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Children’s Hospital Leverages Telehealth For Newborn Care in Rural Areas

Children’s Hospital Leverages Telehealth For Newborn Care in Rural Areas | IT Support and Hardware for Clinics |
Children's Hospital Leverages Telehealth For Newborn Care in Rural Areas

By Wendy Grafius, contributing writer

UC Davis Children’s Hospital plans to use grant to expand telehealth services to nursery clinicians at rural hospitals, study long-term impact on neonatal outcomes

UC Davis Children’s Hospital of Sacramento has received a grant from the U.S. Department of Health and Human Services Office for the Advancement of Telehealth – Health Resources and Services Administration (OAT-HRSA) which will be used for the new Pediatric Emergency Assistance to Newborns Using Telehealth (PEANUT) program. Approximately $750,000 over a three-year period will be disbursed to the nationally ranked hospital for the expansion of its telehealth services to nursery clinicians at rural hospitals and to study the program’s long-term impact on neonatal outcomes.

UC Davis Medical Center, which houses its center of excellence – UC Davis Children’s Hospital – is a pioneer in telehealth programs, providing academic specialty and subspecialty access to hospitals in rural communities. Four hospitals in rural counties with a shortage of health professionals, particularly in pediatric subspecialist areas, were selected to participate in the PEANUT program. The use of UC Davis’ award-winning videoconferencing will give those clinicians access to neonatologists, pediatric cardiologists, and other specialists for guidance in an attempt to address rural disparities in newborn care.

 “Rural doctors and hospitals deliver great care. But they have limited access to pediatric subspecialists,” said Madan Dharmar, assistant research professor in the UC Davis Children’s Hospital pediatric telemedicine program and principal investigator for the PEANUT program. “Without subspecialty guidance, newborn infants may be undertreated, receive inappropriate therapies, or face unnecessary transfers. By providing immediate access to neonatologists and other pediatric experts, PEANUT will provide a safety net for rural clinicians and their patients.”

Education will also be a major component of the PEANUT program. Technicians at the four rural hospitals will be trained in techniques for newborn emergency care and will receive help in implementing new care standards that are required at the state and national level, such as the Critical Congenital Heart Disease Screening Program for neonatal echocardiograms. Ruling out congenital heart defects can eliminate neonatal transfers, while properly identifying them will allow appropriate treatment. “We view this program as an important step in delivering high-quality and cost-effective care throughout California,” said Robin Steinhorn, UC Davis Children’s Hospital’s physician-in-chief, pediatric department chair, and grant co-investigator.

Part of the UC Davis Health System, 619-bed UC Davis Medical Center is the Sacramento region’s only academic health center, and is a “Most Wired” hospital, a Leapfrog Group “Top Hospital”, and ranked Sacramento’s top hospital by U.S. News & World Report. UC Davis Children’s Hospital boasts more than 120 physicians in 33 pediatric subspecialties serving infants, children, adolescents, and young adults with primary, subspecialty, and critical care. A total 129 beds include 36 general, 49 Neonatal Intensive Care Unit (NICU), and 24 Pediatric Intensive Care Unit/Pediatric Cardiac Intensive Care Unit (PICU/PCICU). In addition, the hospital provides the Central Valley’s only Level 1 pediatric trauma center and pediatric emergency department.

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iPad Receives Negative Reviews

iPad Receives Negative Reviews | IT Support and Hardware for Clinics |
iPad Receives Negative Reviews

By Katie Wike, contributing writer

Residents at one hospital were not impressed with the iPad’s clinical abilities

The Journal of Mobile Technology in Medicine published a study conducted by the Department of Medical Education, Riverside Methodist Hospital, stating, “The use of handheld computers by medical trainees isn’t new. A review published in 2006 found that 60 to 70 percent of medical students and residents were using handheld computers for educational purposes or patient care. The most commonly accessed applications included medical reference tools, electronic textbooks, and clinical computational programs. A review in 2009 found 90 percent of residents with personal digital assistants (PDAs) accessed pharmacological prescribing programs and medical calculators on a daily basis. Time management was dramatically improved for house staff who relied on PDAs for laboratory data retrieval.

“Since the iPad release in 2010, two independent market research studies have evaluated digital trends in medicine. In 2011, the Manhattan Research group reported that 81 percent of U.S. physicians own a smartphone, 30 percent were using an iPad, and 28 percent planned to purchase an iPad within six months. In 2012, Epocrates Research group found 34 percent of physicians used a tablet computer and 75 percent planned to buy one within a year. Eighty-one percent with a tablet also owned an iPad.”

This led the authors to “evaluate residents’ perceptions of the iPad’s clinical and educational utility, and examine differences of perceived value between medicine-based and surgical-based residents.” To achieve that goal, during the 2011-2012 academic year, 119 residents at Riverside Methodist Hospital were given a 16GB iPad2 with Wi-Fi “along with a $100 stipend to purchase auxiliary equipment such as case covers and keyboards. After a comprehensive orientation that included directions for accessing the hospital’s medical records, residents were instructed to use their iPad both in and outside the hospital as they saw fit throughout the year.”

A total of 102 residents - 86 percent - participated and the results were less than overwhelming. Low marks were given to the iPad for daily clinical utility and efficiency in documentation, and “all resident groups noted problems with iPad log-in and connectivity/Wi-Fi. During the academic year, 98 tickets specific for iPad set-up and connectivity issues were reported to Information Technology services.”

The iPad was most valued for its ability to source article from outside the hospital and its use as a research tool. There were very few reports of issues with portability or software applications.

The authors conclude, “Residents in this study did not attribute high value to the iPad as a clinical rounding or educational tool. Additionally significant differences existed between medical and surgical residents’ perceived value of the iPad’s utility. Institutions should consider these differences and address connectivity and support issues before implementing iPad programs across all disciplines.”

“Institutions should consider these differences and address connectivity and support issues before implementing iPad programs across all disciplines. Additionally, factors such as hardware/software cost, vendor support, on-going training, in-house support, and connectivity should be considered prior to implementation of a mobile computing program."

FierceHealthIT notes earlier research published in the Journal of Medical Internet Research similarly “found that the use of iPads for certain tasks in an internal medicine residency program fell short of initial high expectations, although users reported overall satisfaction with the tools. Residents who reported more ‘hype’ prior to iPad deployment were more likely to use the iPad to enter orders, according to researchers. Moreover, those residents who used Apple products prior to iPad deployment also were likely to report higher usage of the iPad.”

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