The UPMC Children's Hospital of Pittsburgh was the nation's first center to perform organ transplantation in children. It has performed more solid organ transplants in children than any U.S. center.

With a focus on both outstanding short-term and long-term outcomes, the follow-up of these children typically extends from the immediate period (0-3 months) to long-term follow-up (3 months-20 years post-transplant).

UPMC Children's has transplanted organs for more than 3,000 children, and currently follows more than 900 children (551 liver or liver/intestine recipients, 152 kidney recipients, 177 heart or heart lung recipients, 34 active liver or intestine candidates, 12 heart or lung candidates, and 16 kidney candidates). 

The children live nationwide but the focus is on areas heavily impacted by COVID-19, such as the Northeast and the central and southeastern U.S.

THE PROBLEM

In 2018 and 2019, 36% of the organization's transplanted population were Medicaid and others were in rural areas with poor access to local care, necessitating travel to the center for routine or acute care and follow-up.

"All of these transplant patients are immune compromised; immune-compromised patients are defined as high risk for COVID-19 by the CDC," said Dr. George Mazariegos, chief, pediatric transplantation, at UPMC Children's Hospital of Pittsburgh. "In addition to their risk for COVID-19, all these children faced unique and immediate potentially life- and transplant-organ-threatening lack of access to healthcare because of inability to come to clinic for their usual follow-up."

For these transplant recipients or candidates, a key new option brought on by the pandemic was remote telehealth. Routine surveillance of their ongoing health is critical to monitor the effects of powerful immunosuppressant medications they are prescribed that have serious side effects to mitigate the constant risk of rejection of the organ.

"The telehealth portal was preferentially designed to allow the patient to access their appointment on the Cerner hospital electronic medical record via the HealtheLife app."

Dr. George Mazariegos, UPMC Children's Hospital of Pittsburgh

"We needed a solution for those in the Catch-22 situation of limitations of coming for routine visits because of concern for contracting the virus, but who needed to maintain the usual close peri-transplant access to care," Mazariegos explained.

PROPOSAL

UPMC Children's began working with telemedicine technology vendor Sano Health, targeting two groups of patients: those in the acute post-transplant phase and those with long-term post-transplant care needs.

"We anticipated two timelines: An initial use of 100 devices in the first six months and a subsequent rollout of the 200-300 remaining devices in the upcoming six months," Mazariegos explained. "The initial devices were delivered to initial post-transplant patients in the acute phase of care or delivered to post-transplant patients who were anticipated to have difficulty in accessing on-site care."

The Android devices (administered by Sano Health) were preloaded with the UPMC Children's Hospital App and two related apps for video access – VidyoMobile and HealtheLife – as well as program-specific materials. For example, education for heart transplant or liver transplant materials could be loaded on the device.

Real Time Clinic was loaded onto the devices for subsequent use in the later phase. RTC is able to load medical survey materials that are useful for post-transplant annual follow-up.

MARKETPLACE

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MEETING THE CHALLENGE

In April 2020, UPMC Children's received funding from a telehealth program of the FCC. UPMC Children's was the first pediatric institution to be awarded funds.

"We used the funds to deliver 100 devices to families with children who were recovering from liver, kidney and intestine transplants beginning on May 5, 2020," Mazariegos said. "The telehealth portal was preferentially designed to allow the patient to access their appointment on the Cerner hospital electronic medical record via the HealtheLife app."

RESULTS

Transplant activity at UPMC Children's Hospital was able to be safely maintained during the COVID-19 pandemic. Metrics used to assess telehealth device results were delivery of devices to the acute transplant population, measurement of video visit usage and patient satisfaction.

"The distribution was effective, with delivery to 63% of post liver and intestine transplant patients comprising the majority of the initial patient population," Mazariegos said. "Telemedicine visit utilization increased from 20% in April to 35% in May, after delivery of the initial devices, and peaked at 40% of all monthly encounters for the liver transplant population during the first wave from April to August 2020."

USING FCC AWARD FUNDS

UPMC Children's was awarded $192,500 to provide telehealth services to children who have received organ transplants and are thus immune compromised and at high risk for COVID-19.

"Anticipating this ongoing second wave of telemedicine utilization between late 2020 and into 2021, the transplant team is formulating plans for distribution of the remaining devices to allow access for patients who may be at risk for travel during the second wave, which is anticipated to last until early to mid-2021," Mazariegos said. "The devices will also be equipped with patient satisfaction surveys to better measure patient experience."

The medical focus on the devices will be on acute post-transplant care as in the first set, but with a greater emphasis on facilitating ongoing critical annual health assessments post-transplant, he added.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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