Tag Archive for: technology

Innovative care using health IT lands Children’s National a 2017 HIMSS Enterprise Davies Award

Shireen Atabaki

A new diagnostic tool led by Shireen Atabaki, M.D., M.P.H., helps prescribers determine if CT scans are necessary for children with head injuries through a checklist protocol.

Opportunities to improve the lives of children are increasingly found at the intersection of health and technology, a sweet spot for enhancing care in today’s connected world. A team of experts at Children’s National Health System launched several initiatives using health information technology to improve care delivery, earning the institution the prestigious 2017 HIMSS Enterprise Davies Award. Recognizing outstanding achievements of organizations that have utilized health IT to significantly improve patient outcomes while also achieving a return on investment, Children’s National received the award based on three case studies in particular:

  • Decreasing use of CAT scans by 44 percent – A new diagnostic tool led by Shireen Atabaki, M.D., M.P.H., emergency medicine specialist, incorporated into the electronic health record helps prescribers determine if CT scans are necessary for children with head injuries through a checklist protocol. The new tool reduced the rate of CT scan utilization by 44 percent – decreasing unnecessary radiation exposure for children and resulting in first-year cost savings of more than $875,000.
  • Innovative unit-based quality boards – These electronic boards provide health care teams and families with real-time quality and safety information. By having patient information readily available in one location, the boards improved medication reconciliation by 13 percent, decreased the time to patient consent by 49 percent, and reduced duration of urinary catheters by 11 percent.
  • Improved clinician documentation – To improve outcomes and reduce costs,

Children’s National transitioned from dictation/transcription-driven notes to electronic/voice recognition notes in ambulatory specialty clinics. This allowed for the immediate availability of notes to all care providers and a significant reduction in transcription costs.

These initiatives demonstrate the life-changing quality and safety efforts under way at Children’s National that put patient safety first. Brian Jacobs, M.D., vice president, chief medical information officer and chief information officer, accepted the award on behalf of Children’s National at the HIMSS Awards gala at the Wynn in Las Vegas in March.

Voters select Children’s National innovation as runner-up in national competition

STAT Madness

Facial recognition technology developed and tested by researchers with the Sheikh Zayed Institute for Pediatric Surgical Innovation and Rare Disease Institute at Children’s National was the runner-up in this year’s STAT Madness 2018 competition.

Facial recognition technology developed and tested by researchers with the Sheikh Zayed Institute for Pediatric Surgical Innovation and Rare Disease Institute at Children’s National was the runner up in this year’s STAT Madness 2018 competition. Garnering more than 33,000 overall votes in the bracket-style battle that highlights the best biomedical advances, the Children’s National entry survived five rounds and made it to the championship before falling short of East Carolina University’s overall vote count.

Children’s entry demonstrates the potential widespread utility of digital dysmorphology technology to diverse populations with genetic conditions. The tool enables doctors and clinicians to identify children with genetic conditions earlier by simply taking the child’s photo with a smartphone and having it entered into a global database for computer analyses.

The researchers partnered with the National Institutes of Health National Human Genome Research Institute and clinicians from 20 different countries to acquire pictures from local doctors for the study. Using the facial analysis technology, they compared groups of Caucasians, Africans, Asians and Latin Americans with Down syndrome, 22q11.2 deletion syndrome (also called DiGeorge syndrome) and Noonan syndrome to those without it. Based on more than 125 individual facial features, they were able to correctly identify patients with the condition from each ethnic group with more than a 93 percent accuracy rate. Missed diagnoses of genetic conditions can negatively impact quality of life and lead to premature death.

Children’s National also was among four “Editor’s Pick” finalists, entries that span a diverse range of scientific disciplines. Journalists at the digital publication STAT pored through published journal articles for 64 submissions in the single-elimination contest to honor a select group of entries that were the most creative, novel, and most likely to benefit the biomedical field and the general public.

Each year, 1 million children are born worldwide with a genetic condition that requires immediate attention. Because many of these children experience serious medical complications and go on to suffer from intellectual disability, it is critical that doctors accurately diagnose genetic syndromes as early as possible.

“For years, research groups have viewed facial recognition technology as a potent tool to aid genetic diagnosis. Our project is unique because it offers the expertise of a virtual geneticist to general health care providers located anywhere in the world,” says Marius George Linguraru, D.Phil., M.A., M.S., a Sheikh Zayed Institute for Pediatric Surgical Innovation principal investigator who invented the technology. “Right now, children born in under-resourced regions of the U.S. or the world can wait years to receive an accurate diagnosis due to the lack of specialized genetic expertise in that region.”

In addition to providing patient-specific benefits, Marshall Summar, M.D., director of Children’s Rare Disease Institute that partners in the facial recognition technology research, says the project offers a wider societal benefit.

“Right now, parents can endure a seemingly endless odyssey as they struggle to understand why their child is different from peers,” says Dr. Summar. “A timely genetic diagnosis can dispel that uncertainty and replace it with knowledge that can speed patient triage and deliver timely medical interventions.”

Learning platform teaches clinicians how to spot and treat malaria

Children’s National experts are outlining a novel approach to helping healthcare providers learn how to diagnose and manage malaria; the online tool provides real-time feedback about their decision making.

Children’s National experts are outlining a novel approach to helping healthcare providers learn how to diagnose and manage malaria; the online tool provides real-time feedback about their decision making.

Next-generation medical education looks like this: A white-coat wearing avatar with the voice, face, and know-how of one of the nation’s leading infectious disease experts walks you through the twists and turns of how to diagnose malaria, making stops in a variety of hospital settings. If you make the right diagnostic and treatment decisions, you get instantaneous gold stars. If your choices are off-the-mark, at each decision point you get a clear explanation of why your answer was incorrect.

“This is the future of medical education,” says Barbara Jantausch, M.D., F.A.A.P., F.I.D.S.A., an infectious disease specialist at Children’s National Health System. She’s the female avatar with the John Travolta dance moves and expertise about malaria’s epidemiology, diagnosis, and treatment.

Dr. Jantausch will present a poster, “The Hot Zone: An Online Decision-Centered Vignette Player for Teaching Clinical Diagnostic Reasoning Skills,” during IDWeek 2016, the annual meeting of the Infectious Diseases Society of America. “It’s case-based, interactive e-learning where you choose your own adventure. The beauty of this module is the training can be self-directed,” Dr. Jantausch adds.

“At Children’s National, we’re pioneering the effort to build discovery-based learning platforms,” says Jeff Sestokas, Director of eLearning. In the vignette player, he’s the male avatar named Dr. Bear. Malaria is the first infectious disease training module but others are planned for the global health series, including Chagas disease and Zika virus, Sestokas says.

Identifying the illness

According to the Centers for Disease Control & Prevention (CDC), in 2015 an estimated 214 million people around the world had malaria, a mosquito-borne illness, and 438,000 of them died. Because of the lengthy incubation period, many international travelers do not show malaria symptoms until they return to the United States and experience flu-like symptoms including high fevers, shaking chills, and dehydration. Their lab results may include metabolic acidosis, hypoglycemia, normocytic anemia, or thrombocytopenia. At Children’s, 25 percent of children admitted with travel-related malaria are admitted to the intensive care unit.

“This started as a way to offer people in areas that do not see as many patients with malaria an opportunity to learn the same critical thinking skills,” she adds.

People who click through the vignettes play the role of a clinician working in the emergency department whose patients include a 10-year-old girl who has just returned from vacation two weeks prior. The exhausted girl lies on a bed amid weeping parents and grandparents. She suffers from a headache and muscle pain and has a 39.8 C fever, though it spiked higher before her arrival at the ED.

“Because symptoms for malaria can mimic other infectious diseases, clinicians need to be able to recognize it in order to ask the most appropriate questions,” she says.

Making real-time decisions

In the vignette, participants are asked to type additional questions to help with diagnosis. Then, they select one of three geographic regions to explore in the 20-minute module in order to gain a better appreciation of the epidemiology of malaria, including the Plasmodium species that cause disease in those regions; to recognize a patient with symptoms of malaria; and to manage their care in keeping with the CDC’s guidance.

Within a few clicks, participants select the degree of the girl’s parasitemia, view slides from thick and thin blood smears, choose the medicine best suited for the parasite causing illness and geographic region the family visited, and decide on follow-up care.

“The timed sections force decision-making in real-world situations,” Sestokas adds. “Behind the scenes, we can look at how well clinicians recognize the subtleties prior to making their decisions and we provide feedback in real-time. Ultimately, our goal is to stimulate deliberate, reflective practices.”

At AAP: hands-on simulation training with life-saving technology

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Recent medical breakthroughs have enabled very premature infants and children with rare genetic and neurological diseases to survive what had once been considered to be fatal conditions. This has resulted in a growing number of children with medically complex conditions whose very survival depends on ongoing use of technology to help their brains function, their lungs take in oxygen, and their bodies remain nourished.

“Many pediatricians care for technology-dependent children with special health needs,” says Neha Shah, M.D., M.P.H., an associate professor of pediatrics in the Division of Hospitalist Medicine at Children’s National Health System. “These kids have unique risks – some of which may be associated with that life-saving device malfunctioning.” Because there is no standard residency training for these devices, many clinicians may feel ill-equipped to address their patients’ device-related issues. To bridge that training gap, Dr. Shah and co-presenters, Priti Bhansali, M.D., M.Ed., and Anjna Melwani, M.D., will lead hands-on simulation training during the American Academy of Pediatrics 2016 National Conference.

“Inevitably, these things happen at 3 in the morning,” Dr. Shah adds. “Individual clinicians’ skill level and comfort with the devices varies. We should all have the same core competency.”

How the training works

During the simulation, the audience is given a specific case. They have eight minutes to troubleshoot and resolve the issue, using mannequins specially fitted with devices, such as trach tubes and feeding tubes, in need of urgent attention. Depending on their actions, the mannequin may decompensate with worsened breathing and racing heartbeats. The high-stakes, hands-on demo is followed by a 12-minute debrief, a safe environment to review lessons learned. Once they complete one simulation, attendees move to the next in the series of four real-life scenarios.

“We’ve done this a few times and my heart rate still goes up,” Dr. Shah admits. After giving similar training sessions at other academic meetings, participants said that having a chance to touch and feel the devices and become familiar with them in a calm environment is a benefit.

Dr. Shah came up with the concept for the hands-on training by speaking with a small group of peers, asking about how comfortable they felt managing kids with medical complex cases. The vast majority favored additional education about common devices, such as gastronomy tubes, tracheostomy tubes, and ventriculoperitoneal shunts.  In addition to the in-person training, the team has created a web-based curriculum discussing dysautonomia, spasticity, gastroesophageal reflux disease, enteric feeding tubes, venous thromboembolism, and palliative care, which they described in an article published in the Fall 2015 edition of the Journal of Continuing Education in the Health Professions.

“Most times, clinicians know what they need to do and the steps they need to follow. They just haven’t done it themselves,” Dr. Bhansali adds. “The simulation forces people to put their hands on these devices and use them.”

AAP 2016 presentations:
Saturday, October 22, 2016

  • W1059- “Emergencies in the Technology-Dependent Child: What Every Pediatrician Should Know” 8:30 a.m. to 10 a.m. (SOLD OUT)
  • W1131-  “Emergencies in the Technology-Dependent Child: What Every Pediatrician Should Know” (Encore) 2 p.m. to 3:30PM

Popular Science awards smart tissue autonomous robot

stm-star01rescaled

Technology developed in the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National has been named one of the 12 Most Important Health Innovations of the Year in the November/December 2016 issue of Popular Science. Smart Tissue Autonomous Robot (STAR), a technology that performed the first supervised, autonomous robotic soft tissue surgery on a live subject (in vivo) this year, has been awarded a 2016 Popular Science Best of What’s New Award in the Health category.

How the smart tissue autonomous robot works

STAR removes the surgeon’s hands from the procedure, instead utilizing the surgeon as supervisor, with soft tissue suturing autonomously planned and performed by the STAR robotic system.  The system integrates near infrared florescent (NIRF) markers and 3-D plenoptic vision to provide uninhibited tracking of tissue motion. This tracking is combined with an intelligent algorithm that autonomously adjusts the surgical plan in real time as tissue movements occur.

About Popular Science health innovations of the year

Each year, the editors of Popular Science review thousands of products in search of the top 100 tech innovations of the year—breakthrough products and technologies that represent a significant leap in their categories.

The Best of What’s New awards honor the innovations that shape the future,” says Kevin Gray, Executive Editor, Popular Science. “From lifesaving technology to incredible space engineering to gadgets that are just breathtakingly cool, this is the best of what’s new.”

David Wessel to speak at USN’s Healthcare of Tomorrow

David Wessel

The fourth annual U.S. News & World Report Healthcare of Tomorrow conference will take place on Nov. 2 in Washington, DC. The leadership forum, which examines challenges in health care and how we must evolve with policies, society, and technology, will hold children’s hospital sessions for the first time. The topics will include pediatric population health, patient safety, strategic partnerships, and genomic medicine. Children’s National’s David Wessel, M.D., executive vice president and chief medical officer, hospital and specialty services, is scheduled to speak during the event.

Interventional cardiac magnetic resonance team welcomes new specialist

elena-grant-photo

The Interventional Cardiac Magnetic Resonance (ICMR) Program at Children’s National is actively developing newer and safer ways to perform cardiac procedures on young patients, with some of the world’s leading experts in cardiac catheterization and imaging. Elena Grant, M.D., a former pediatric cardiology fellow at Children’s National, is the newest member to join the team that pioneered real-time MRI-guided radiation-free cardiac catheterization for children.

In addition to clinical work as a Children’s National Interventional Cardiologist, Dr. Grant will perform preclinical research at the National Institutes of Health to develop new procedures, techniques, and devices that can be translated to clinical practice to treat children and adults with congenital heart disease.

Dr. Grant specializes in interventional cardiology. She received her medical degree from the University of Dundee Medical School in Dundee, Scotland, followed by Foundation Training in Edinburgh, Scotland. She completed her pediatric residency at Massachusetts General Hospital, her Pediatric Cardiology fellowship at Children’s National, and she recently finished an advanced fellowship in interventional pediatric cardiology at Children’s Healthcare of Atlanta and Emory University.

Advances in interventional cardiovascular MRI

Children’s National is at the forefront of this exciting new field and is currently the only institution in the United States to perform radiation-free MRI-guided cardiac catheterization procedures in children.

ICMR is a partnership with the National Institutes of Health that brings together researchers, clinicians, engineers, and physicists to provide radiation-free, less invasive, and more precise diagnostics and treatment options for pediatric patients and adults with congenital heart disease.

The ICMR approach to heart catheterization uses real-time MRI, instead of X-ray, in pediatric research subjects undergoing medically necessary heart catheterization. This research study is intended as a step toward routine MRI-guided catheterization in children, which attempts to avoid the hazards of ionizing radiation (X-ray).

In 2015, after working with NIH to explore how interventional cardiovascular MRI could be integrated into pediatric practices, the ICMR team, including Dr. Grant, Russell Cross, M.D., Joshua Kanter, M.D., and Laura Olivieri, M.D., performed the first  radiation-free MRI-guided right heart catheterization on a 14-year-old girl at Children’s National. Since then, nearly 50 such procedures have been successfully completed, and the team is working to broaden the age range and cardiac disease complexity of patients who can undergo the procedure.

About 1 percent of newborns are born with a heart condition, and the team at Children’s performs more than 450 X-ray guided cardiac catheterizations and over 500 cardiac MRI scans per year.