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President Joe Biden and First Lady Jill Biden tour the telehealth command center at Children's National Hospital

President Biden, First Lady tour cardiac telehealth command center

President Joe Biden and First Lady Jill Biden paid a recent visit to the Cardiac Intensive Care Unit (CICU) at Children’s National Hospital, where leaders of our cardiology services toured them through the state-of-the-art telehealth command center embedded on the unit.

The big picture

Children’s National is pioneering the integration of telemedicine into CICU care. It’s one of the few pediatric hospitals in the world to do this.

Experts liken the telehealth command center to an ‘air traffic control tower’ for the most vulnerable patients with critical heart disease. The President and First Lady saw how complex the environment is, with real-time monitoring of all 26 high-risk patients in the CICU. The system combines traditional remote monitoring, video surveillance and artificial intelligence tools.

What this means

“With this technology, we’re helping to predict and prevent major adverse events,” said Ricardo Munoz, M.D., executive director of the Telemedicine Program and chief of the Division of Critical Care Medicine at Children’s National. “For example, our neuromonitoring system can help signal an impending brain injury before it happens.”

Dr. Munoz says President Biden expressed interest in the prevention strategy of adverse events and this new approach to caring for children with critical cardiac illness.

What they’re saying

  • “It was important to share with the Biden’s that caring for these kids is a long-term endeavor, not simply a single surgery or procedure to fix their heart abnormality,” said Yves d’Udekem, M.D., Ph.D., chief of Cardiac Surgery at Children’s National. “That means making sure they have the earliest diagnoses, the best treatments from surgeons and others who truly understand their condition, and a technologically advanced, attentive place to recover and heal as safely as possible.”
  • “Many people don’t believe that ‘pediatrics’ and ‘innovation’ can co-exist,” said Annette Ansong, M.D., medical director of Outpatient Cardiology at Children’s National. “During the Biden’s visit, they were at the crux of a novel way to closely monitor some of our sickest children with the added ability to predict bad events before they happen.”

Dr. Ansong hopes bringing awareness of these cardiac capabilities to the President and First Lady is the first of many steps in seeking support for children with congenital and acquired heart disease.

Ricardo Munoz

Ricardo Munoz, M.D., named MacCutcheon Family Professor in Cardiac Critical Care Medicine

Ricardo MunozChildren’s National Hospital named Ricardo Munoz, M.D., the MacCutcheon Family Professor in Cardiac Critical Care Medicine at Children’s National Hospital.

Dr. Munoz serves as chief of the Division of Cardiac Critical Care Medicine, executive director of Telehealth, and co-director of Children’s National Heart Institute at Children’s National Hospital. He is professor of pediatrics at the George Washington University School of Medicine and the main editor of several books in pediatric cardiac critical care medicine.

About the award

Dr. Munoz joins a distinguished group of 42 Children’s National physicians and scientists who hold an endowed chair. Professorships at Children’s National support groundbreaking work on behalf of children and their families and foster new discoveries and innovations in pediatric medicine. These appointments carry prestige and honor that reflect the recipient’s achievements and donor’s forethought to advance and sustain knowledge.

As chief of the Division of Cardiac Critical Care Medicine, Dr. Munoz leads a multidisciplinary team of specially trained physicians in providing intensive pediatric cardiac critical care. Dr. Munoz is credited as pioneering telemedicine for pediatric critical care, dedicated to increasing access and quality care for children with special hearts in the nation’s capital and across the world.

The MacCutcheon Family Foundation, through their vision and generosity, are ensuring that Dr. Munoz and future holders of this professorship will launch bold, new initiatives to rapidly advance the field of pediatric cardiac critical care, elevate our leadership and improve the lifetimes of children with special hearts.

About the donors

Jim MacCutcheon’s involvement with Children’s National dates back to 1983. He has served in many leadership positions, most notably on the Children’s National and Children’s National Hospital Foundation board of directors. Jim and his daughters, Megan MacCutcheon, Candice Kessler and Colleen Crowley have supported Children’s National Heart Institute by funding the development of the MacCutcheon Cardiovascular Operating Suite and the Halle MacCutcheon Playroom on the heart and kidney unit. They have also provided support for the Peter Holbrook Endowed Lecture in Critical Care Medicine, the mobile health clinic and various events and capital improvement projects.

The MacCutcheon family’s investment to establish the MacCutcheon Family Professorship in Cardiac Critical Care Medicine allows Dr. Munoz and his team to provide innovative care utilizing telemedicine and artificial intelligence in support of our patients with special hearts.

CICU telemed command center

New telehealth command center redefines hospital care

CICU telemed command center

The new CICU command center redefines hospital care for children with the riskiest heart conditions.

Children’s National Hospital has opened a new telehealth command center that uses cutting-edge technology to keep continuous watch over the most fragile children with critical heart disease. The new command center, located in the Cardiac Intensive Care Unit (CICU), builds off a care model deployed outside the CICU in 2019, but now offers improved collaborative communication to better help predict and prevent major events, like cardiac arrest.

“The new center acts like an air traffic control tower. It allows our telehealth team to remotely monitor each patient room and alert the bedside team to any abnormal trends,” says Ricardo Munoz, M.D., executive director of the Telemedicine Program and chief of the Division of Critical Care Medicine at Children’s National. “Better communication with the bedside team and easier access to all members of the medical and surgical teams means we can provide the best possible care to these fragile infants.”

In the early stages of recovery after heart surgery, vulnerable patients can regress quickly with few outward physical symptoms. The telehealth virtual surveillance system flags early warning signs that a critically ill infant may suffer a serious adverse event.

The system combines traditional remote monitoring, video surveillance and an artificial intelligence algorithm. New features include:

  • Neuromonitoring: Doctors are developing an adaptable neuromonitoring system that can help signal an impending brain injury before it happens.
  • Echocardiography: A cardiologist, embedded in the new command center, is available to expedite and improve communication within the multidisciplinary team.
  • Real-time audio and video: A telemedicine cart is placed in the room of high-risk patients to allow for rapid communication with a bedside nurse.
  • E-CICU team: A team of CICU nurses and physicians implement a second layer of safety over patient care by doing a systematic review of video feeds from patient rooms, patient monitors, artificial intelligence tools trained to detect dangerous trends, labs and imaging studies.

Since the center’s launch, the system’s virtual surveillance has tracked 8,697 virtual surveillance activities, resulting in:

  • 2,350 non-critical communications
  • 199 critical communications that prevented major adverse events

“Parents of our highest-risk patients are comforted knowing our team of doctors and nurses are watching their child at every moment,” says Dr. Munoz. “We are one of the few pediatric hospitals in the world integrating telemedicine into our CICU. Our goal is to expand our monitoring capabilities both nationally and internationally to improve pediatric heart care.”

Children’s National is a recipient of the Telehealth Accreditation from URAC and is the first pediatric hospital to receive this recognition for its ability to leverage technologies to advance high-quality care that promotes clinical best practices, consumer protections and care continuity between patients and providers.

The Board of Visitors Telehealth Command Center was funded by an Auxiliary Board of Children’s National.

FCC Chairwoman Jessica Rosenworcel visited Children’s National Hospital

Acting FCC chairwoman Rosenworcel highlights telehealth for pediatrics

FCC Chairwoman Jessica Rosenworcel visited Children’s National Hospital

Acting FCC Chairwoman Jessica Rosenworcel visited Children’s National Hospital yesterday to highlight the importance of connectivity in healthcare and learn more about how the hospital is using telehealth to serve families during the pandemic. Children’s National Hospital in Washington, D.C., has provided pediatric care for 150 years and is among the nation’s top 10 children’s hospitals. Last year, Children’s National, an academic pediatric health system, saw more than 219,000 children from the capital region and from across the country and around the world.

“So much more can be done to connect children and their families — in both urban and rural parts of the country — to the care they need not only to survive, but to thrive,” said Rosenworcel. “Telehealth can help bridge that gap by bringing specialty care available only in hospital centers to smaller clinics and even the home where problems can be addressed quickly, before they prove life threatening. I was encouraged by the creative work that Children’s National Hospital is doing to address the unique health needs of children from all backgrounds especially during these challenging times.”

Acting Chairwoman Rosenworcel was joined by her colleague FCC Commissioner Nathan Simington for a tour of the hospital, where they met with Shireen Atabaki, M.D., M.P.H., associate medical director of Telehealth, Emergency Medicine physician and program director for the COVID-19 Telehealth Program at Children’s National Hospital. The visit also included a demo of a telehealth robot by Ricardo Munoz, M.D., Cardiac Critical Care Medicine chief, and Alejandro Jose Lopez-Magallon, M.D., medical director of Telemedicine, both at Children’s National.

“The pandemic catapulted telehealth as a tool for the future of health care delivery,” said Dr. Atabaki. “With the support of the FCC, Children’s National is excited to introduce a robot and other state-of-the-art digital health technology to support provider-to-patient pediatric care and expert consultations in our hospital’s emergency departments and across our region. These innovations in telemedicine will facilitate access to specialized expertise and care of COVID-19 patients.”

In May 2020, Children’s National Hospital was approved for funding as part of the FCC’s COVID-19 Telehealth Program and established a regional pediatric telehealth consortium. This will enable the hospital to expand its telehealth platform to support 15 health care sites in the region serving children and young adults, providing care to children with COVID-19, as well as those who are medically vulnerable.

Acting Chairwoman Rosenworcel is committed to closing the digital divide and sees access to telehealth care services — especially for underserved and marginalized communities — as a top priority. To learn more about telehealth efforts at the FCC, including the COVID-19 Telehealth Program and the Connected Care Pilot Program, visit: https://www.fcc.gov/connecting-americans-health-care.

telemedicine control room

Telehealth and AI reduce cardiac arrest in the cardiac ICU

telemedicine control room

The telehealth command center located a few steps away from the cardiac ICU at Children’s National Hospital.

The cardiac critical care team at Children’s National Hospital has developed an innovative Tele-Cardiac Critical Care model aiming to keep constant watch over the most fragile children with critical heart disease in the cardiac ICU. The system combines traditional remote monitoring and video surveillance with an artificial intelligence algorithm trained to flag early warning signs that a critically ill infant may suffer a serious event like cardiac arrest while recovering from complex cardiac surgery. This second set of eyes helps bedside teams improve patient safety and quality of care.

These high risk post-operative patients are often neonates or small infants born with the most complex and critical congenital heart diseases that require surgery or interventional cardiac catheterization in their first days or weeks of life. At these early stages after crucial cardiac surgery, these patients can decompensate dangerously fast with few outward physical symptoms.

The AI algorithm (T3) monitors miniscule changes in oxygen delivery and identifies any mismatch with a child’s oxygen needs. It also tracks and displays small changes in vital sign trends that could lead to a serious complication. The cardiac ICU command center staff then analyzes additional patient data and alerts the bedside team whenever needed.

The Tele-Cardiac Critical Care program started two years ago. In that time, the program has contributed to a significant decrease in post-operative cardiac arrest for this patient population.

“It’s easy to see how a model  like this could be adapted to other critical care scenarios, including our other intensive care units and even to adult units,” says Ricardo Munoz, M.D., chief of Cardiac Critical Care and executive director of Telehealth. It allows the physicians and nurses to keep constant watch over these fragile patients without requiring a physician to monitor every heartbeat in person for every patient at every hour of the day to maintain optimal outcomes for all of them.”

Dr. Munoz and Alejandro Lopez-Magallon, M.D., medical director of Telehealth and cardiac critical care specialist, presented data from the pilot program at the American Telemedicine Association’s virtual Annual Meeting on June 26, 2020.

telemedicine control room

Telehealth connects pediatric heart experts about critical COVID-19 details

telemedicine control room

Telehealth is more than a doctor-to-patient tool during COVID-19. Experts in congenital heart disease meet weekly to share details about how it affects their vulnerable patients.

During the COVID-19 pandemic, telehealth has been crucial in allowing doctors to maintain safe contact with patients who require ongoing medical care without an office visit. Just as important is the role that telehealth is playing to connect care providers with each other to ensure that everyone around the world has the information they need to provide the best care possible for this swift-moving disease.

One good example of this specialist-to-specialist thought leadership connection is the ongoing weekly meeting hosted by the Children’s National Hospital cardiac critical care specialists. Since early in the spread of COVID-19, the Cardiac-ICU team, led by cardiovascular specialists including Ricardo Munoz, M.D., chief of cardiac critical care medicine and executive director of telehealth at Children’s National, have connected pediatric clinicians around the world to discuss how best to care for particularly vulnerable patients with pre-existing heart diseases, and to discuss breaking news in epidemiology of the disease and the effectiveness of various treatment approaches.

The video conference attracts hundreds of physicians and nurses who specialize in pediatric cardiac care from countries all over the world. In the last week of April, the meeting featured a late-breaking session to discuss new pediatric intensive care observations of inflammatory symptoms similar to Kawasaki disease, which were being detected in the United Kingdom, Paris and the United States. While more information is needed about this discovery, the ability of these experts to gather and compare disease phenotypes from country to country facilitates both the additional classification of pediatric-related symptoms and improves how all centers, no matter their location, can prepare to treat children who present locally with these symptoms.

In recent weeks, cardiac physicians and nurses from some of the world’s hardest hit regions, including Italy and Spain, have shared detailed information about their on-the-ground experiences to help colleagues in the U.S. and elsewhere better prepare for new developments.

“This new disease is a moving target, especially when it comes to understanding how it might impact children and adults with existing cardiac disease, particularly those with congenital heart disease,” says Dr. Munoz. “It is extremely important that we learn from each other, especially when we are able to connect with our colleagues in the epicenters of the most serious outbreaks of COVID-19. We are happy to host this important weekly meeting with the goal of helping every specialist keep as many patients with cardiac diseases as safe as possible throughout the global health emergency.”

If you would like to join these weekly telehealth meetings, please send your request to COVIDMultiCICUResponse@childrensnational.org.

covers of books edited by Children's National faculty

We wrote the book

Children’s National Hospital is proud to have a number of faculty members who literally wrote the books on pediatric cardiology, neonatology, neurology and pulmonology. These texts, edited by experts Gil Wernovsky, M.D., Gordon Avery, M.D., Ricardo Munoz, M.D., Anastassios Koumbourlis, M.D., MPH, Robert Keating, M.D. and Roger Packer, M.D., have become the definitive references for medical students everywhere.

Through these books, generations of children worldwide will benefit from the expertise at Children’s National:

  • Anderson’s Pediatric Cardiology. Wernovsky, G., Anderson, R.H., Kumar, K., Mussatto, K.A., Redington, A.N., Tweddell, J.S., Tretter, J.T. (Eds.). (2019). Philadelphia, PA: Elsevier Publishing.
  • Avery’s Neonatology: Pathophysiology and Management of the Newborn. MacDonald, M.G., and Seshia, M.M.K. (Eds.) (2015). Philadelphia, PA: Lippincott Williams & Wilkins.
  • Critical Care of Children with Heart Disease: Basic Medical and Surgical Concepts. Munoz, R.A., More, V.O., da Cruz, E.M., Vetterly, C.G., da Silva, J.P. (Eds.). (2010) London, UK: Springer-Verlag London Ltd.
  • Diagnostic Tests in Pediatric Pulmonology. Davis, S.D., Koumbourlis, A.C., and Eber, E. (Eds.). (2015) London, UK: Springer-Verlag London Ltd.
  • Pulmonary Complications of Non-Pulmonary Pediatric Koumbourlis, A.C., and Nevin, M. (Eds.). (2018) London, UK: Springer-Verlag London Ltd.
  • Tumors of the Pediatric Central Nervous system. Keating, R.F., Goodrich, J.T., and Packer, R.J. (Eds.). (2013) New York, NY: Thieme Medical Publishers.

covers of books edited by Children's National faculty

telemedicine

Children’s National partners with Sabará Hospital Infantil to provide pediatric telehealth services in Brazil

telemedicine

Through a new partnership with Sabará Hospital Infantil in São Paulo, Brazil, Children’s National Hospital will provide access to pediatric cardiac intensive care specialists and consultations via telehealth. This is the first international telehealth offering from Children’s National for pediatric cardiac critical care.

The partnership includes sharing care proposals, second opinion for complex cardiology cases, alignment with international benchmarks, adoption of diagnostic and therapeutic protocols, development of critical mass for continuous process improvement and continued training. Joint multidisciplinary visits will also be carried out to help Sabará validate and improve existing protocols and learn about innovations and service improvement opportunities.

Children’s National will also provide teleconference-based training for Sabará nursing staff and second opinions through medical teleconsultation with specialists in all areas of pediatric cardiology, based on each patient’s individual needs.

“It is an honor to partner with Sabará Hospital lnfantil,” says Ricardo Munoz, M.D., executive director of Telemedicine and chief of Cardiac Critical Care at Children’s National. “We look forward to working together toward our shared goal of providing the best health care possible for the children in Brazil.”