Pediatric urologist William Kennedy, MD, is a leader in expanding access to high-quality care through telehealth.
Early in my tenure at Lucile Packard Children’s Hospital Stanford, I spent a lot of time on the road.
As a pediatric urologist, my specialty is in short supply but it is vital to kids with urinary problems. I’d had a busy practice at the hospital’s clinics since I arrived in 1997, but I knew more children needed this kind of specialized care, so I also saw patients at the Stanford Medicine Children’s Health Pediatrics – Monterey. But getting back and forth to Monterey meant hours commuting.
To me, that was time lost that I could be seeing patients. I wanted to be more efficient.
Now I’m doing just that, thanks to telehealth, an expanding model of health care delivery that makes virtual clinical appointments very much like the real thing. For the past two years, I’ve been “the doctor on TV” to many of my young patients. From my hospital clinic on Welch Road in Palo Alto, I chat with patients and parents in the Monterey region via a large, high-definition monitor and secure communication network. Our nurse practitioner examines the child, while a high-resolution camera and microphone let me see and hear exactly what the nurse practitioner does.
In fact, I can travel virtually anywhere in the world and still check in on my patients. Everything I need — my laptop with secure software and a plug-in high-definition video camera — fits in my backpack. This is especially useful when I monitor my Northern California patients following surgery.
Since telehealth makes a true clinical experience possible even from a distance, it has tremendous potential for people who live in rural and underserved areas and need access to specialty care.
Along with other doctors who are putting telehealth to the test, I’ve learned that parents appreciate being able to see a specialist close to home. In the past, many Monterey patients would have to drive 80 miles to visit my 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, I encountered an exhausted patient and frazzled parent at the end of the long trek.
Perhaps most importantly, telehealth has dramatically reduced patients’ wait for an appointment. In the past, 75 percent of my patients faced a 60-day wait for a clinical visit due to the limited number of pediatric urologists. Now that I conduct virtual appointments, the average wait time is down to two weeks. I still visit each clinic regularly to consult with staff, but the majority of patient appointments are virtual.
Kids like the new paradigm, I’ve found.
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. 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 our patient surveys. That’s especially important since many of my patients face surgery, and their parents are often anxious. It is crucial 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, that clinical services are equivalent, whether delivered in person or using telehealth services.
This made it feasible for me to offer virtual appointments to patients not just in Monterey, but also through the Stanford Medicine 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.
Our success is not surprising. Lucile Packard Children’s Hospital and Stanford Medicine Children’s Health have long been telehealth pioneers. Across Northern California and the U.S. Western region, we’ve used telehealth to diagnose eye problems in preemies, conduct gastrointestinal and liver transplant outreach, and perform video EEGs for neurology. Telehealth also makes it possible to transmit tele-echocardiograms to consulting cardiologists and to provide care conferences for high-risk births. Pilots are under way for child and adolescent psychiatry, along with plans to expand telehealth though new programs in dermatology and transplant.
It’s a model of health care delivery 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.
Those of us who are responsible for delivering pediatric medical services want to ensure that patients who need high-quality, specialized care can receive it in a convenient and timely way. We are pleased that our telehealth program for urology, offered through Stanford Medicine Children’s Health, is serving as a model for other pediatric specialties. With a strong record of success, we believe telehealth is here to stay.
Discover more about our Pediatric Urology or call (650) 497-8156.
