Expanding care for kids through telehealth

This year, Stanford Medicine Children’s Health plans to more than double its telehealth services—from 1,100 visits in 2018 to 2,500 visits in 2019.

These days it’s hard to find someone who doesn’t use digital health technology. Most of us go online to make appointments, access our medical records, look at test results and exchange notes with our doctor’s office. Many of us take advantage of remote virtual appointments and use devices to track health data that can give providers a broader picture of our well-being.

Digital health technology is also helping Stanford Medicine Children’s Health offer patients and their families better access to Stanford Medicine pediatric experts.

Currently, telehealth virtual visits are offered to patients for follow-up appointments. Some of those are clinic-to-clinic visits, in which a nurse practitioner at a primary care office connects with a physician at a specialty clinic.

During a clinic-to-clinic visit, a nurse practitioner at the remote clinic examines the child while a high-resolution camera and microphone—both on a secure communication network—let the physician at the specialty clinic see and hear exactly what the nurse practitioner does.

Vandna Mittal, director of digital health services at Stanford Medicine Children’s Health, said these clinic-to-clinic telehealth visits are used for an array of appointments, from diagnosing eye problems in premature infants to performing video electroencephalograms for neurology. Because the Stanford Medicine Children’s Health network spans from Santa Rosa to Salinas, these virtual visits help families fit appointments into their schedules.

“Through virtual visits, we are not only saving families time travelling to appointments and taking their kids out of school and work, we are also maximizing our providers’ ability to see more patients, fill in last-minute cancellations and accommodate urgent requests,” said Mittal.

Patients also benefit from clinic-to-home visits. Through the Stanford Medicine Children’s Health MyChart patient portal, patients and families can connect with their physicians remotely using their own devices, such as phones and tablets. Mittal said such virtual visits are popular among teen behavioral-health patients who go away to college but want to maintain a close relationship with their mental health provider at Stanford. Additionally, providers within the developmental-behavioral clinic are using these visits to observe patients in their natural play environments, at home or even on the playground, which provides a more realistic evaluation of the child’s condition.

In addition, Stanford Medicine Children’s Health offers clinic-to-school visits, in which physicians can connect remotely with a patient in a school nurse’s office. With the patient’s parents and the school nurse onsite, they can hear from the patient’s doctor directly. Clinic-to-school visits provide a comprehensive approach for patients who may need ongoing monitoring by a health care provider (e.g. a school nurse), while minimizing the need to be in the doctor’s office. According to Mittal, this approach is working well among patients with diabetes who may live far away from the hospital, but require ongoing support and blood glucose monitoring.

Telehealth is also being used within Lucile Packard Children’s Hospital. From inpatient units, on-call doctors are evaluating patients in the emergency department via telehealth before they are admitted; in some cases, specialists are able to advise ED care teams on the most appropriate transfer methods for patients. This approach cuts down on provider walking time and limits the time families spend waiting for care consultations.

“Although virtual telehealth visits are not a blanket solution for everyone or every visit, they are instrumental in helping patients and families who require more care or live away from their specialists, without sacrificing that vital connection,” said Mittal. “Thanks to advances in medicine and science, we are able to care for more children with chronic or serious conditions than ever before, and digital health allows more flexibility and greater access to the best care available.”

In November, Stanford Medicine Children’s Health launched a new service in conjunction with Stanford Health Care that offers digital second opinion consultations from Stanford physicians. Through the program, called Grand Rounds, patients don’t have to visit the hospitals or clinics for this service. Rather, people can create an account through the Stanford Medicine Children’s website and pay a $700 fee; Stanford will collect all of their medical records for them (if the records are in the United States). An expert from Stanford will then review the medical information and send a written second opinion, usually within two weeks.

Mittal noted that Stanford Medicine Children’s Health’s multipronged digital health approach—including telehealth, remote care monitoring and patient portal access—will continue to empower families and patients to manage their health care and enable providers to make better-informed care decisions.