Nicklaus Children's Health System

Evelyn Terrell

Telehealth Integration Steward

Telehealth services are enabled through state-of-the-art innovative technologies that bridge time/distance and bring caregivers and patients together. Telehealth has proven to be a valuable tool in managing the pediatric population, including high-risk children with medical complexity, by avoiding unnecessary trips to the emergency room or readmission to the hospital and preventing potential exposure to communicable diseases. Virtual care models may address social determinants of health (SDOH), increase equity, and reduce disparities by extending the reach of providers to underserved communities.

Telehealth is also a tool to address an increasing shortage of healthcare professionals. The supply and demand gap is increasing in Florida due to the state’s population growth and aging population. It is projected that by the year, there will be a shortfall of physicians in the Sunshine State (add citation). Additionally, advances in medicine have improved child survival and reduced mortality rates for children who are living longer with chronic conditions and disabilities (add citation).

Large pediatric medical centers and specialty hospitals are in a position to extend the reach of pediatric subspecialists with neonatal expertise to underserved communities through a robust network of community affiliations and support systems. Cross-sector collaborations bring systems together, help address workforce challenges, and transform care for rural and underserved communities. Strategic alignment, synergy, and integration between health systems support in meeting broader, diverse community healthcare needs.

Hospitals and health systems are forging affiliations and integrating systems to meet broader, diverse community healthcare needs. Collaboration among healthcare organizations is paramount to increase access to care for underserved communities, outcomes, and experiences. Collaborative alliances may improve the overall performance of organizations to achieve strategic goals, regulatory requirements, and other organizational priorities.

Organizations may face common barriers during system integration. Some of the challenges may include differing organizational structure, policies, business models, and culture; lack of EMR/technology integration, interoperability, and data collection; credentialing and privileging processes; as well as opportunities related to communication among stakeholders and clinician engagement. Leaders and clinicians across systems must collaborate to address barriers, expand the reach of clinicians to underserved communities, and support a hybrid care delivery approach.

“Collaboration among healthcare organizations is paramount to increase access to care for underserved communities, outcomes, and experiences.”

Nicklaus Children’s Hospital in Miami, Florida, expanded collaboration with affiliate health systems in South Florida to become a regional resource and overcome broader access challenges within their communities through the neonatal intensive care unit (NICU) telehealth consultation program. The new telehealth model and workflows provide access to over 70 pediatric specialists in 12 subspecialties, facilitating virtual inpatient visits, peer-to-peer consultations, and streamlining facility transfers, when appropriate, for patients with high acuity requiring a higher level of care.

Objectives of the program include recognizing the impact of strategic affiliations and community partnerships in meeting organizational priorities related to access, supporting health equity, and addressing a wide range of community health needs. A secondary objective is to identify best practices in organizational structure, shared governance, and other strategies to develop evidence-based interventions, streamline operations, and promote integration across systems.

Community collaborative alliances may improve the overall performance of organizations to achieve strategic goals, regulatory requirements, and other organizational priorities, thus breaking down geographic barriers to subspecialty care.

Key results and lessons learned of the pediatric healthcare system in creating effective affiliations and community partnerships to support health equity and strategic alignment. 

Over 30 agreements executed in 2022 with hospitals and health systems, including professional services and transfer agreements, in addition to other affiliations with community organizations.

• Increased access to in-person or virtual inpatient care for pediatric specialties within 24 hours

• Increased access to outpatient specialty care within seven days