Telemedicine: A Stanford specialist's dream come true

Early in Dr. William Kennedy's tenure at Lucile Packard Children's Hospital Stanford, he spent a lot of time on the road.

Kennedy is a pediatric urologist, a specialist in short supply but vital to kids with urinary problems. He'd had a busy practice at the hospital's clinics since arriving in 1997, but he knew more children needed the kind of specialized care he could provide. Prior to the hospital joining forces with the Pediatric Group of Monterey in 2014, he was seeing patients there, but it meant hours commuting back and forth.

"I viewed that drive in terms of time lost that I could be seeing patients," he said. "I wanted to be more efficient."

Now he is doing just that, thanks to telehealth, an expanding model of health care delivery that makes virtual clinical appointments just like the real thing. For the past two years, Kennedy has been "the doctor on TV" to many young patients in the Monterey region. From a hospital clinic on Welch Road in Palo Alto, he chats with patients and parents via a 56-inch high-definition monitor and secure communication network. As a nurse practitioner examines the child, a high-resolution camera and microphone let Kennedy see and hear exactly what the nurse practitioner does.
"It's a true clinical experience," said Kennedy, "and it has tremendous benefit for people living in rural and underserved areas who need access to specialty care."

Kennedy, chief of pediatric urology at Lucile Packard Children's Hospital and Stanford Children's Health, can also check in on his patients when he is traveling, using his laptop, secure software and a plug in high-definition video camera that fits in his backpack. This is especially useful when monitoring his Northern California patients following surgery. He has even conducted follow-up appointments from hotels when traveling abroad.

For parents, being able to see a pediatric specialist close to home is an enormous boon. In the past, many of Kennedy's Monterey patients would have to drive 80 miles to visit his Palo Alto office. Not only could this delay much-needed treatment for the patient, it usually meant missing work and school and often created child or elder care expense for those left at home. Too often, Kennedy encountered an exhausted patient and frazzled parent at the end of the long trek.

Perhaps most importantly, Kennedy's telehealth practice has dramatically reduced patients' wait for an appointment. In the past, 75 percent of his patients faced a 60-day wait for a clinical visit, a consequence of the limited number of pediatric urologists. Now that he conducts virtual appointments, the average wait time is down to two weeks. He still visits each clinic regularly to consult with staff, but the majority of patient appointments are virtual.

Kids like the new paradigm.

"When I first see a child in person, that child is usually clinging to mother or hiding under the examining table, and I have to coax them out. But when they see me on the screen, they run up to talk to me. It's like talking to Grandma or Grandpa on Skype," says Kennedy. "Once, when I saw a child in person for the first time, he said, 'There's my doctor from TV!'"

Parents have adjusted too, according to patient satisfaction surveys.

"Many of my patients face surgery, so the parent is often anxious," Kennedy says. "It is important that the virtual experience feels authentic, since I may not meet them in person until we are outside of the operating room."

Sporadic forms of telehealth have been around for years, but in 2012, California enacted legislation that removed barriers to its wider use by establishing, among other key points, thatclinical services are equivalent, whether delivered in person or using telehealth services.

The next year, Kennedy began offering virtual appointments to patients not just in Monterey, but also through the Stanford Children's Health Pediatric Specialty Center at California Pacific Medical Center in San Francisco, thanks to support from the corporate social responsibility program of Cisco Systems.

This success is not surprising. Lucile Packard Children's Hospital and Stanford Children's Health have long been telehealth pioneers. Across Northern California and the U.S. Western region, the organization has used telehealth to diagnose eye problems in preemies, conduct gastrointestinal and liver transplant outreach, and perform video EEGs for neurology. Telehealth also is available for the transmission of tele-echocardiograms for cardiology and to provide care conferences for high-risk births. There are also pilots under way for child and adolescent psychiatry, plus plans to further expand telehealth though new programs in dermatology and transplant.

It's a health care delivery model that is growing in acceptance and practice, with the American Telemedicine Association reporting that about 3,500 sites provide telehealth services in the U.S.

The American Academy of Pediatrics is a big supporter, noting that the use of telehealth technology by primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists "...has the potential to transform the practice of pediatrics," according to a statement issued in June. Telehealth can "...improve access to care, provide more patient- and family-centered care, increase efficiencies in practice, enhance the quality of care, and address projected shortages in the clinical workforce," the statement said.

Kennedy sees the Stanford Children's Health telehealth program for urology as a model for other pediatric specialties. "Everyone in the U.S. is looking to ensure those needing high-quality, specialized care can access that care in a convenient and timely way," he said. "That's why we believe telehealth is here to stay."

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