Boston has long proven itself a mecca for healthcare innovation, a hub of some of the best minds and most prestigious hospitals in the nation. And the 2014 Boston Children's Hospital Innovators' Showcase proved no exception.
Featuring some 35 innovations developed by engineers, researchers and clinicians at Boston Children's, the exhibit boasted an array of cutting-edge technologies and problem-solving platforms. Amid the bustling showcase floor were, among others, robotic implants, phototargeted nanoparticles, drug delivery devices and clinical IT platforms that could signify big things for patient care.
One of them, the Integrated Clinical Information Sharing System, or ICISS, is all about bridging the communication gap between provider and patient, and bringing healthcare connectivity out of the Dark Ages. And, from what developers have seen anecdotally, it's already beginning to do so.
The ICISS Web-based platform works like this: Say your child has autism, and you're taking them to see the doctor. Before the visit, you receive an email with access to a Web-based survey and short questionnaire on how your child is doing, what medications they're currently on and related side effects, and autism-specific questions related to the child's health. The survey data is then fed back to the clinicians in real time, allowing them to assess how the patient is doing before they even arrive for a visit.
"The classic model of healthcare is, you come to me, I write you a prescription, and a few months later you show up, and we say, 'how'd it go? Any problems?" said Eric Fleegler, MD, co-developer of the software. "This is trying to go beyond that, so when we write a prescription when we're not seeing you, we can actually track how you're doing."
Now, as Fleegler pointed out, when a patient comes in for a visit, "rather than spending half the time trying to gather data on how the child is, you actually have right in front of you the real information."
Fleegler and his team have reported early success, already expanding from one disease-specific platform to five. They've also gone from the platform being deployed at one clinic to now seven. His ultimate goal? "We'd like to make this national."
Another platform deserving a shout out is the Discharge Communications platform, or DisCo, aimed at making the patient discharge follow-up process a whole lot easier -- clinicians are hoping it may even help lower readmission rates.
"Previously, we would have hours of nursing time dedicated to straight out cold calling all of our discharge patients to follow up," said Kelly Dunn, RN, nurse practitioner and a member of the platform's development team. It was a matter of following up with each patient, asking how the child is doing, seeing if they got their medication, if they had follow-up questions. "It was inefficient," added Dunn, who said the process just couldn't be justified any longer.
The brainchild of Vincent Chiang, MD, vice chair for finance at Boston Children's Hospital department of medicine, DisCo means to change the direction of how communication is traditionally made: "Instead of us trying to reach out and pull information from the families, to have the families be able to push the information to us, and say, 'hey, I need your help,'" said Dunn. "If you call the Children's Hospital main number and say, 'I was discharged from the hospital yesterday, and where was my amoxicillin sent?' That might be difficult to reach an actual live person who can help you with that problem."
With the platform, families with children at the hospital are enrolled online where they fill out the best contact information, a time they prefer to be reached and whether or not they want to be contacted via email or text. After the patient is discharged to go home, they would get a message to their smartphone with a link to a Web-based survey, asking questions like: Did you get your child's medications? Was your follow up appointment scheduled, and did anything else happen? "They would let us know, 'yes, we got it. Yes, it's scheduled. No, everything else is fine,' and they're done, or they might say, 'no, we didn't get that amoxicillin. No, I never heard back from urology,'" explained Dunn.
The clinician would look at the dashboard every morning, and items would show up in red if, say, the family indicated they did not get their medication or they had a question for the physician.
Dunn recalled one instance where they had a family visiting from Israel with no primary care provider in the area, so they couldn't follow up with anyone. "So it was really nice to know that this extra stop-gap measure existed, something in between nothing and returning to the emergency room for further care."
As far as decreasing hospitalizations, Dunn said they've just started collecting data and can't say for certain, but anecdotally, it's looking good so far. Out of 138 patients enrolled, about 50 percent communicated to clinicians via the platform, with 82 percent of them saying it was helpful. "I like knowing that everything is sort of set up and is going to go smoothly and they have a way to wave a flag if they do need help," added Dunn. "I would love it if all of my patients had this."
Then there was Michael Rich, MD, and Julie Polvinen (left), who developed the Children's at Home platform, which, as Rich described, is "based on 20 years of research we've done giving sick kids camcorders and saying, 'teach us what it's like to live with your condition.'"
Think of it as YouTube strictly for kids living with certain diseases, a place where they can upload videos of what they're going through and meet other kids who are living with similar diseases.
The video platform has already taken off, and Rich and his team have seen impressive results. "Kids got better," he said. "Disease specific quality of life improved simply from shooting video about it." That's partly because the platform, in a sense, acts as a mirror allowing the children to almost see themselves in the third person and realize, "oh, I'm not really doing my medicine right, or I'm not following my diet," Rich pointed out. By bringing kids together who share a common disease, whether it be asthma, HIV or sickle cell disease, "there was this instant synergy that happened."