CHOC: Acceleration of telemedicine for paediatrics

CHOC: Acceleration of telemedicine for paediatrics

‘Wonderful world’ of telemedicine eases pressure on patients who access care through The CHOC Link at Children’s Hospital of Orange County...

The pledge by clinicians at the Children’s Hospital of Orange County (CHOC) to ‘protect the magic of childhood’ could not be more apt when you discover one of their founder’s was Walt Disney.

Disney provided financial support to open the first dedicated children’s hospital in California 55 years ago. Today, it’s undergoing a digital transformation - harnessing the power of intuitive technology - which is creating a smooth experience for patients and clinicians.

Since 1964, CHOC has provided the highest quality medical care to children. Affiliated with the University of California, Irvine, the regional paediatric healthcare network includes a state-of-the-art 334-bed main hospital facility in the City of Orange and a hospital-within-a-hospital in Mission Viejo. 

CHOC also offers many primary and specialty care clinics, more than 100 additional programs and services, a paediatric residency program, and four centres of excellence – The CHOC Heart, Neuroscience, Orthopaedic and Hyundai Cancer Institutes.

One side effect of the COVID-19 pandemic has been a drop in the number of patients attending hospital appointments. This downtick has accelerated the need for healthcare providers, such as CHOC, to have a Digital Front Door (DFD) and offer telemedicine to their young patients.

The CHOC Link

More than two million children across four counties are now benefiting from telemedicine as their parents’ can now access their electronic medical records (EMR), make virtual appointments and check their billing and health plans on a system called the CHOC Link.

John Henderson, Vice President & Chief Information Officer highlighted how the use of telemedicine on the CHOC Link accelerated during the pandemic.

“Prior to COVID-19 our telemedicine presence was minimal - we were only doing about 100 visits a year - but this moved very, very quickly and by mid-March we had launched a full-scale program and we were doing almost 600 visits a day and wound up doing almost 70,000 telehealth visits,” he commented.

As CHOC has focused on getting our patients coming back to in person visits, our telemedicine visits are now averaging 350 a day which is about 22 per cent of CHOC’s ambulatory volume. “Initially it was a bit of a challenge to educate everyone on how to use the platform as we were moving really fast to get up and running, yet we wanted to educate as many providers as possible. We had to do a lot of education with our providers who hadn't really been doing telemedicine visits prior to the pandemic, “ said Henderson who pointed out patient satisfaction has stayed at the 90th percentile. 

The CHOC Link is a parent’s secure connection to their child’s medical information. It is a place for parents to communicate with their child’s doctors and clinics using a free and easy-to-use tool. 

“We know medical bills and records can be confusing for patients so we can assist with insurance, identifying prior authorisation requirements, deductibles and helping parents obtain and understand their child’s medical records,” commented Henderson.

The CHOC Link offers the following:

  • View and print a child’s health issues, allergies and medications
  • Send a message to doctors or health care teams
  • Request an appointment
  • View current appointments and request to reschedule or cancel them
  • See a child’s laboratory results
  • Review and print radiology reports after reviewing with a physician
  • View visit summaries and discharge documents
  • Review and print radiology reports after reviewing with your physician
  • Request prescription renewals
  • Learn more about your child’s medications through our connected health library
  • Pay a bill

“Our digital transformation has been focused on enhancing the patient and clinician experience,” commented Henderson. “It really began with the implementation of the EMR which is really the hub of the engine from which everything sprouts from.”

CHOC’s digital transformation aims to make the patient’s visit more efficient by eliminating the paperwork - which can be filled at home or wherever it's convenient for the patient by us taking a mobile first strategy and a key element of improving the patient experience.

“We are very focused on population health and managing our populations. So we feel our digital transformation is going to help us focus on if someone's not coming in for a visit due to COVID concerns or any of the other health maintenance they are missing, we're going to know who they are and we'll be able to do the outreach with our care managers so we can make sure we keep them safe and get the care necessary to keep them healthy.”

Henderson pointed out telemedicine is particularly useful in assisting specialty clinics such as diabetes and obesity but particularly psychology which also gives a physician a glimpse into a patient’s socio economic conditions which they didn’t always have access to before the pandemic.

“We don’t always get this kind of insight during an in-patient visit and they may not be really willing to share what's happening at home. A telemedicine visit is obviously visual and from a provider perspective, the clinician has a better insight which helps them provide even better care,” said Henderson.

CHOC is currently focused on growth and expansion. “Although we serve the Orange County region, we also are focused on serving the surrounding geography as it is our vision to be the leading destination for children's health regardless of geography. We don't want to have any borders with the patients that we serve - we want to serve all pediatric patients - wherever they live,” commented Henderson. 

NicoBoard app – helping parents stay engaged

Parents of patients in the neonatal intensive care unit (NICU) at CHOC came up with the idea of a new app to help better understand, track and analyse data showing their baby’s progress while receiving care.

“This is just one example of parents working with the hospital,” said Henderson. “Our families play an integral and active role in their child’s care plan. These tools build upon that commitment and help families stay engaged and ask important questions.”

The NicoBoard is a tablet-based app that translates a stream of numbers pulled from their baby’s EMR – data such as body temperature, weight gain and loss, feed volumes and more – into easily understood, simple sentences complemented by visual aids like graphs and charts. Coupled with curated education and research materials, this helps parents better analyse trends and track progress and enhance decision making.

Virtual environment

CHOC has a number of partners including ePlus (with Cisco) VMware which is vital for its virtual environment.

“I always say you need a solid, strong foundational infrastructure otherwise you can introduce shiny, new objects and it's like you're building on quicksand. Our foundation in modernising our infrastructure was critical so VMware is a key partner in our virtual environment and how we deliver solutions through our mobile phones,” said Henderson.

“Our in-patient units use virtual desktops for speed. We want our clinicians to be as efficient as possible. So they tap in with their best authenticate to that system, but what’s important for the patients is that his device roams with them.” Henderson points out that when a provider or clinician gets interrupted and returns five minutes later to re-engage the device will remember all their details saving the clinician time.”

Adam Gold, Chief Technology Officer, commented on how the vendors ePlus (with Cisco), VMware Palo Alto were critical in getting the hospital’s infrastructure built. 

“Cisco was a great partner when it came to the server and network technologies. VMware is the company we use to stand up our new virtual desktop environment, as well as our new mobile device management environment. So leveraging the VMware horizon infrastructure, which is actually running within our Amazon web services and cloud infrastructure was critical especially for our remote workforce. 

“ePlus was the vendor we worked with on our VAR basically to coordinate all of those efforts. The expertise they brought to the table was really the underlying understanding of our environment. But also the understanding of our culture and what we're really trying to accomplish. They took all of that information and really made sure that the resources working on our projects were in line with what we were trying to do. 

Gold, who has been CTO at the hospital for nearly three years, said the future of IT would move towards a more virtual environment.

“There will also be the continued expansion into the cloud as this is going to be key for us over the next few years, which really ties into big data, analytics and machine learning. There's a lot of focus right now in leveraging that data to help make the right clinical decisions on the right business decisions,” he said.

The Bill Holmes Tower ushered in a new era for the hospital in 2013. In January 2021 CHOC was certified as a Health Information Management Service (HMIS) level, state seven organisation. This was the third time it had achieved this designation and is one of the first paediatric hospitals in the US to have this status.

CHOC was recognised in January 2021 by The Leapfrog Group who named it as the top children’s hospital in South California. “I think one of the things that makes CHOC unique is our fantastic quality and safety,” commented Henderson.

Augmented reality

Predicting what advances in technology will shape the future of healthcare, Henderson points out that augmented reality will help to streamline information and content.

“I think it’s really going to help drive a lot of the change in healthcare. There's so much information, so much content and it's all over the place and this will make it simple for providers, clinicians and the back office workforce.”

Commenting on data analytics, Henderson said this is always going to be a strategic asset when it comes to predictions and will help to see how a hospital is performing in a real-time scenario. “Embedding those things at the point of clinical care delivery means we’re doing a number of things with data science, such as prediction and looking at the history of re-admission or detection of potential events. I think those are the things that are going to become more prevalent.

“I think those types of technologies are what's going to really be critical for healthcare and beyond,” he said.

As CHOC accelerates its digital transformation one focus is going to be wellness from a paediatric point of view. “We want to make sure what we're doing is providing the opportunity for not only physical wellness, but also mental health and wellness. That's the key focus for CHOC in the future. We're going to connect and continue to build upon those programs,” he said

Legacy of Walt Disney for CHOC

Walt Disney’s legacy lives on for young in-patients at CHOC. From his early fundraising efforts before the hospital was built, to the resort’s $5 million gift toward construction of the new Bill Holmes Tower, CHOC and Disney have enjoyed a meaningful partnership.

Having a children’s hospital in the community was important to Walt Disney, who in 1960 sat on the hospital’s founding board. Early in CHOC’s history, Disneyland artist Bob Moore designed the CHOC mascot Choco Bear. Disney artists also helped create the child-friendly feel of the lobby of the new tower, which houses the interactive “Turtle Talk with Crush” show donated by Walt Disney Imagineering.

Adam Gold, Chief Technology Officer at CHOC enjoys stepping away from his desk and interacting with the patients. “It's a nice reminder as to why we're here. We love interacting with the patients and working on tech projects that we know are going to benefit the patients,” said Gold.

“A few times a day we have our partners down the road at Disney interact with the kids in real time. So they get to talk to Nimo, Crush or their favourite Disney character. The kids really enjoy that. We also do a program called Tech Tuesday where we go out and we do a tech hands-on technology project with the kids in our resource centre which is cool and that seems to have got some good traction as well.”

The Disney Team of Heroes app unlocks stories, games, and other entertainment offerings on mobile devices that can be enjoyed in the hospital. The app interacts with special Disney, Pixar, Marvel, and Star Wars murals to bring their characters to life.

Disneyland Resort is CHOC’s largest corporate donor over the past 25 years. Last year’s annual CHOC Walk in the Park at the Disneyland Resort raised more than $2.1 million.