Pain Points in Pediatrics/Hacking Pediatrics
The second annual Hacking Pediatrics took place this weekend in Boston at the Microsoft NERD center. The event brought together a large group of engineers, scientists, doctors and developers dedicated to hacking the pain points in pediatrics. There are many pain points in the current medical system and pediatrics has its unique share of inefficiencies and problems.
A major issue that plagues the United States health system is chronic disease. Adults create habits in childhood that continue into adulthood and can lead to chronic diseases such as diabetes and heart disease. 30-35% of children in Boston Public Schools are overweight or obese; the community needs to support families and help them make healthy choices. When families are in the office with the provider, it is easy to be motivated and agree to make lifestyle changes. However, once families get back into their home environment, routine sets in and families can fall victim to their unhealthy habits. Solutions need to be created to help families make small changes and stick with them. Telemedicine could be a good avenue for keeping up with patients after they have left the hospital. There is an overwhelming amount of information available, but it is difficult to transfer this information to parents and patients in a clear, concise and easily digestible format.
Coordination of care is an issue for all of healthcare, however it is a bigger issue for pediatrics because there are so many actors involved in a child’s care. These individuals include, but are not limited to specialists, school nurses, camp counselors, nannies, relatives, older siblings, and pediatricians. It is very difficult to provision patient portal accounts for all of these individuals because of HIPPA laws and because systems at these disparate facilities cannot communicate with each other. A child may see a provider at a hospital that uses EPIC, an ambulatory care provider that uses Allscripts and a school nurse who uses Healthshare to connect to the state HIE. All of these providers could be missing critical information about the child due do HIPPA laws and the lack of interoperability between systems.
In adult medicine it is usually clear who the patient is, however in pediatrics, who the actual patient is not clear. Is the patient the child, one or both of the parents or a family member? This begets the questions when should a child begin to take responsibility for his or her own care and when should a parent no longer have access to the child’s medical record unless the child approves. Should parents be automatically allowed access to a teen’s patient portal? If so, would this not allow the teen to be as open as they would like to be with their provider about sensitive subjects such as sexual activity and drug use? Pediatrics is also difficult because the age group includes one pound infants to 250 pound 18 year olds. This makes prescribing medicine very difficult because the dosage of medicine is usually based on weight. The size of medical tools can also vary a lot by age and it is necessary to have the correct size for each individual patient.
The processes and workflows need to be made simpler for children in their families. Children just want to get out of the hospital, get back to life and not be a patient anymore. Parents have to repeat the same forms over and over and keep paper records of all their child’s health information. To find all information of car maintenance all one has to do is enter the VIN number in Carfax and all maintenance, and accident information comes up. While, there are not as many privacy concerns with car information, lack of interoperability between systems is usually a result of politics and not technology. Medication reconciliation is another pain point because many times there are outdated medicines or doses in a child’s chart. Many parents have to carry index cards to the hospital with all their child’s prescription medications, over the counter medications and allergies to present to the provider.
Despite all the pain points and difficulties in pediatrics, many providers are committed to making the child’s stay as fun and as painless as possible. Most hospitals have a childlife department that plans parties for the holidays, creates fun activities and finds ways to distract children from the fact that they are ill. Most hospitals also have teen rooms, playrooms and games. Children can feel like their nurses are their big sisters aunts and uncles and that they are at a big slumber party. Follow the link below to view all the ideas that participants came up with during this year’s hacking session.
Link to ideas from Hacking Pediatrics 2.0