CHOC Children’s at Forefront of Leveraging Data to Enhance Quality of Care

Earlier this year, clinicians, hospital administrators, and other leaders in the medical field gathered for the American Hospital Association (AHA) Health Forum Critical Conversations in health care event in Texas, which focused on leveraging health care data to improve care.

Dr. William W. Feaster, chief health information officer at CHOC Children’s, presented on the ways CHOC is applying intelligence to data and building it into the care process to better understand quality of care and patient satisfaction scores.

Dr. William Feaster, chief health information officer at CHOC

CHOC uses Cerner’s HealtheIntentSM platform to bring in data from different sources, such as EHRs, pharmacies and payers. The system normalizes the data and builds “smart registries” for certain high-cost pediatric conditions. Dr. Feaster explained that these registries go beyond tracking patient status and outcomes for a defined population. Built on top of multiple EHRs and other sources, they extract data and then feed key patient information to clinicians at the point of care, creating a living tool, rather than a more static reporting mechanism. Adherence to clinical guidelines at CHOC has improved progressively with the advent of these smart registries.

CHOC is also using analytics to improve asthma care quality and outcomes. Additionally, CHOC is applying machine learning tools to predict readmissions and to provide this information to case managers to better manage the patient discharge process. For outpatients, CHOC is also exploring how these data science tools can help predict and prevent appointment no-shows.

To learn more about CHOC’s case study, click here for a copy of Cerner’s Transforming Health Care Delivery ebook.

IT Update from the Chief Health Information Officer: Dr. William Feaster

As our current fiscal year comes to an end, I am pleased with all the progress we have made this year and look forward to new and exciting information technology (IT) projects on the horizon. Last February, we welcomed a new vice president and chief information officer, John Henderson, to our organization. He joined us from Texas Children’s Hospital and has been a huge addition to our leadership at CHOC Children’s. A seasoned IT leader, John has a successful track record of guiding cohesive teams in the design, deployment, administration and enhancement of enterprise IT applications and infrastructures. We are also excited to onboard our new chief technology officer, Adam Gold, who will also be a great addition to our team.  The CTO is a new position for CHOC and Adam will be responsible for all our infrastructure including computers, networks, data center, communications and other technologies.

Dr. William Feaster, chief health information officer at CHOC

Currently, our technical staff just finished the roll-out of tap-and-go access to our clinical computers in the inpatient areas, emergency department, surgery (outside of OR and procedure rooms) and Outpatient Infusion Center. Now, when you log-in to our systems from these clinical areas, you can tap-in with your badge.  This has been a huge win, especially for our nursing staff, saving them a lot of time during the day as they frequently log in and log out. We hope to continue to optimize the performance of this technology and implement it in our clinics and other outpatient service areas beginning in July.

Remote access to our systems is also changing with the addition of two-factor authentication (2FA), a security process in which the user provides authentication factors to verify they are who they say they are. This is just as essential for protecting patient medical records as it is your bank account.  While 2FA is not new, it has become more prevalent in the current digital age. Beginning in June, we will be cancelling access to remote.choc.org for those who have already registered for two-factor authentication and over the following months, we will be switching all remote users to secure.choc.org.  Stay tuned for more information coming soon.

We are currently implementing a new Dynamic Documentation build in our Children’s Medical Group (CMG), replacing their current PowerNotes documentation. Beginning in July, we will be implementing our Cerner EMR in our other primary care practices, along with Cerner Pro Fee billing, and a new version of Cerner’s registration and scheduling called Cerner Practice Management (CPM).  CMG and our specialty care clinics that are part of CHOC Children’s Network will also be going to the new Pro Fee billing and CPM over the next year.  These enhancements are a huge undertaking, which are currently consuming our IT resources and may delay some of the requests that are frequently submitted.  We ask for your patience over these next several months.

In addition, we are continuing to advance our work in population health, data science and analytics. We are also continuing to develop new technologies to improve the care of our patients with chronic diseases, advance home monitoring technologies, better support our care management staff both in and out of the hospital, and develop predictive models for readmission and patient deterioration, among other things.

Lastly, we are eagerly awaiting the final word on our capital budget for FY19 to determine what new projects are approved for next year. Our highest priority right now is to implement E-prescribing for controlled substances (EPCS), which we hope to do in the first half of FY19.

Should you have any questions about any of these developments, or other issues related to current information technology systems, please feel free to contact me at wfeaster@choc.org, or at 714-509-7637.

William Feaster, MD

CHOC Children’s Chief Health Information Officer

CHOC Heart Patients Among First to Experience Clinic of the Future

A pilot program at CHOC Children’s is giving cardiac patients and their families more peace of mind. Launched by pediatric cardiologist and CHOC’s chief intelligence and innovation officer Dr. Anthony Chang, the CHiP (Cardiopulmonary Health intelligence Program) clinic provides home monitoring equipment to families for the purpose of tracking patients’ vitals, such as blood pressure and oxygen saturation. Through telepresence, families can also connect with their physicians without leaving their homes.

Dr. Anthony Chang
Dr. Anthony Chang, pediatric cardiologist and chief intelligence and innovation officer at CHOC Children’s

“Patients and families feel more comfortable outside the clinical setting. But when away from the hospital, parents can feel very anxious about their children’s health and well-being,” explains Dr. Chang. “Our CHiP clinic ensures continuity of care, while providing great comfort to parents who know they can connect with their physicians without visiting their offices.”

CHiP is based on another innovative idea from Dr. Chang: the iClinic. According to Dr. Chang, the iClinic is a philosophy of leveraging emerging technologies to help create efficiencies, improve workflow and the continuity of care for patients by bringing CHOC expertise to patients’ homes.  The ultimate goal is improving quality care and positive outcomes for patients.

CHOC Children's Heart Institute

There are five key components of the iClinic, all starting with the letter “I”:

  • Instantaneous – Instead of periodic measurements at home, monitoring devices can measure at any time.
  • Intermittent – Instead of being limited to scheduled visits, virtual visits can happen at any time. These virtual visits can include educational sessions, in addition to wellness checks.
  • Individual therapy – Precision medicine is built into the iClinic, including genomics and pharmacogenomics, to find the medicine or treatment best suited for the patient.
  • Intelligent data-driven medicine – All data is compiled and analyzed to make the best possible decisions, including personalized medicine and drug discovery.
  • Intuitive interactions – Through telepresence and the ability to provide instantaneous data with feedback, the iClinic contributes to an experience that feels authentic and intuitive.

Dr. Chang envisions rolling the “clinic of the future” to other specialties at CHOC, beyond CHiP.

“This is the clinic of the future. It is inclusive of wearable devices, avatars, artificial intelligence and genomic medicine. But it’s important to note we’re not using the technology for the sake of just using fancy gadgets.  We are leveraging emerging technologies to really change how we deliver care in the best possible way,” explains Dr. Chang.

Providers who are interested in piloting a similar program at their institutions are free to contact Dr. Chang at achang@choc.org.

John Henderson Joins CHOC as Vice President and Chief Information Officer

CHOC Children’s new vice president and chief information officer, John Henderson, brings decades of information technology (IT) experience in the healthcare setting to his role.  Most recently, John served as an assistant vice president at Texas Children’s Hospital, where he was responsible for IT operations, including business and clinical application delivery, business intelligence and analytics, and infrastructure technology.  We recently asked him to share a few details of CHOC’s upcoming investments in technology.  Here’s what he had to say.

What support will be provided to our population health efforts?

We will continue to expand our population health and pediatric system of care capabilities with new registries, real time information and analytic technologies to improve care coordination, management of patient population, and as well as improve the patient experience.

Will CHOC be investing in telemedicine technology?

We are undergoing a strategic review of telemedicine to position CHOC for broader reach, helping improve across the continuum of care and enhance the patient experience.

What are a few other IT projects you think our physicians should know about?

We are continuing with the roll out of Cerner’s PowerChart Touch for the iPad to bring more mobility and efficiency to our physician community.  We will also place a heavy emphasis on expanding our Enterprise Data Warehouse platform to increase access to clinical, administrative and operational information via web-based dashboards, key performance indicators and scorecards.  I am particularly interested in communications platforms for clinicians and shared services departments that improve efficiencies and eliminate the number of devices, so we will be exploring solutions in support of this.  We are also looking to enable a content and collaboration platform that allows for secure document sharing using Microsoft’s OneDrive and leverages Skype for Business, including instant messaging and web conferencing.

ROSA Robot Assists in CHOC Patient’s Successful Epilepsy Surgery

Five-year-old Ian Higginbotham recently enjoyed his best summer yet.  He experienced his first family vacation. He learned to swim and ride a bike. He got himself ready for kindergarten.  These are milestones most kids and parents, alike, eagerly welcome.  But there was a time when Ian’s parents weren’t certain their son, who was born seemingly healthy, would enjoy such happy pastimes.

Ian began talking and walking in his sleep as a toddler.  When the episodes, including night terrors, increased in frequency and severity, his mom Lisa made an appointment with the pediatrician.  One day, Lisa knew something just wasn’t right and didn’t want to wait for the appointment to get Ian checked out.  She and her husband Derek took him to the Julia and George Argyros Emergency Department at CHOC Children’s Hospital.  To her surprise, doctors diagnosed her son with epilepsy.    Ian’s “sleepwalking” and “night terrors” were actually seizures.

The family was referred to CHOC’s comprehensive epilepsy program.  A national leader in pediatric epilepsy care, CHOC’s comprehensive epilepsy program offers cutting-edge diagnostics, innovative medical approaches and advanced surgical interventions.  CHOC was the first children’s hospital in the state to be named a Level 4 epilepsy center by the National Association of Epilepsy Centers, signifying the highest-level medical and surgical evaluation and treatment for patients with complex epilepsy.

CHOC Children's

Ian’s neurologist Dr. Andrew Mower suspected he was experiencing complex partial seizures, which was confirmed by video EEG monitoring.  Complex partial seizures start in a small area of the temporal or frontal lobe of the brain, and quickly involve the areas of the brain affecting alertness and awareness.  The pattern of Ian’s seizures suggested they were originating from the right frontal lobe.  Dr. Mower knew Ian and his family were in for a tough journey.

“I really don’t think the general public understands the impact epilepsy has on a child and his family.  Its effects are multifaceted and extensive.  Our team’s goal is to reduce or eliminate our patients’ seizures, helping improve their quality of life,” explains Dr. Mower, who placed Ian on a series of medications.

The medications reduced Ian’s seizures, but did not control them.  Dr. Mower was concerned about the seizures affecting Ian’s development, and presented his case to the epilepsy team.   The multidisciplinary team agreed Ian was a candidate for epilepsy surgery.  For children who fail at least two medications, surgery may be considered early in treatment versus as a last resort.  Surgery can result in an improvement in seizure control, quality of life, and prevent permanent brain damage.  Ian’s surgery was going to be performed by CHOC neurosurgeon Dr. Joffre Olaya.

While the thought of surgery was frightening to Lisa and her husband, they were confident in the team and comforted to know their son was going to benefit from innovative technology, like the ROSA™ Robot. Considered one of the most advanced robotized surgical assistants, ROSA includes a computer system and a robotic arm.  The computer system offers 3D brain mapping to aid surgeons in locating the exact areas they need to reach and planning the best surgical paths.  The robotic arm is a minimally invasive surgical tool that improves accuracy and significantly reduces surgery/anesthesia time.

Dr. Olaya used ROSA to accurately place electrodes in the area of Ian’s brain suspected to be the source of his seizures.  By using the robot, Dr. Olaya avoided performing a craniotomy.

“ROSA is an amazing tool that yields many benefits for our patients, including less time under anesthesia in the operating room.  It reduces blood loss and risk of infections.  Patients tend to recover faster than they would if they had craniotomy,” says Dr. Olaya.

Lisa was amazed at the outcome. “I couldn’t believe how great Ian looked after the placements of the electrodes with ROSA.  He wasn’t in any pain, there was no swelling.  It was wonderful!”

She and her husband were also amazed at how well Ian did following his epilepsy surgery.

“We got our boy back,” says Lisa. “There were no more side effects from medication and, more importantly, no more seizures!  He started developing again and doing all the things a child his age should do.”

Ian’s care team isn’t surprised by his recovery.

“Children are resilient, and their brains are no different.  In fact, the plasticity of a young brain allows it to adapt to changes and heal more easily than an adult brain,” explains Dr. Mower.

Learning to ride a bike and swim were among the first of many milestones Ian quickly reached following surgery.  He enjoys playing with his younger brother and his friends.  And, whether inspired by his experience with ROSA or not, Ian loves robots.