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telehealth

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. Full story »

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(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. Full story »

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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. Full story »

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(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.” Full story »

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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. Full story »

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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. Full story »

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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.” Full story »

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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, Full story »

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[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). Full story »

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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. Full story »

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