Children's Health, Dallas, TX
Interviewees: Julie Hall-Barrow, Ed.D., Pete Perialas, Peter Roberts
Interviewer: Jon Mertz, Vice President, Marketing, Corepoint Health
Design thinking is about empathy, and Children’s Health is developing and implementing technology and processes centered on the patient experience. Chris Durovich, CEO, is inspiring a vision of reaching the whole family in the care of a patient, meeting them where they are and offering them more control of their lives. This vision has sparked a lot of innovation at Children’s Health – from population health to telehealth to mobile health. With design studios to gain insights directly from patients, Children’s Health is putting empathy into action.
The design studio alone is innovative. Eli Stefanski, who is with the Business Innovation Factory and partners with Children's Health on these initiatives, sums up their design thinking approach well:
“We have a host of prototypes and programs that we test and co-create with families, but more importantly, the families actually deliver the final program or approach. It isn't just us saying, ‘Thank you so much for your ideas,’ but taking it one step further and saying, ‘Okay, what is it that you can do to help deliver this program?’ We create a deeper level of engagement.”
Children’s Health is setting the example for new investments and capabilities within a population health model, all centered on the patient. Key initiatives include virtual health, remote monitoring and house calls.
A recent nationwide survey of primary care physicians found that 57 percent of practicing physicians are prepared to conduct video visits with their patients. With a ready mindset, Children’s Health launched a three-prong approach to virtual health. The first focus is on all employees of Children’s Health; the next is their pediatric partners, and the third area is on the consumer.
Many health care employees have limited time to schedule care when they need it. With the virtual health approach, employees can go to a virtual health console in a Children’s Health facility, and after that initial visit, they can use their mobile device to visit with a care provider. More than convenience, care is delivered when an employee needs it.
To expand beyond the hospital’s four walls, Children’s Health is extending their virtual platform to over 300 pediatric partners. With solid early results and positive feedback from participating physicians, the implementation momentum will continue. A key value point is to reduce the number of urgent care visits and to maintain a clinically integrated approach to patient care and service.
Children’s Health is taking a consumer convenience approach to virtual health. The goal is to meet patients where they are. While pharmacies are a part of the implementation, schools are included as well. For two years, Children’s Health has provided telemedicine visits in urban, rural and independent school districts across the Dallas-Fort Worth area.
As Julie Hall-Barrow, Ed.D., vice president of virtual health and innovation, said:
“Child wellness and learning are linked, and it is a really big focus for us. If you're not well, you can't learn. We're trying to ensure kids get the health care they need in a prompt manner so they continue to learn and participate.”
Engaging patients where they are and when they need care is central to the innovation principles at Children’s Health. A result of this approach is also a complete health record for an individual. Pete Perialas, senior vice president of population health, emphasized,
“We want to reinforce the patient-centered medical home. These kids and their families look to us as a partner and support services organization. Just going to urgent care or the first doctor that will see you erodes the whole concept of the core triple aim. By adding virtual health, we'll be able to deepen that patient and family relationship, which is good for everyone.”
Children’s Health is looking beyond the normal school term and applying a similar virtual health approach to summer programs. Virtual health is the glue to keep the patient-centered medical home together – delivering care when they need it, where they are.
Patient engagement principles that serve as a rallying point are:
- Deeper relationships
- Connect with the patient through the continuum of care, delivering quality at each step
- Deliver on the triple aim in a more modern way
Remote Patient Monitoring
Children’s Health is expanding their virtual health technologies to monitor remote patient health management activities. An example scenario is a child who has a life-threatening kidney or liver disease. They come to Children’s Health for a transplant and then go back to their hometown.
After the transplant, there are numerous follow-up visits to the surgeon and other providers. Over time and as the patient improves, the distance and inconvenience of travel can often result in no shows. With virtual health, those follow-up visits can happen more consistently.
The same principles apply to remote patient monitoring. The transplant group was the first pilot, working closely with Dr. Dev Desai, chief of pediatric transplant at Children’s Health. Two groups of patients were included with the pilot; post liver transplant patients (at or close to discharge) and adolescent kidney transplant patients. With a large group of adolescent transplant patients who have been on medications for a significant amount of time, transitioning to self-care can be challenging. Adolescents are fearless, so utilization and adherence to their medications are an issue. Missing their anti-rejection drugs will have big impacts. Nationwide, re-transplantations in this population is beginning to rise. Remote patient monitoring can help solve this potential issue.
Using a tablet creates a better user experience, so all of the devices are Bluetooth-enabled (e.g., blood pressure, weight, O2 stats). The data is synced to the tablet and then sent to a Children’s Health. By having the data collected and communicated, the patient visits are more productive since the physician has all the current data.
Getting real-time data from where the patient is located enables the care team to be more predictive without having the patient visit the hospital.
Also, with transplants, after their initial discharge, they usually come in twice a week for 4 to 6 weeks. Children’s Health can eliminate one of those visits with a virtual visit. An essential benefit from the virtual visit is they get better information because the child is in their natural surroundings. Kids are more comfortable in providing information when they are in their homes and the risk of encountering new infections is reduced.
Another benefit is better patient education. As with all transplants, medication changes may be necessary. to the care team at Children’s Health follow –up with patients to ensure they understand the new regimen and recognize the pills via phone. Recently during a follow-up call the nurse was asking the adolescent if they had incorporated their beige pill. The patient was unsure if they had a beige pill. Using the RPM video system, they had the patient show their medications and clarify that the “off white” one is the beige pill being questioned. More clarity of instructions and importance happens by adding video to the follow-up care.
Virtual health and remote patient monitoring deliver more complete care while engaging young patients and their families in more comprehensive ways – a win-win for higher quality care and better patient engagement.
At times, a physician or clinician need to be physically present. An on-demand service model is woven into our society. House calls are not new, although they are less prevalent today than many decades ago. Children’s Health jumped into the modern house call through a strategic investment in Mend, a Dallas-based concierge service for families.
Taking this approach incorporates convenience and develops deeper relationships with patients. Meet them in a place that is convenient for them – more than a statement, it seems to be a mantra at Children’s Health. Patient engagement increases with this mindset.
After a Mend visit, the next follow-up could be virtual. Melding the approaches keeps a health care system engaged with an individual and vice versa.
Pete Perialas says it well, “We are looking at this approach as another arrow in our quiver of how we connect with consumers, bringing health and wellness to the community in a way that works for them.”
Innovation Applied to Patient Engagement
Woven through the initiatives at Children’s Health are the concepts and practical application of design thinking, innovation, trusted agents, and building deep relationships with patients. With innovation, the Children’s Health approach starts with:
- Is this a good idea?
- Does it improve outcomes?
- Does it improve the consumer experience?
If the answer is yes, then the conversation focuses on risk and evaluating a better way to keep an individual and family healthy. Follow-up questions include:
- Does it improve the health and wellness of this individual?
- Will it reduce claims?
- Will it reduce future expense?
All good questions as better strategies are explored and implemented to engage patients.
Trust is a vital element. Trust is needed in the community – with patients and their families, with physicians and nurses, and with insurance companies.
As Peter Roberts, president of population health and insurance services, stated, “Trusted agents in the community are essential. A nurse in a school is a trusted agent. A specialty physician in the cancer program is a trusted agent. Your local primary care physician is a trusted agent. By building these relationships, we gain access to families where they are, and in return, they gain access to the highest possible quality of care.”
As Children’s Health exemplifies, trusted agents and design thinking serve the patients very well.
About Children’s Health℠
Children’s Health℠ is the seventh-largest pediatric health care provider in the nation and the leading pediatric health care system in North Texas, providing a full spectrum of health care services—from daily wellness and primary care to specialty visits and critical care. Holding eight disease-specific care certifications from The Joint Commission, Children’s Health has been consistently named one of the nation’s top pediatric providers by U.S. News & World Report. The Children’s Health system includes the flagship hospital Children’s Medical Center Dallas, as well as Children’s Medical Center Plano, eight specialty centers, 20 Children’s Health Pediatric Group primary care practices, nine Our Children’s House rehabilitation facilities, home health, physician services and the Children’s Medical Center Research Institute at UT Southwestern. For more information, please visit www.childrens.com.