Telemedicine Pilot Program Aims for Improved Access to Pediatric Care Throughout BJC

Pediatric patients needing psychiatric evaluation in the Farmington, Mo., area now have access to a Washington University child psychiatrist without having to travel to St. Louis Children’s Hospital (SLCH). A new telemedicine suite located in the Medical Office Building at Farmington’s Parkland Health Center brings the expertise of Dehra Glueck, MD, directly to the patient via video conferencing.

“Nationally there is a shortage of child psychiatry services available, and this is especially true in outlying communities,” says Dr. Glueck. “This telepsychiatry pilot program allows patients and families to receive evaluations without traveling to St. Louis, which means a significant savings in time and expense for them.”

The telepsychiatry service is based on an enhanced consultation model already in place at Washington University where child psychiatrists work closely with local primary care providers who can refer their patients with mental health needs for consultation. Dr. Glueck evaluates patients via telemedicine and discusses treatment options with patients and families and then, together with the families’ primary care providers, develops a treatment plan. The plan may include up to three additional visits to the telemedicine clinic to initiate treatment. If ongoing care with a child psychiatrist is required, options for follow-up with other qualified providers within the local community are discussed at the conclusion of the consultation.

“Patients usually get accustomed to the telemedicine technology within the first few minutes of the first visit, especially when it becomes clear to the children that I can see exactly what they are doing in real time,” says Dr. Glueck. “We use extremely high-resolution video and audio equipment at both sites including equipment in the Parkland Health Center suite donated by the Parkland Health Center Foundation. This kind of high-quality equipment helps me connect with the patients. Patients experience all the wonderful human emotions that are present in face-to-face interactions, and are able to feel compassion and understanding in an interaction.”

The telepsychiatry pilot program at Parkland began in April and consists of weekly half-day clinics. Plans call for expanding the pilot to Boone Hospital Center, Columbia, Mo., in coming months.

Testing the telemedicine waters

Child psychiatry is just one area in which St. Louis Children’s Hospital, Washington University School of Medicine (WUSM) and BJC HealthCare are partnering to investigate the feasibility of using telemedicine to expand the hospital’s outreach. A telemedicine steering committee chaired by Feliciano Yu, Jr., MD, SLCH chief medical information officer and medical director, Washington University Pediatric Computing Facility, is exploring telemedicine opportunities in three areas: traditional office visits, emergent clinical settings and family communication.

“For traditional office visits, we will expand the pilot beyond psychiatry to include testing how gastroenterology and cardiology may use the technology,” says Dr. Yu. “For instance, the care of GI patients often involves pre-visit interviews and follow-up visits. We feel these are areas that can be made more convenient for families through telemedicine. For cardiology, we are looking into advanced equipment that records and transmits heart sounds, thus allowing our cardiologists to ‘listen from a distance’ while still providing quality patient care.”

The newborn intensive care unit (NICU) will be the first emergent clinical setting to pilot telemedicine for uses such as consulting with physicians at outlying BJC locations. Depending on the pilot results, potential exists for using telemedicine in other ICU settings as well as the emergency unit and transport services.

Potential for family communication exists within all these areas, from patient and family education and answering questions regarding care to consulting with parents as their child is transported to Children’s.

“Once the pilot program ends next year, we will have a better idea of how to scale our telemedicine efforts in regard to pediatric subspecialties and outreach to other locations,” says Dr. Yu. “We are aiming at developing a program that is not only effective but also sustainable.”

SLCH/WUSM/BJC Telemedicine Steering Committee

• Feliciano Yu, Jr., MD, committee chairman; SLCH chief medical information officer and medical director, Washington University Pediatric Computing Facility
• Jennifer Albertina, executive director, Business Affairs and Strategic Planning, WUSM Pediatrics Department Administration
• Michael Caputo, assistant dean/Chief Information Officer, WUSM Medical Computing Services
• Dahra Glueck, MD, Washington University child psychiatrist
• Chero Goswami, Director, Information Systems, Academic Hospitals and WUSM Integration
• Ellyn Rosenblum, Manager, Planning & Business Development, SLCH
• Jerry Vuchak, Vice President, Information Services, BJC Information Systems