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Baby Rozlyn Contreras sleeps inside an incubator equipped with a webcam at the neonatal unit of Parkview Community Hospital in Riverside, Calif. The installed webcam system means her parents can check in anytime via computer or smartphone. Photos by Joe Kohen / AP Images for American Medical News

Neonatal webcams welcome the ever-present parents

Hospital webcams provide a constant watchful eye for relatives of babies, but do the systems pose liability risks for health professionals?

By — Posted April 16, 2012

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While transferring critically ill newborns from a nearby medical center to his hospital's larger neonatal intensive care unit, neonatologist Daniel Saesim, MD, realized how difficult it is for new mothers to be separated from their babies. Being apart even for a short time is painful for parents and harmful to bonding, said Dr. Saesim, associate medical director at Parkview Community Hospital in Riverside, Calif.

So when Dr. Saesim noticed that a neighboring hospital had installed cameras in its NICU that allowed parents to watch babies from afar, he approached Parkview with the idea.

“Sometimes parents miss out on bonding,” he said. “I thought these cameras would help bridge that gap. A lot of times these babies, who are in our units for weeks or months, don't get to meet anybody except for parents and grandparents. This is another way for [people] to show off their babies without family and friends having to physically be in the room.”

Parkview is among a growing number of hospitals that have installed webcam systems in their NICUs. Many use systems called NICVIEW, which allow parents to log in from home computers or smartphones and watch a live video stream projected from a camera above the baby's bed. Since January 2011, about 30 hospitals nationwide have installed NICVIEW systems or have acquired a demo system for further evaluation, said Blake Rutherford, a founder of NICVIEW. The system was created by Healthcare Observation Systems LLC, a health care technology company based in Louisville, Ky., and started being marketed nationwide in 2011.

Participating hospitals include St. Jude Medical Center in Fullerton, Calif.; Deaconess Women's Hospital in Newburgh, Ind.; and Ochsner Medical Center in New Orleans.

The American Hospital Assn. said it does not track the prevalence of such systems. Of the nearly 625 Level III NICUs in the nation, about half have contacted Healthcare Observation Systems for information about the NICVIEW cameras, Rutherford said.

Not everyone believes 24-hour video cameras are a good idea for hospitals. Some attorneys and doctors are concerned about potential liability risks and security breaches.

Proponents of the webcams say the cameras are secure and that the systems' infrastructure protects against unlawful use. Some medical centers are exploring ways to expand webcam use into other areas of their facilities.

“As far as I'm concerned, they could be used anywhere,” said neonatologist Kenneth Herrmann, MD, medical director for Newborn Services at the Deaconess NICU.

Doctors on camera, too

Webcams in NICUs are not entirely new. In the past, hospitals used video cameras to share images of new babies with distant relatives.

St. Luke's Hospital of Kansas City, Mo., has used a webcam since 2008. The camera, which is pushed through the NICU on a rolling cart, allows parents to log on from home to watch and hear their baby, said Sharon Wood, RN, St. Luke's clinical nurse manager.

At Deaconess Women's Hospital, Dr. Herrmann and his staff have used NICU webcams since 2006 to help connect babies to parents serving in the military overseas. They struggled with the systems early on, but have used NICVIEW since 2011 without issues.

The live feeds have no sound and are used on a secure Internet line that is designed to preclude recording by a parent or the hospital. Parents receive a password to log onto the system, which can be passed to other family members and friends. A 24-hour, seven-day-a-week control center in Louisville monitors each webcam. Parents and medical staff can call the center with questions, and company technicians can change the camera's angle.

The systems cost $25,000 to $150,000, depending on hospital size and the number of cameras installed. Expense per bedside is about $700.

Parkview shuts off its live feeds during shift changes and certain procedures. Nurses and doctors also have the option of pushing a pause button during rounds. Dr. Saesim keeps the camera rolling.

“I usually leave it on, or I may move it out of the way. Occasionally, I wave to it, as a way to say hi to parents,” he said. Some staff members leave notes in front of the webcam with messages such as “I just had a bath today,” or “I can't wait to see you, Mom.”

Cameras spark privacy concerns

Like most forms of technology, the webcam systems appear to be a double-edged sword, said Kristi Watterberg, MD, a neonatologist at the University of New Mexico Children's Hospital. She is a member of the American Academy of Pediatrics Committee on Fetus and Newborn.

On one hand, the webcams help family members connect with their children. But being filmed generally makes medical staff nervous and raises privacy concerns, said Dr. Watterberg, who has heard about other hospitals using NICU webcams. New Mexico Children's Hospital does not use them.

“I think it's a fine idea, but I think you have to be cautious while doing this,” she said. “There's a lot of other babies there. You wouldn't want to include other families'” children in the video.

The systems could create unnecessary headaches for health professionals, not to mention liability problems, said Autumn Matthews, a Florida-based attorney who practices health care law.

“As a parent, I would want to see what you're doing on medical rounds, if you're administering medication,” Matthews said. “That would raise suspicion on my end if the screen goes black. Why can't I see that?”

She worries that the webcams may distract from patient care. Another possibility is that a parent might try to record the video and use it against the hospital. “I don't think a hospital could stop a family from recording,” she said. “What's stopping you from videotaping your TV screen?”

Rutherford said a computer-savvy person probably could record the live stream from another device. But similar to DVDs, the images on the NICVIEW systems are copyrighted, so making copies is illegal, he said. Hospitals are encouraged to have patients sign consent forms detailing privacy rules before allowing them to take part in the program. The webcams have changed interactions with parents. Previously, they might have called to check on their baby. Now they might question why their baby is crying or why the child is positioned differently than the last time they watched the webcam.

These are the questions parents asked after Parkview installed its system, Dr. Saesim said.

There was “a learning curve,” he said. Staff “had to reassure the parents that it's normal for babies to cry, and that we will address it as need be.”

Parents adjusted, and medical staff became less leery of the systems, Dr. Saesim added. “The benefits far outweigh the risks.”

Webcam use in other types of care

Some hospitals have found ways to use webcams elsewhere. At St. Luke's, for example, the rolling webcam has made its way through adult patient rooms, allowing heart transplant patients to interact with family members. Deaconess hospital is adding webcams to its healthy baby nursery so relatives can connect with babies, Dr. Herrmann said.

Dr. Saesim said the webcams could be used as a teaching tool for students or other doctors. Perhaps a recording feature could be added so doctors can play the images back and analyze the frames, he said.

If in 10 years, most hospitals have integrated webcams into their daily care of patients, it would not surprise Dr. Watterberg of the AAP.

“Our whole society is moving toward recording everything that happens,” she said.

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Premature babies may stay on camera a long time

The number of premature births in the United States has decreased in recent years. But these births still strain the health care system.

  • In 2009, premature babies with low birth weight remained at the hospital for an average 29 days.
  • In 2010, 12% of babies were born prematurely. About 70% were born from 34 to 36 weeks. The rest were born at less than 34 weeks.
  • About one in 33 babies is born with a congenital anomaly. Among the most common are heart defects, cleft lip and spina bifida.
  • The average hospital cost for a premature baby in 2009 was $50,000. The annual societal economic cost of premature babies, including medical, educational and lost productivity costs, was $26.2 billion, according to a 2005 report.

Sources: March of Dimes, Centers for Disease Control and Prevention, Dept. of Health and Human Services' Agency for Healthcare Research and Quality

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Premature birth rates decline in recent years

Since 1990, the U.S. rate of premature births increased slightly then decreased again.

Type of preterm birth 1990 2000 2005 2010
Total premature babies in U.S. 10.6% 11.6% 12.7% 12.0%
Late preterm (born 34-36 weeks) 7.3% 8.2% 9.1% 8.5%
Early preterm (32-33 weeks) 1.4% 1.5% 1.6% 1.5%
Less than 32 weeks 1.9% 1.9% 2.0% 2.0%

Source: “Births: Preliminary Data for 2010,” Centers for Disease Control and Prevention's National Center for Health Statistics, National Vital Statistics Report, Nov. 17, 2011 (link)

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External links

“Births: Preliminary Data for 2010,” Centers for Disease Control and Prevention's National Center for Health Statistics, National Vital Statistics Report, Nov. 17, 2011 (link)

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