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, as part of a panel titled “Startup to Success, Strategies for Pediatric Telemedicine.”
In this simulation, physicians at Boston Children's remotely view a baby's pupils to assess his clinical status.
TeleConnect, which launched recently, links the Medical/Surgical Intensive Care Unit at Boston Children’s to the Emergency Department (ED) at South Shore Hospital in Weymouth, about a half hour south of us. Created by critical care physician David Casavant, MD, TeleConnect uses real-time video conferencing and sharing of medical images to evaluate critically ill patients before they are transferred to Boston Children’s. This enables specialists in Boston to determine the best mode of transport to use (ambulance versus helicopter), coordinate children’s care before they arrive and direct them to the right care settings (OR versus ICU, for example).
As with any new project, there are many challenges. As the project enters the pilot phase of the Innovation Lifecycle, here are some of the lessons I shared:
• The importance of clinical champions: TeleConnect involves extensive coordination between two different hospitals, making it critical to have clinical champions who understand the political, operational and clinical landscape of their respective institutions. The clinical champions for TeleConnect at Children’s are Casavant and Karen Gruskin, MD, who helped educate, train and motivate staff and to secure the “buy-in” of a broad group of clinical participants. From South Shore Hospital, the champions include Mark Waltzman, MD, chair of Pediatrics, June Hanly, MD, director of Pediatric Emergency Medicine, Jason Tracy, MD, director of the Emergency Room, and Rory St. Pierre, RN, who helped navigate legal, liability and privileging issues.
• Developing the workflow: In critical and complex care environments, adoption is easiest when the new telemedicine program follows the existing workflow as much as possible. In our case, we built TeleConnect around the successful processes already being used by the Transfer Center at Boston Children’s, which coordinates all incoming requests for patient transfers.
• Garnering financial support: We obtained funding to acquire the necessary hardware and software. Fortunately, we were able to get various stakeholders, including Network Relations and the division of Critical Care Medicine, to donate money and provide key clinical and research support for program development, execution and evaluation. This was truly a cooperative effort among many.
• Training users: Training is vital before a telehealth system goes live — but can be difficult in a fast-paced critical care location like an ED where clinicians can’t easily take time out. We trained users with “Sim Babies” and other simulation mannequins. Combining telehealth and simulation during mock code drills and other practice scenarios increases realism and builds clinicians’ competencies in managing pediatric emergencies at remote locations.
• Evaluate continuously: To select the best metrics for evaluating the program, its objectives and goals must be clear. In our case, we will evaluate TeleConnect’s impact on patient transfers to Boston Children’s and the efficacy of the telehealth technology. In addition, we will track the experience of the clinicians involved and the participating patients and families.
I spoke about bridging the “o-gap” or operationalization gap of the Innovation Lifecycle – the challenge of moving a new idea out of the pilot phase and diffusing it broadly across an organization. For TeleConnect, key issues will include:
• Achieving scalability: To develop systems and workflows that are scalable, we will need to involve more clinicians across the Boston Children’s enterprise and other organizations outside our care network.
• Building human infrastructure: In addition to assembling the required technical, administrative and clinical staff, we will need to create a robust program for training them in telehealth best practices.
• Finding the right business model: Since Massachusetts does not currently support reimbursement for telehealth activities, we are exploring other possible business models to maintain or grow the program.
The pieces are steadily falling into place for a robust telehealth program at Boston Children’s. We are actively leveraging telehealth to advance our mission of providing affordable, high-quality care to all patients.
