Advances in Telehealth

Transcription:

Melanie Cole (Host):  With the advancement of technology, we’ve seen incredible changes in the way patients and providers are able to manage healthcare. Welcome. You’re listening to Pediatric Insights, Advances and Innovations With Children’s Health. I’m Melanie Cole. And today we’re talking about advances in Telehealth at Children’s Health. Our experts are Dr. Stormee Williams. She’s a pediatrician and Medical Director of school-based Telehealth and Jason Isham. He’s the Director of the Integrated Behavioral Health Program at Children’s Health. We’ll be discussing Telehealth and specifically, school-based Telehealth. And we’ll be examining ways that Telemedicine is changing the landscape of medical practice at Children’s Health. Welcome to both of you. I’m so glad to have you with us. So, Jason, I’m going to start with you. What is Telehealth? Tell us a little bit about the evolution of Telemedicine.

Jason Isham (Guest):  So, Telehealth is the provision of services outside of specific Telemedical procedures via technology. And in my case, my program provides Tele Behavioral Health to students in schools across north Texas.

Host:  Dr. Williams describe this current program at Children’s Health and what are you doing that’s changing that landscape of medical practice at Children’s Health? Tell us a little bit about how it works and how you are using it in the school-based setting.

Stormee Williams, MD (Guest):  Sure. So, we started our school-based Telemedicine Program back in 2013. We saw a need for children to get the care that they needed for low acuity sick visits right where they are, right where they spend the majority of their time. What we saw was that there is an increased number of children accessing emergency rooms for nonemergent issues. For things like pink eye and ear infections and so we saw a place there where we could really intervene where children spend the majority of their time and try to take care of them where they are versus waiting until a time that’s more convenient for the family, which is usually in the evenings when the parents are off of work and they have reliable transportation to get somewhere and what’s open at those times, the emergency rooms or urgent cares.

So, we took this innovative approach and put Telemedicine specific equipment into our partnering school nurse’s offices. This equipment is fantastic. It allows for us to use video software to have a live video interaction with the school nurse and it also has electronic equipment such as a digital stethoscope and a digital otoscope that allows us to look in ears, listen to heart and lung sounds. We can even check the throat. And so by partnering with the school nurse and training her on how to use this equipment; when a child comes to her office for let’s say an asthma exacerbation or ear pain; she can make an appointment, a same day appointment with my team and we will be able to see that child using this equipment right then and there while they are in the school.

And what we found is that by using our electronic health record, we have access to children who have accessed our health system before so we can get a little bit more information about their health history. We can also send electronic prescriptions as necessary to their pharmacy that the parents have designated. And then we are actually keeping kids in school where they need to be, and actually helping them be healthy and feel better quicker so that they can return to the classroom healthier and feeling better. It’s really an overall great program for not just children but also for the schools, for the parents. Just we are doing a great job in taking care of families.

Host:  Really amazing. What a great tool. Now Dr. Williams, where do the parents fit into this picture? As a parent, I know I always want to be involved in children’s even if it’s pink eye. But you really want to be involved in that appointment. So, if it’s through the school nurse, how are the parents involved?

Dr. Williams:  So, prior to the visit, the parents have to give us permission to do that. We still have to have consent to treat and then we also have a consent process for Telemedicine, for a Telemedicine visit. And then before the child is seen on the day of the appointment that the nurse requests; we get in touch with the family to make sure that they still agree with us doing the visit but then we also give them the opportunity to be a part. And what we see is that let’s say a child has a fever. Well they still would need to go home because that is school policy, however, when the parent comes to pick up the child; they can be there and be a part of that visit. We also have parents who say, I can’t leave work right now, so, I’d like to call in and hear what’s going on during the visit so I can speak with the provider.

So, we have a myriad of ways to get the parents involved, but what we found is that the parents trust the school nurse so much that a lot of them say if the school nurse see that she needs this, or he needs this; I’m completely fine with it. And as a part of our program, what we do is create the after-visit summary that really summarizes what our diagnostic findings where, any prescriptions that are necessary and also education about the diagnosis. That goes home with the child in their backpack and it also gets sent to their primary care doctor. So, that we really are providing a good continuity of care for the family as well as their medical home.

Jason:  And if I may add to Dr. Williams’s comment. So, in our Tele Behavioral Health Program, we are able to involve the parents in similar ways. Our licensed behavioral health clinicians will outreach to the family prior to initiating Tele Behavioral Health visits. And they will conduct an assessment over the phone which is something that we provide at no cost to the schools and no cost to the families. And then based on that assessment, then we can offer Tele Behavioral Health Therapy sessions in the school. The really cool thing is that our platform allows us to connect our licensed behavioral health clinician with the student while they are at school. We can also do a three way video conference call with the parent while they are at work. So, in that way, we can connect the school, the parent and the student and a provider on a video conference Tele Behavioral Health session each from a convenient location where they are.

Host:  Well you got to my next question Jason. I was going to be to ask about behavioral health component. Expand a little bit more on that component and what that really means for parents and for the child and for the school as far as the behavioral health issues that might come up with a child.

Jason:  Certainly. And so, as Dr. Williams mentioned, when they launch these school-based Telemedicine program, it dint take long for our school affiliates to come to Children’s and ask what could we do for them in terms of behavioral health. They were seeing increases in children exhibiting behavioral health difficulties in the schools and at younger and younger ages. And so, in the fall of 2017, we launched our school-based Tele Behavioral Health Program in five high schools in north Texas. Today, as we sit, we are in 48 campuses across north Texas and we are serving children from elementary all the way up through high school. The idea here, is that as the school identifies a student with a potential behavioral health need, and I say potential because they don’t have to have a formal diagnosis or formal previous treatment. In fact, if we are able to catch them before they reach those stages; that’s even better.

And so the school will identify those students and they will let the student and the parent know about the affiliation with Children’s Health and the school-based Tele Behavioral Health Program. Once they receive consent from the parent, then they will then send the referral or our team. our team is staffed by licensed master’s level behavioral health clinicians and when we receive that referral, we will conduct a telephonic outreach to the family. Upon reaching the family, we will provide a telephonic behavioral health assessment to get a sense of what is happening for that child and their family and to put really the behavioral health issues in a greater context.

Based on that assessment then, we will develop a unique individualized care plan for that student and their family which may include referrals to community resources as needed. We also provide follow up telephonic case management support at no cost. And then when it’s clinically appropriate, we can offer Tele Behavioral Health Therapy session in the school. The way that that works is that each school that we support, each of those 48 campuses has an iPad that’s Children’s owned and on the iPad there’s an application called Children’s Health Virtual Visit. And that is the way that we connect with students while they are on the campus. So, the way that the process works is that when it’s time for the student’s session, the counselor will send a pass to the student to get out of class. They come to class and in 30 minutes they will be able to have a Tele Behavioral Health Therapy session with a licensed behavioral health clinician and then they are back in class.

So, in that way, they never have to leave campus. Mom and dad don’t have to get off work to take them to a therapy office across town and so in that way, we minimize disruption to instructional time, we minimize disruption to parents’ work time, and we provide a convenient access point in a setting that students know and that they trust as Dr. Williams alluded to earlier.

Host:  Dr. Williams, can you tell us a specific story on how Telehealth has helped one of your patients?

Dr. Williams:  Absolutely. One that comes to mind is a child who has asthma and his family did not have insurance because one of the parents lost their job and so he was in between having insurance and so the school nurse reached out to us for a Telehealth visit. And the nurse knew that we could prescribe the medicines that the child needed. Because he was between insurance, he wasn’t going to his primary care provider’s office and so when we saw – when I saw him, I noticed that his asthma was very poorly controlled. I could see in our electronic health record that he had missed a couple of appointments with our pulmonology team. And then at this particular visit, the parents were there at this visit.

And so, in talking with them; we realized that it was more than just needing prescriptions for his asthma. They actually needed help in navigating the application process for Medicaid or CHIPS and so by the end of the visit; not only did I write the prescriptions for him; but I also connected him with our team that helps patients apply for health insurance and we also connected them with our social work team who was able to help him insure that he would be able to afford and get the medications that we prescribed.

So, I did a follow up visit with that child two days later. And just his entire countenance was different. He was smiling when I saw him on the video, and I said well how are you feeling? And he said, I can breathe. And that just showed me right there, like wow, how many kids are sitting in class and they just can’t breathe? They don’t breathe comfortably because their asthma is poorly controlled or because their allergies aren’t controlled.

And so, when we talked to him. When we did the follow up visit, the parents were so excited because they had received calls from some of our other services here within the health system and they really felt like they were on track to getting him back to where he needed to be to be healthy. So, that’s just one of the stories that stands out to me. I can still visualize his face and his smile when I saw him, and he said I can breathe. What a thing that we take for granted, right? So, that’s just one of the stories that I remember that always stands out for me about what this program can do for children and for their families.

Host:  What a great story. Absolutely a great scenario. So, Jason, first last word to you. Is there a main message that you would like to leave other providers and listeners with? Something specific that you would like them to know and to take from Telehealth in the schools and specifically your Behavioral Health component?

Jason:  Absolutely. And I think that message would be that Telehealth and Tele Behavioral Health services are something to be embraced. I think in terms of providing access to behavioral health therapy services particularly in a place like Texas with a large geographic footprint and in very rural areas where it is difficult to get physical providers; Telehealth provides an option to get care to where people need it.

Host:  And Dr. Williams, last word to you. How does Telemedicine transform your decision making scenario? What functionality does it provide from a clinical perspective? What would you like to leave other providers with about the advent of this amazing technology you’ve both described today?

Dr. Williams:  Right. So, kind of like Jason is saying, Telemedicine is one of the tools we have in our toolbox. We are in the great information age and innovation and technology are ever evolving. But we can’t look at it through a lens of it’s something new and not the way we’ve always done things. I’m so grateful to work in an organization where we are always looking for ways that we can better take care of our families. And so, I would just say that we are in fact, using this technology to our benefit.

We realize that it is not the same as an in-person visit and we don’t necessarily want it to be. But it is an important tool in our toolbox that we have to use. In the case of things like behavioral health, where we hear about mental health crises that our youth and our entire society is actually facing now; what a great way to improve access to mental health providers by using something that really wasn’t even around ten years ago.

And so, I would just say that for other clinicians to consider it, to not be afraid of it or not be intimidated by it. It is a great tool for us to use as we continue to expand our ways of treating the families that we take care of.

Host:  Absolutely great information. Thank you both Dr. Williams and Jason for your time with us today and to our audience for listening to Pediatric Insights, Advances and Innovations with Children’s Health. You can find more information at www.childrens.com/schools. And if you found this podcast helpful, please rate and review or share the episode and please follow Children’s Health on your social channels.