A Bridge To Better Health

Rapid advancements in technology have been truly revolutionary in health care, enabling possibilities that were once only imagined. As technology has become more accessible, new products, applications and delivery methods help solve age-old challenges, create new opportunities to share knowledge and connect us in ways that are driving optimal health.

Not just for technology’s sake

Beginning with physician order entry systems in the 1980s, Nemours has been on a steady journey toward the future. Its fully integrated electronic health record (EHR) system was deployed enterprise-wide nearly 20 years ago. Today, Nemours’ wealth of data coupled with early adoption of emerging technologies has had positive impacts on the health of children everywhere and earned HIMSS Stage 7 revalidation. Benefits of advancements include:

  • efficient patient care
  • improved public health
  • reduced errors
  • increased understanding
  • decreased costs
  • reduced wait times
  • improved access
  • better communication

Keeping complex care closer to home

For children facing very complex or life-limiting conditions, attending doctors’ visits is not only challenging for families, but can be risky for patients. With a focus on quality of life, the Nemours Medically Complex Coordination Clinic (MCCC) at Nemours Children’s Hospital helps to supplement the primary care of more than 170 medically fragile patients. These are patients who rely on assistive/adaptive medical technology and have other special medical needs due to causes like rare genetic syndromes or neurologic diseases.

The MCCC has started to use telehealth to eliminate unnecessary travel for families, many of whom live in different cities throughout Florida. “Our team has started to offer and perform follow-up visits via telehealth, including me, the nurse practitioner, nutritionist and health coach,” says Amber Hoffman, MD, director, MCCC. “These visits can include reviewing subspecialty recommendations, test results, checking in on the care plan, addressing new health concerns, and just being the listening ear that is not always possible during a regular doctor’s visit.”

Expanding Telehealth

Deployed in 2014, Nemours CareConnect has expanded in use and benefit to patients, families, providers, students and educators. In 2018, Nemours was awarded the American Telehealth Association’s President’s Award for Health Delivery Innovation.

  • NICU/PICU/ED Consults in Collaborating Hospitals
  • First Pediatric 24/7, On-Demand, Direct-to-Consumer Urgent Care
  • Participant Screening for Research Studies
  • First School-Based Partnership
  • Specialty Care Access in Primary Care
  • Cruise Ship Consults and Pediatric Training
  • Integration with mHealth and Remote Monitoring
  • Child Care-Based Pilot
  • Interdisciplinary Clinic Access
  • On-Field Ortho/Sports Medicine Consults

Building Connection To Improve Compliance

Kathryn Blake, PharmD, director, Nemours Center for Pharmacogenetics and Translational Research, was awarded a five-year, $3.74 million NIH R01 grant. The grant will study the combined effects of telehealth and remote monitoring on improving patients’ asthma medication adherence and health outcomes. For all participants, the study will include remote sensors that attach to daily and emergency-use inhalers. Sensors will track patients’ usage through an app. Data will also be uploaded into a single, cloud-based platform that displays the total sum of medication use.

Half of the study participants will also be paired with a pharmacist to help them keep track of their health and medicine with interactions via smartphone. This will be key to studying the importance of continuity, convenience and context in helping patients better understand and control their condition.

“In addition to real-time data for the patient, our hope is that the interactions with the pharmacist provide better instruction and build relationships. From age 14 to 30 [the age of study participants], there is so much transition in life: high school to college, then starting a career and family… this is often where we see a breakdown in adherence for a variety of reasons,” explains Dr. Blake.

A prior study conducted by Dr. Blake used FaceTime to observe and improve patients’ use of inhalers. Through convenient, contextual instruction, health outcomes were improved. “We are hoping this new study will reap the same results and provide further encouragement for utilization of these impactful technologies,” notes Dr. Blake.

Roadmap For Action

Nemours National Office, The Children’s Partnership and Winter Park Health Foundation, in partnership with NORC at the University of Chicago, prepared Roadmap for Action, a guide for interested stakeholders to move toward wider adoption of school- and child care-based telehealth programs.

Technology is only the medium. The real OPPORTUNITY lies in innovation’s ability to build and DEEPEN RELATIONSHIPS — “personable” medicine.

Remote Monitoring

Two new use cases for remote monitoring are now available for Nemours patients. For cardiac patients who have received an implanted device, the Nemours nurse practitioner is able to pull data directly from the Medtronic pacemaker, load it into Nemours’ EHR and conduct routine follow-up visits with families via Nemours CareConnect.

A more common monitoring device — a blood pressure (BP) monitor — is used to track twice-daily BP readings for Nemours’ nephrology patients being treated for adolescent hypertension. The data automatically uploads into the patient’s Nemours EHR. If the child’s BP is out-of-range or abnormal, an alert is sent via in-basket and the patient is triaged to a telehealth visit or put on the schedule for an in-person visit

Nemours was awarded the 2018 “Innovation of the Year” Service Award from the Florida Hospital Association for its development of sophisticated, in-house 3D printing technology. Featured in last year’s report, this technology enables multidisciplinary preparation within days for complex surgical procedures, reduces procedure time and minimizes unexpected findings in the operating room.

True to form, Nemours is already moving forward with emerging technology — hologram software (as shown at left) is providing similar benefits to 3D printing with greater immediacy.

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Augmented Reality: Real-World Relationships

Being hospitalized can be isolating for children. Medical complexities and equipment can make moving difficult or impossible; immune systems depressed by chemotherapy can make social contact dangerous. Nemours is leveraging virtual reality (VR) to improve the lives of children facing these circumstances.

With support from a top developer of multiplayer video games, Nemours hopes to connect kids in new ways. “We are developing apps that enable kids to pick their own avatar. If they want to look like themselves, we actually have a surface scanner to do that. Through the VR goggles, kids can see each other and interact; they can play games together, hopefully making their very difficult experience a little bit better,” says Craig Johnson, DO, chair, medical imaging.

The VR applications are also expected to assist children with rare diseases in developing personal connections with others who share those conditions, better facilitate group therapy opportunities and expand education options.

Leveraging Leadership to Move the Nation Forward

Nemours National Office has leveraged Nemours’ success and leadership in telehealth to convene national leaders, advocate for increased access, and help others identify barriers and accelerators.

  • Co-hosted a pediatric health policy conference focused on expanding access to telehealth programs in schools and child care resulting in Roadmap for Action.
  • Successfully advocated for language in bills relevant to telehealth, including provisions requiring guidance and studies related to Medicaid payment for substance use disorder treatment via school-based telehealth.