February 10, 2016 the Honorable Myra Crownover Chair Committee

February 10, 2016 The Honorable Myra Crownover Chair Committee on Public Health Texas House of Representatives P.O. Box 2910 Austin, Texas 78768 Re: House Public Health Committee’s Interim Charge Hearing on Telemedicine in Texas. Dear Chair Crownover, Thank you for the invitation to provide testimony on telemedicine in Texas, as part of the House Public Health Committee’s interim study on telemedicine. I am Julie Hall-Barrow, EdD, Vice President of Virtual Health and Innovation at Children’s Health System of Texas. Telemedicine is alive and growing in Texas, and in many areas Children’s Health is leading the way. Children’s Health is embracing telemedicine and virtual health to enhance access to our medical professionals and specialists outside our hospital walls, in local communities where Texans live, work and play. Our telemedicine and virtual health programs address medical and specialist workforce shortages across the state; provide a lifeline to the hospital for children who have special needs or following a surgery like an organ transplant; and link children to the health system who do not have a primary care provider. Further, we are doing this is a way that improves health outcomes and reduces costs to the health system. This written testimony provides an overview of several ways Children’s Health is using technology and innovation to enhance the delivery of care to children in Texas. Importantly, the Texas Medical Board’s rules allow all the telemedicine programs Children’s Health currently conducts, as well as the innovative virtual health programs we seek to implement over the next year. Telemedicine in Schools Children’s Health partners with local schools on a number of initiatives to keep children healthy. From asthma and obesity education to prevention and chronic illness management, these programs improve health literacy and decrease the time kids are out of school due to illness, thereby increasing the amount of time spent on learning. Alongside these programs, Children’s Health developed a “School-Based Telemedicine” pilot program through the Section 1115 Medicaid waiver. The program was active last school year in 26 schools. Today, the program operates in 57 schools, and will expand to another 30 campuses over the course of this school year. In addition — with the expertise and technology Children’s Health developed through the pilot program — we are able to offer advice and technical support to other providers, which expands the program’s reach even further. 1935 Medical District Drive | Dallas, Texas 75235 | 214.456.7000 | www.childrens.com Julie Hall-Barrow, EdD, Children’s Health System of Texas February 10, 2016 The School-Based Telemedicine Program allows in-school virtual consultations with physicians through the use of mobile telehealth “carts.” The carts connect a Children’s Health Pediatric Group physician or Pediatric Nurse Practitioner to a child that may visit the school nurse’s office with a complaint that is outside the scope of school nursing practice. Through advanced, encrypted telemedicine technology, children at participating campuses from elementary to high school can receive HIPAA-compliant health care services. Pre-registration in the program by the parent is required, and a parent is always invited to attend the consultation in person or electronically. If needed, electronic prescriptions can also be sent to the family’s preferred pharmacy. This initiative will eventually be expanded to help children with disease management by providing education, monitoring and follow-up for chronic conditions such as asthma, allergies and weight management. Children’s is demonstrating that telemedicine in schools works. We are providing primary care to children and reducing costly and time-consuming trips to the emergency department, where care is much more expensive. Children’s is also connecting children to resources in the community. For example, children who have recently moved to the area or who do not have a relationship with a primary care provider are connected to a nurse or social worker who links them to community resources. HB 1878, which passed during the 84th Legislature and was signed into law last year, establishes a sustainable reimbursement model for telemedicine in schools; we believe the demonstrated success of the Children’s Health program and the stable reimbursement model will allow the service to proliferate across the state. Telemonitoring in the Home for Children with Complex Medical Needs Children’s Health is one of the largest pediatric transplant centers in the nation and the only one in the Southwest to have performed more than 1,000 transplants during the program’s more than 25 year history. As the only pediatric organ transplant provider in North and West Texas, many of my patient families live hundreds of miles away from a major medical facility equipped and knowledgeable about the care of transplant recipients. Extended travel places significant logistical and financial burdens on the family to move medical equipment and disrupt their child’s routines. Additionally, the medical transport of complex transplant patients adds a significant financial burden on our state’s limited resources. Telemonitoring allows our surgeons and medical care teams to follow up remotely with our post- surgical transplant patients after they have been discharged from the hospital. By remotely monitoring patients’ vital signs and other medical parameters, we can address conditions as they emerge and avoid unnecessary visits to the emergency room or hospital where their weakened immune systems are exposed to germs and viruses. Children’s Health launched a comprehensive Remote Patient Monitoring (RPM) program, which is the first of its kind in the nation. Under the model established by Children’s Health, these patient families receive an integrated telemedicine kit programmed to provide interactive telemonitoring support for their at-home needs. The kit includes an encrypted 4G tablet and 2 Julie Hall-Barrow, EdD, Children’s Health System of Texas February 10, 2016 wireless health devices that can monitor blood pressure, blood oxygen levels, weight and other vitals through Bluetooth connectivity. Parents are provided extensive education about how to use the equipment. The program enables clinical staff at Children’s Health to monitor patient health status and progress via secure mobile technologies including one-touch video conferencing for virtual visits from the comfort of a patient’s home. Through this program Children’s physicians are able to address conditions early and intervene before they escalate. While currenlty in its pilot stage, the RPM program will soon consist of 50 pediatric patients of various ages and geographic locations. The first 15 enrollees are from the Children’s Health Liver and Renal Transplant Division. Patient data can be monitored in real time to help improve coordination of care and decision making across multiple specialites. This technology will help pave the way for higher-quality patient interactions, decreasing costs through early intervention and all-around better care management. This is a winning proposition for all stakeholders. Today, our physicians provide these services with no reimbursement from Medicaid because we believe it is the right thing to do medically. We are demonstrating that the service is worthwhile and successful, but we need a stable and reliable reimbursement mechanism to keep providing this valuable service. Virtual Health Children’s Health employees can connect with a doctor anytime through Children’s Health “Virtual Visit” program. This convenient new service is available to all employees, regardless of whether you are covered under the Children’s Health medical plans. Using Virtual Visit, a patient can make an appointment and speak to a doctor by secure videoconference from any video-equipped computer, without having to leave home or work. Virtual Visit can address common conditions such as coughs, respiratory infections, colds, sinus infections, fever, flu, headaches, diarrhea, strep throat and pinkeye. Virtual health also allows Children’s Health to more efficiently connect specialists within our health system. For example, mental and behavioral health specialists at Children’s Medical Center are able to connect virtually with children visiting any of our 20 Children’s Health Pediatric Health physician practice offices across North Texas. In this way, a single child psychologist can provide ADHD or behavioral health screening and/or follow up in multiple locations without excessive travel time across the region. In addition, Virtual Visit will allow Children’s to provide additional follow-up care to existing patients when they are discharged from the hospital, when appropriate. Specialty Care: TeleNICU & TeleER Children’s Health has harnessed the power of technology to help extremely ill infants who were born or are being treated at other hospitals that aren’t fully able to meet their needs. In response 3 Julie Hall-Barrow, EdD, Children’s Health System of Texas February 10, 2016 to a growing need for access to pediatric subspecialty care that only Children’s Health can provide, in 2013 we launched the Children’s Health TeleNICU, the state’s first dedicated neonatal telemedicine service. The TeleNICU links the specially trained, board-certified UT Southwestern neonatologists on the medical staff at Children’s Health to physicians at other hospitals’ neonatal intensive care units (NICUs) to consult and guide the treatment

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