Innovative Texas Telehealth Program Eyes New Service Frontiers

| URAC Staff
Doctor discussing check up information on tablet with little girl and mom in hospital

They say things are bigger in Texas, and Tamara Perry isn’t one to disagree. As Senior Director Operations, Virtual Health and Innovation at Dallas-based Children’s Health, she’s leading an already massively successful telehealth program with Texas-sized ambitions for the future. “We usually try to stay about five years ahead of everyone,” she says.

Hear Perry speak at the Telemed Leadership Forum 2019 in Washington, D.C., April 3-5, 2019, a 2-1/2-day event designed for physicians and leaders in hospitals and health systems, health plans, academic medical centers, telehealth providers and networks, as well as government regulators and policymakers.

Children’s Health is licensed for 616 beds and receives nearly 800,000 patient visits annually from all 50 states and around the world. Its pediatric intensive care unit is one of the largest in Texas, and its pediatric cardiac ICU is the largest heart center for children in North Texas. It recorded over 180,000 visits to its pediatric group locations in 2018 

Children’s Health launched its first telemedicine program in 2013: tele-NICU services. “We provide neonatal telemedicine services to hospitals in rural Texas, allowing those hospitals to keep the infants there onsite and not have to transport them over,” Perry says. While she’s happy with metrics across the board, she is especially enthusiastic to report that “for over 57 percent of those patients that we see, they're able to stay onsite, and not have a transport conducted, which is great.”

Building on that momentum, Perry and team next kicked off a school-based telehealth program. Children’s Health looked at the zip code numbers of incoming emergency room and clinic patients. “We decided to reach out to those particular communities” and the response was overwhelmingly positive, Perry says.

While telehealth is helping to improve rural access to care, Perry says it is having a positive impact on urban patients, too. “What we found is even in the urban space, we have parents that are working, and if they are using public transportation, catching two or three buses to get to one visit, it takes up an entire day,” she says.

Perry and Children’s Health took it to the next level in 2015 with a new children's health virtual visit platform. “It gives us an ability to see patients anywhere they are, anytime, from home, from school, from out of state, if needed, because we have providers credentialed around the state as well,” Perry explains. Children’s Health first set up kiosks at retail pharmacy locations, and then added kiosks at its occupational health offices in Plano and Dallas.

In recent years, Children’s Health has ramped up behavior telehealth in school-based programs. “We now have 22 schools where [a designated] counselor is the point person. Counselors identify students that need counseling, and once they do that, reach out to our behavioral health case managers,” Perry says. Remote providers do a telephonic assessment with the parent and the child, and gauge where the child is vis a vis their behavioral health need. Once counselors and remote practitioners do that, patients are set up with virtual visits.

The child is then able to go into the counselor’s office, check out an iPad, and connect with a behavioral health counselor during the school day. Patient privacy is carefully guarded, she says. If the parent needs to join into the video call, they can do that via multipoint connectivity. Weekend appointments are available as well as needed, Perry says.

Children’s Health has also been leveraging new remote patient monitoring capabilities in its telehealth program, Perry says. For example, the tools have been valuable helping adolescent patients adhere to complicated and ongoing medication and treatment regimens – especially with organ transplant patients.

“Well, no one likes to take medicine, but if you're an adolescent who is out playing and you feel great, sometimes those medications [get] skipped, and you would either have to be readmitted back to the hospital, or have re-transplants,” she says.  “We worked very closely with our transplant doctors, and we were able to roll out Proteus, which is a digitized medication device. We were the first pediatric hospital to roll that out.” Proteus is a device that's encapsulated into the medication. It's no bigger than the end of a stick pin, and it's made of zinc, magnesium, and all-natural material that the body is able to dissolve and expel if needed, Perry says.

Looking ahead, Children’s Health is just beginning to harness the power of virtual reality in telehealth – especially with cardiology providers, Perry says. “Virtual reality is a huge space that we are documenting some of the surgeries,” Perry says. “Before those cardiologists go into surgery with the patients, they're able to play in the space, if you will.”

For example, physicians can work with a 3D image of the heart, where multiple providers can go into that same virtual space with virtual reality goggles. “They can try to put in the bag, the ventricle device that goes into the space, and see if they can fit it into the cavity of the patient virtually, before they open the patient to do it,” Perry says. “They can also show the parents what the surgery will look like prior to opening up the patient. 3D modeling is huge for us.”

Peering further around the bend, Perry says Children’s Health has Texas-sized ambitions when it comes to exploring new ways to leverage artificial intelligence and algorithms to help get ahead of health problems. “We're really into the space of predicting and preventing healthcare issues,” she says.

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