Stories about: telemedicine

Telemedicine brings expert blindness screenings to preemies

ROP screening in the NICU
Gretchen Hamn (L) and Margie Young screen a premature infant for retinopathy of prematurity. (Photos: Katherine C. Cohen)

We’re in the Neonatal Intensive Care Unit at South Shore Hospital. Six tiny, swaddled preemies are ready to be examined, their eyes numbed and their pupils dilated with special drops.

Gretchen Hamn, NNP, and medical assistant Margie Young go from isolette to isolette. Young tends to the first baby and gently positions him for his exam. Hamn pulls over a cart and extends a kind of hose with a camera at the tip. This she places directly on each of the baby’s eyes, taking a digital video of his retinas.

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Rash conclusions: Teledermatology as a “shared care” model

With a quick photograph by the pediatrician, a “mystery rash” can be diagnosed remotely.

“Hey, can you take a look at my patient’s rash?”

This question comes up on an almost-weekly basis at Martha Eliot Health Center, the community health center of Boston Children’s Hospital where I see children for primary care. While dermatologic conditions are common in pediatrics, and we, in the primary care setting, often know what to do about them, patients sometimes come in with rashes that don’t look like anything we’ve seen before. In these situations, we wish we could have a trained dermatologist just take a look, but the demand for new dermatology appointments at Boston Children’s is high and wait times for non-urgent clinic visits can be long.

From the dermatologists’ perspective, a large proportion of the patients in their clinic actually don’t actually need to be there—they have common conditions that can be managed in the primary care setting, in the patient’s medical home, in a much more convenient and cost-effective way.

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Pay Me Maybe: Can we get past this telemedicine barrier?

Telemedicine has the potential to transform healthcare and lower costs. A new Massachusetts law requires insurers to pay for it—but with a potential loophole.

The mandate for broader access to health care in Massachusetts has brought millions of newly insured patients into the system. At the same time, the cost of health care in Massachusetts has continued to rise, and care access issues have emerged.

This past August, Massachusetts Governor Deval Patrick signed a new law that attempts to lower costs by shifting providers away from fee-for-service payment to alternative payment models (APMs) in which they incur more financial risk, and encouraging the development of accountable care organizations (ACOs).

One provision of this law requires insurers to pay providers for services delivered remotely via “telemedicine.”

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Strategies for pediatric telehealth: Lessons from TeleConnect

Boston Children's David Casavant, MD, in a mock TeleConnect drill with South Shore Hospital.

Naomi Fried, PhD, is Boston Children’s Hospital’s chief innovation officer. Shawn Farrell, MBA, Telehealth Program Manager at Boston Children’s Hospital, contributed to this post.

Imagine yourself in an emergency department taking care of a very sick child. Should he be transferred to a higher-level care setting? Can he safely go by ambulance, rather than helicopter? As a doctor, you would like to consult virtually with colleagues and experts at remote locations.

Then imagine yourself in a large room in the heart of Silicon Valley, just a stone’s throw from Cupertino and Apple headquarters. In that room are 5,000 of the biggest thinkers in health care and technology, exploring the next major paradigm shift in care delivery: telehealth. You realize that health care is on the brink of a telehealth explosion.

The energy was palpable as I took the stage at the recent American Telemedicine Association (ATA) conference. I was there to share our experiences launching the TeleConnect program at Boston Children’s Hospital,

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Empowering patients: Intelligent devices and apps for better health

Melinda Tang, MEng, is a software developer for the Innovation Acceleration Program at  Boston Children’s Hospital.

When children return home from the hospital after surgery, parents can be overwhelmed by the written information and instructions for follow-up. At the MIT Media Lab’s Health and Wellness Hackathon earlier this year, the focus was on empowering patients to take an active role in their health. As my colleague Brian Rosman described, our team from Boston Children’s Hospital attended and spent two weeks developing “Ralph,” a mobile application for managing post-operative care that incorporates an avatar and features of gaming to engage and motivate children to follow their regimen. I was one of the primary programmers for our group.

We won third place, working alongside five other talented teams. Here are some snapshots of what they were up to — helping patients manage asthma, diabetes, pain, cardiac rehab and more.

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A physician-turned-mobile app developer: My first hackathon

Brian Rosman, MD, is the current Robotic Surgery Research Fellow in the Department of Urology at Boston Children’s Hospital. He focuses on applying modern technology to improve the practice of medicine.

When I entered the MIT Health and Wellness Innovation “hackathon,” it wasn’t with high hopes. I felt our team from Boston Children’s Hospital had a solid idea to develop, but I’d taken part in similar collaborations that fell victim to personal disputes, group member apathy and overzealous leadership. This time I was wrong.

The idea we brought to the 10-day event/competition, sponsored by MIT Media Lab, was a mobile telecommunication robot that could monitor children in their homes after surgery. Our mobile robot, the VGo, has the potential to be a great tool, but when we’re not using it to make remote visits, it just takes up space in the patient’s house.

We felt the robot could be enhanced if the family could interact with it to ask questions, through some type of artificial intelligence, while the child played with some kind of game or character that would help them stay on their post-operative regimen. 

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“See one, do one, teach one” goes global

[Ed. note: Tune in to the livestream Monday at 9:30 a.m. ET]

Can the inventors of Watson help save sick children in the developing world? A “cloud-based” pediatric learning module, conceived by Children’s Hospital Boston and built by IBM Interactive, is being beta-tested this year in 20 countries. Provisionally called OpenPediatrics, it will give 1,000 doctors and nurses on five continents the next best thing to hands-on training. (Above is just a preview).

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Innovation opportunities from healthcare reform

President Obama signs the Patient Protection and Affordable Care Act, March 23, 2010 (Pete Souza/Wikimedia Commons)

National healthcare reform, including President Obama’s Affordable Care Act of 2010, is being driven by widespread dissatisfaction with the high cost and limited accessibility of care. Although we’ve yet to feel the full impact of these national reforms, the reform experience in Massachusetts indicates that mandated universal coverage, by itself, has failed to drive down costs.

So, in Massachusetts, we’re now in the next phase of healthcare reform, focusing on how to control and cut costs while still providing nearly universal access to high quality services and care. The need to bring down costs is stimulating healthcare innovation in three major areas – perhaps offering some lessons for the nation as it moves toward universal care.

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Medical robots: A children’s eye view

Hospital innovators are beginning to turn to robotic systems – some as simple as a cell phone that enables video conferencing between doctor and patient – to enhance patient care and lower costs (see yesterday’s post). The Child Life department at Children’s Hospital Boston asked kids staying at the hospital to share their ideas for robots that could help them and assist their doctors and nurses. A few hospital staff got in the spirit, too.  At left and below are a few of their submissions. Click to enlarge them.

>>>Designed first with legos, “Harold” has two antennae that function both as hands and an FM radio, so it can help carry things around the hospital while rockin’ to some tunes.

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Improving global health: texting and behavioral economics

This urine test gives a numerical readout that TB patients can text to clinicians.

The number of mobile phone subscriptions worldwide is approaching 5 billion, many of them in developing countries where cell phones are the most reliable communications platform. So it’s no wonder that they’re becoming a global health tool to combat diseases like tuberculosis and AIDS.

In a recently reported trial in Kenya, for example, HIV patients who were texted weekly on their cell phones

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