The telemedicine trio

Implementing one of the nation’s most advanced EHR systems in conjunction with achieving Stage 7 are not the hospital’s only accomplishments meriting bragging rights.

In July, Boston Children’s also launched three telehealth pilot programs, aimed at testing the viability of the fledgling tele-technology, that officials say is just starting to make its big debut. 

“The telehealth industry generally is pretty young," said Naomi Fried, chief innovation officer at Boston Children’s Hospital. “You can’t go to literature and read that everyone’s done these things already.”

Fried heads the hospital’s Innovation Acceleration Program, a two-year-old program responsible for spearheading several initiatives aimed at spurring innovation technology at the hospital.  One of these initiatives consists of the three pilots currently being tested at the hospital.

The trio of pilots includes TeleDermatology, TeleConnect and TeleUrology.

"With all of these projects, I think the mantra is the right care, at the right place, at the right time,” said Shawn Farrell, the Telehealth and Telemedicine program manager at Boston Children’s.

The TeleDerm pilot was created in response to first dermatology being one of the most sought after medical specialties – with wait times often averaging two-to-three months – and second, there exists an insufficient number of dermatologists to meet the growing need of patients.

The TeleDerm pilot allows clinicians to securely send patient skin images and data to a dermatologist rather than having the patient visit the hospital.

Despite the physician-to-physician nature of the pilot, Fried maintained that the big beneficiary is ultimately the patient “because of the access improvement, because they’re getting diagnosed potentially more quickly, and because of the tremendous convenience of not having to go to another clinic appointment.”

The second pliot, TeleConnect, consists of a med surge intensive care unit clinician at Children’s providing their expertise and clinical support remotely to a community hospital emergency room. This pilot, Farrell explained, is “about getting that physician to the bedside in the emergency room in an acute emergency moment to help make better decisions about the care and treatment of that patient.”

Because the intensivist can visualize and continually monitor the patient, better care decisions can be made, particularly when it comes to patient transport. Critical care transportation, Farrell said, is both costly and in high demand. By reducing the number of unnecessary patient transports, the hospital can really begin to drive down costs. “We want to try to make the best decision about resource utilization,” added Farrell.

The third pilot program, and the most interactive among the three, is the VGo TeleUrology robot, a project spearheaded by Bob Nguyen, MD, urologist at Boston Children’s.

Robot revolution reforms care

A lot of children who’ve had urological surgery require monitoring, Nguyen explained. They don’t, however, require the level that you receive in the hospital, but they do need more monitoring than the parents can provide. Enter the VGo robot, which graciously accompanies the children home to further monitor their health. 

“We thought this was the perfect patient population to send a robot home with them, so that they could take care of these kids, provide that high quality care that we’ve always been wanting them to have, but not having to spend the money of them staying in the hospital.”

The approximately three-foot tall robots are all named after SpongeBob characters. Healthcare IT News interviewed Mr. Krabs, who, interestingly enough, proved to be altogether pleasant.

The results of Mr. Krabs and his cohorts, thus far, have been remarkable. Nguyen has witnessed children connect with the robot, ultimately leading them to be more involved in their own health.

He told a story about how a child patient outfitted her robot in a dress because she thought it was naked, or the child who rushed home from school each day to greet the robot. This connection, Nguyen said, has powerful implications for the child’s recovery and health. 

“The kids became more engaged in their healthcare. They suddenly cared about what was going on with them; they suddenly cared about what surgery they had and why they had it, and they cared about what they should do in the future to keep themselves healthy,” Nguyen remarked.

Kids began to ask questions about their health. “It really became something where these kids start going, ‘Well, why do I have reflux?’ No one ever asked me that before. The parents may ask you, but the kids, never."

"Or the kids go, ‘If I drink more water, that means I won’t get these infections, right?’ Kids are starting to preempt a lot of the things we’re trying to do.”

Nguyen is working on developing a robot that can take urine samples from the child or perform such things as finger pricks to then relay data levels back to the clinician. This prototype will also be capable of simulating interactive educational modules for the children, which he said would further engage the child in the recovery process.

In addition to the child being more involved with his or her health, which translates to health benefits, Fried expects the pilots will show that telemedicine implementation will ultimately translate into cost savings. “When you take care to the patient, you don’t require a brick-and-mortar space for them anymore.” Although patient outcomes are the predominant driver behind the telehealth pilots, Fried said the extra benefit of financial savings is a welcomed bonus for an industry continuing to see rising costs.

Biggest reason for success

Health IT has clearly played a crucial role in transforming pediatric care at Boston Children’s Hospital, but all individuals interviewed point to clinician engagement as the driving force behind its success. “I think it’s one of the primary reasons that over the years, we’ve been successful is that we’ve used clinicians to be part of the team,” said Nigrin.

Thus, despite the shift towards a culture of cutting-edge creations, towards paper-tossing and chronic-cased computing, there can be no forgetting the human drive, the uniquely biological enthusiasm and determination to improve status quo. Here, there can be no forgetting the minds behind the metal.