Stories about: telemedicine

RNSafe: Remote video checks of bedside drug dosing

RNSafe-Bunker nurse view Screenshot_2015-04-16-10-31-32When a nurse gives a complex medication at the bedside, a second nurse must come in to observe and verify the dose. But flagging down a nurse on a busy hospital floor can be pretty challenging, especially when the nurse has to “suit up” because of infection control precautions in the patient’s room. During a Nursing Morbidity and Mortality (M&M) Conference at Boston Children’s Hospital, a group of nurses expressed concern that this arrangement could potentially jeopardize safety. “We thought we should be able to do better,” says project co-developer Jennifer Taylor, MSEd, BSN, RN-BC, CPN.

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How Skype and FaceTime inspired remote care for home-ventilated patients

Casavant telemedicine home ventilationFrom a series on researchers and innovators at Boston Children’s Hospital. At left, David Casavant demos TeleCAPE at a Boston Children’s Hospital Innovators Showcase.

It is said that necessity is the mother of invention, so when David Casavant, MD, observed his teenagers routinely using FaceTime and Skype to connect with friends, he had a lightbulb moment. Could videoconferencing help him support his patients—children and young adults who require mechanical ventilation in their homes?

“It just seemed obvious,” says Casavant, a physician in the Boston Children’s Hospital’s CAPE (Critical Care, Anesthesia and Perioperative Extension & Home Ventilation) program, part of the Division of Critical Care Medicine. “In my work we are always weighing the risk versus the benefit to the patient. It’s easy for ambulatory patients to swing by their primary care office, get a prescription or go for an x-ray, but that’s not the case for patients who have to have their oxygen, their suction or their ventilator. If you don’t have to put them on the road you are better off not to.”

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OPENPediatrics: A blueprint for big innovation

My father had a favorite bit of advice as we embarked on our adult lives: “Go big or go home.” Going big is exactly what OPENPediatrics is doing, empowering physicians and nurses to care for children across the globe.

The Web-based digital learning platform was conceived 10 years ago by Jeffrey Burns, MD, MPH, chief of critical care at Boston Children’s Hospital, and Traci Wolbrink, MD, MPH, an associate in critical care. It concluded a year-long beta test in April 2014, and version 1 has now been launched.

Developed to impart critical care skills, OPENPediatrics uses lectures, simulators and protocols to deliver training. In the process, it has helped save lives.

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Teamwork and telemedicine combine for lifesaving rescue

telemedicine
Cameron with Galina Lipton, MD

By the time Cameron Shearing arrived at the South Shore Hospital Emergency Department (ED) during a December snowstorm, he wasn’t breathing. He didn’t have much time. The two-year-old had aspirated a chocolate-covered pretzel, which sent tiny bits of material into his lungs.

The odds of a good outcome were not high. Pretzel is one of the worst foods to aspirate for two reasons: The small pieces can block multiple small airways, and the salt, which is very irritating, causes a lot of inflammation.

“Cameron was one of the sickest patients I ever cared for as an emergency physician. I did everything I could within my scope of practice, but he needed the tools and expertise of pediatric subspecialists,” recalls Galina Lipton, MD, from Boston Children’s Department of Emergency Medicine, who was staffing the South Shore Hospital emergency room that evening.

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Can telemedicine deliver value for home-ventilated patients?

A clinician's-eye view of a patient with spinal muscular atrophy during a telemedicine visit.
A clinician’s-eye view of a patient with spinal muscular atrophy during a telemedicine visit.

The jury is still out on telemedicine. Proponents and many patients appreciate its ability to deliver virtual patient care and to extend the reach of experts beyond the brick-and-mortar setting of a hospital. But the real question about telemedicine is: Does it make it difference? Does is it improve care and if so, in what circumstances?

TeleCAPE, a small pilot project at Boston Children’s Hospital, inches the dial toward “yes” for some patients—in particular, home-ventilated patients.

Home-ventilated patients require an inordinate amount of health care resources for even minor conditions. Costs for a simple urinary tract or viral respiratory infection that might be managed without hospitalization can reach up to $83,000 because the child’s complex medical needs require ICU admission.

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The 21st century home visit

An early prediction of telemedicine
The TeleDactyl, as depicted on the cover of Science and Invention magazine in 1925.
Shawn Farrell, MBA, is Telemedicine and Telehealth Program Manager at Boston Children’s Hospital.

Back in the 1920s, when medicine was more an art than a science and doctors made home visits, a publishing and radio pioneer named Hugo Gernsback predicted the future of telehealth. As described on Smithsonian.com, he wrote of a device called the TeleDactyl: “a future instrument by which it will be possible for us to ‘feel at a distance’”—dactyl, from the Greek, meaning finger.

Since that time, the practice of medicine has changed dramatically. Our understanding of the human body has advanced beyond our wildest dreams, producing drugs, devices and procedures that have made hospitals a place for healing and curing. At the same time, home visits were abandoned in favor of the office visit, making doctors more efficient. Almost 100 years later, several converging forces are making the home visit popular again, increasing the likelihood of seeing Gernsback’s vision become a reality.

The rollout of the Affordable Care Act, which will add millions of new patients to the health care system, comes at the same time that we have a shortage of primary care doctors, specialists and other care providers.

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State regulations are slowing health care innovation

(Diane Campbell Payne, used with permission)
(Diane Campbell Payne, used with permission)

Naomi Fried, PhD, is chief innovation officer at Boston Children’s Hospital. This post is adapted from her remarks at the Connected Health Symposium on October 24, 2013. She tweets @NaomiFried.

In the health care industry, we rely heavily on regulations to ensure the safety of our patients, procedures and drugs. New national health care regulations can even spur innovation in care delivery, but in the case of telehealth, they can be an impediment.

Telehealth, the remote delivery of care via computers, mobile devices, videoconferencing and other technologies, has great potential to improve the patient experience and reduce health care costs by removing the barriers of brick and mortar. At Boston Children’s Hospital, the Innovation Acceleration Program’s pilot telehealth programs have focused on both direct patient care and virtual clinician-to-clinician consultations.

Unfortunately, most states’ regulations are limiting providers’ ability to broadly offer telehealth services.

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10 trends to watch in pediatric medicine: Part 1

Girl looking in microscope-ShutterstockSince our “trends” posts at the top of the year are among our most viewed, Vector took time out this summer to take an interim snapshot of pediatric medicine’s cutting edge. Here we present, in no particular order, our first five picks. Check back next Friday for Part 2. If you want more, there’s still time to register for our National Pediatric Innovation Summit + Awards (September 26-27). The posts will also appear as an article in the fall issue of Children’s Hospitals Today magazine.

1. Digital health apps 2.0

The electronic revolution in health care continues. According to recent surveys, more than 90 percent of physicians have smartphones and more than 60 percent are using tablet devices like iPads for professional purposes. Dr. Eric Topol and others think these digital tools are the future of medicine.

Mobile apps keep proliferating, adding more and more features: high-quality image capture, voice-to-text capabilities and gaming techniques to motivate adherence, as well as sensors that gather physiologic data, like glucose levels and heart rate. Consumers are tracking and sharing data themselves, saving time in the clinic and helping physicians monitor their symptoms. Through the much-hyped Google Glass, it won’t be long before doctors can seamlessly call up patient data, look up a drug dosage and get decision support during a clinical visit without using a hand-held device.

One limiting factor in this “Wild West” scenario is the FDA’s ability to keep up with digital advances from a regulatory standpoint.

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For overweight adolescents, health begins at home

(Flickr/Anonymous Account)
(Flickr/Anonymous Account)
This post is third in a series on obesity. Read last week’s posts on food addiction and what it means to define obesity as a disease.

The goal of any community health intervention is for individuals to achieve daily lifestyle goals in a way that realistically takes into account their cultural backgrounds, neighborhoods, families and home lives. For overweight or obese adolescents, these intimate surroundings play a pivotal role in allowing healthful behaviors to take root.

Research teams at Boston Children’s Hospital and suburban affiliate Wareham Pediatrics are conducting a study that lets adolescents collaborate with their doctors online to improve their weight. Videoconferencing technology, provided by Boston Children’s Telehealth Program, brings services directly to subjects in their homes.

“We’re bringing high-quality interventions directly to kids in the community where they live and simultaneously learning about the community itself,” says Cara Ebbeling, PhD, associate director of the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital, and one of the leading researchers. “For example, we are looking at what grocery stores are located in the community and what opportunities exist for physical activity.”

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Could more time online improve teens’ health? For diabetes, possibly

Teens with type 1 diabetes can download their blood glucose data and attend "virtual clinics" from home.
Most adolescents fight for the freedom to manage their own lives, especially when it comes to friends, curfews and hobbies. That excitement conspicuously slips away when they’re faced with managing something less glamorous—like diabetes.

Since diabetes is a chronic illness with potentially serious risks, it requires continuous management. But adolescents aren’t exactly lining up around the block for extra medical visits.

“Some adolescents forget to do things like take insulin or check their blood glucose level, and they could benefit from more frequent check-ins with their diabetes team,” says Erinn Rhodes, MD, MPH, director of the Type 2 Diabetes Program and Inpatient Diabetes Program at Boston Children’s Hospital. “But that’s not easy, especially if time is limited or if transportation is a challenge.”

So Rhodes has designed a study for adolescents 13 to 17 years old, to see if “televisits”—video conferences between teens and their diabetes care providers—can improve their diabetes while encouraging better self-management.

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