relationship with CCMH Previous telemedicine relationship with CCMH Robust technology and telecommunications infrastructure Robust technology and telecommunications infrastructure

6. Planning Identify champions and key stakeholders – build a Team Identify champions and key stakeholders – build a Team Assess capacity of support staff and services Assess capacity of support staff and services Evaluate capacity and reliability of technology/telecommunications Evaluate capacity and reliability of technology/telecommunications Define Operational Processes and Protocols Define Operational Processes and Protocols Credentialing Credentialing Billing Billing Scope of Practice Scope of Practice Training Training

7. Hybrid Model - Team approach 6 Neonatologists assigned to team 6 Neonatologists assigned to team 10 Neonatal Nurse Practitioners/APRNs 10 Neonatal Nurse Practitioners/APRNs Telemedicine cart in CCMH NICU Telemedicine cart in CCMH NICU Telemedicine software on laptops of Neonatologists Telemedicine software on laptops of Neonatologists

8. Level of Support Neonatologists Rotate on site 3 times weekly Rotate on site 3 times weekly No more than 2 days apart No more than 2 days apart Lawton Neonatologist rounds daily on site Lawton Neonatologist rounds daily on site On site total coverage – 236 days On site total coverage – 236 days Neonatal Nurse Practitioners Rotate on site 24 hr shifts Rotate on site 24 hr shifts NNP coverage 365 days NNP coverage 365 days

9. Telemedicine support Dial on demand – 24/7/365 Dial on demand – 24/7/365 Used on days Neonatologists are not on site Used on days Neonatologists are not on site Emergent assistance Emergent assistance Technology meets American Telemedicine Association guidelines Technology meets American Telemedicine Association guidelines HIPPA compliant HIPPA compliant High Definition cameras with 40 x zoom High Definition cameras with 40 x zoom Cameras can be controlled remotely by Neonatologists Cameras can be controlled remotely by Neonatologists Broadband telecommunications connection Broadband telecommunications connection

10. Telemedicine exam Embedded video here Embedded video here

11. Outcomes @ 1 yr Of 400 babies, 290 babies receiving services and/or eliminating transfer to CHO Of 400 babies, 290 babies receiving services and/or eliminating transfer to CHO High family satisfaction- High family satisfaction- reduced travel reduced travel increased communication increased communication Increased understanding and participation in plan of care Increased understanding and participation in plan of care Expanded capacity and support for CCMH Expanded capacity and support for CCMH Laboratory testing and support Laboratory testing and support Pharmacy Pharmacy Radiology Radiology Developmental Care/Multidisciplinary Care Developmental Care/Multidisciplinary Care Additional training for CCMH Additional training for CCMH Nursing staff Nursing staff Respiratory Therapists Respiratory Therapists

12. Outcomes @ 1 yr cont. $$ Payers saved on avoided transports $$ Payers saved on avoided transports $$ families saved not having to go and stay in OKC $$ families saved not having to go and stay in OKC $$ families saved with early return from CHO to CCMH of their infant $$ families saved with early return from CHO to CCMH of their infant

13. Advantages Of Telemedicine Quality of Care Quality of Care Access to care Access to care Reduced transports/reduced transport and travel costs Reduced transports/reduced transport and travel costs Increased support services capacity Increased support services capacity Increase patient/family satisfaction Increase patient/family satisfaction Cost Savings previously stated Cost Savings previously stated

14. Disadvantages Potential increased technical costs Potential increased technical costs Potential increased need for tech support Potential increased need for tech support

15. Patient/Family Satisfaction - quotes “The convenience of being here really makes a big difference,” says Daniel Ghrayyeb, Molly’s father “The convenience of being here really makes a big difference,” says Daniel Ghrayyeb, Molly’s father

17. Questions? Dr. Arlen Foulks Arlen-foulks@ouhsc.edu 405-271-5215 Mike McCoy Mike-mccoy@ouhsc.edu 405-271-5215