A roadmap of Stanford Children's telehealth program: 6 questions with Dr. Dennis Lund

The telehealth program at Stanford (Calif.) Children's Health has come a long way since it began offering telehealth virtual visits in January 2013.

Funded with a grant from Cisco, William Kennedy, MD, chief of the pediatric urology department, kicked off the program with a basic clinic-to-clinic telehealth model that connected the children's facility to Stanford's main hospital in Palo Alto, Calif. Under his leadership, the program eventually grew to connect to specialty services at Stanford facilities in San Francisco and Monterey, Calif.

Today, Stanford Children's Health offers telehealth services to patients as part of a broader digital health program, Dennis Lund, MD, CMO and interim CEO of Stanford Children’s Health told Becker's Hospital Review. That includes clinic-to-home telehealth visits — which Stanford Children's began offering in May 2017 — as well as in-hospital and remote care monitoring, patient portal access, and clinic-to-school telehealth.

"The goal," Dr. Lund said, "[is to provide] patients and families the ability to access their Stanford Children's Health clinicians, without having to interrupt their lives to travel to the hospital or clinics."

The program has been widely successful. In fact, as of August 2018, the children's hospital has equipped 47 of its 65 clinic sites — in addition to its hospital — with telehealth capabilities.

These efforts aren't going to waste, either. Last year, Stanford Children's completed 1,100 visits, but it plans to more than double that in 2019 to complete 2,500 visits.

Becker's Hospital Review caught up with Dr. Lund to discuss how Stanford Children's telehealth program works, how Stanford supports it clinicians with telehealth and what makes the program unique.

Editor's note: Responses have been lightly edited for clarity and length.

Question: Can you describe some of the patient facing technologies that are a part of Stanford Children's telehealth efforts?

Dr. Dennis Lund: At Stanford Children's Health, we are enabling patients to stay connected with their physicians not only through telehealth virtual visits, but also through EHR-integrated home monitoring programs. For example, for families with babies who have single ventricle congenital heart disease, which requires a series of three heart surgeries, Lucile Packard Children's Hospital Stanford has a home monitoring program that begins when the patient goes home following their first surgery shortly after birth. The home monitoring program helps the care team determine when the family should return for the second surgery. In 2017, the single ventricle home monitoring program team began piloting a digital solution to alleviate the cumbersome, manual process of parents recording patient data in a logbook at home and communicating the information via a weekly phone call with a cardiology nurse practitioner, who would then manually enter the patient's information into the EHR.

Q: What makes Stanford Children's telehealth program unique?

DL: Our multi-pronged digital health approach, inclusive of telehealth, remote care monitoring and patient portal access, is what sets us apart. Chronic illness leads to significant delays in child development and that is partly due to them having to miss school and social activities to receive care. Our digital health program allows patients and families the ability to access their Stanford Children's Health clinicians without having to interrupt their lives to travel to the hospital or clinics. For example, we have psychiatry patients who have close relationships with their providers at Stanford Children's Health, but who go away to college. Thanks to telehealth, they can stay connected with their psychiatrist back home from their dorm rooms. Another example — we have tracheotomy patients, some of whom are on ventilators and live hours away from the hospital. When issues arise, it can be a six-hour ambulance trip for them to come to Packard Children's. Telehealth makes it possible for tracheotomy patients to instead travel just to their local physician and communicate remotely with their specialist at the hospital. They can resolve issues quickly this way, allowing them to return to work and school with far less disruption.

Q: How have patients been reacting to Stanford Children's telehealth offerings?

DL: Our program is still relatively new, but initial feedback has been very positive. Among a survey of our patient families using telehealth virtual visits, 100 percent of our patient families have stated that they are willing to participate in another telehealth visit and two-thirds surveyed would prefer a telehealth consultation to onsite visits. Additionally, patients strongly agreed that they were able to see and hear the provider clearly, and that the provider was able to address their child's reason for visit.

Q: How did you equip your physicians with the tools they need to deliver care to children via telehealth?

DL: Our digital health services team comprised of information systems specialists met with each practice that was interested in implementing telehealth and sat down with them to understand their needs. They filled out a protocol document to provide information on the patient needs they were trying to fill with telehealth, and who the most appropriate patients would be for virtual visits, knowing it is not a blanket solution for everyone or every visit. The digital health team walked providers and clinic staff through the way a telehealth visit works, from connecting them to the video to sharing best practices for communicating. Best practices include looking at the camera, avoiding wearing distracting patterns and how to do a virtual fist-bump or high-five with their patients — something that goes a long way with pediatric patients. Emphasis was placed on training clinics' medical assistants and front desk staff, less so the doctors. The more confident and trained the support staff is, the smoother it goes. The goal of this approach was to keep the telehealth process simple for doctors so they can join calls after the video connection has been made to really focus their role on patient care, rather than troubleshooting technicalities of the video call connection.

Q: What was the biggest challenge in developing your hospital's telehealth program?

DL: Although the initial response from providers has been overwhelmingly positive, we continue to focus on helping our clinics integrate virtual visits into their day-to-day practices so they are using it for patient care consistently.  This represents a new workflow for physicians and patients, and they must be brought along and shown how this is more efficient and simplifies their doctor-patient interactions.

Q: What is ahead for Stanford Children's telehealth program? What could patients hope to see in the next year or so?

DL: Our goal is to expand telehealth services from 1,100 visits in 2018, to 2,500 visits or more in 2019. We are currently offering telehealth virtual visits to patients for follow-up appointments.  In the future, I believe there will be tried-and-true algorithms for the application of digital health technologies that should save both patients and physicians time and make their interactions more efficient and, hopefully, more satisfying.  

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