Like many physicians working in pediatrics, Jeff Vergales, MD, has long known that children often improve more quickly in their home environment versus the hospital.
“Take oral feeding for example,” says Vergales, a pediatric cardiologist at UVA Children’s. “We know babies do much better with a sole care provider doing feeding at home. We see kids all the time who are just limping along with feeding in the NICU, and they suddenly do awesome when they get home.”
However, physicians have resisted sending patients home sooner without effective ways to monitor them, Vergales explains. “Not every patient has the ability to understand what a vital sign is and measure it and communicate it accurately,” he says. “At the same time, direct consumer products required physicians to log into a different system or read a long email to get the data they needed. There were too many points where error could be introduced.” Sending children home to heal was not safe and effective.
In response, UVA Children’s partnered with Locus Health to create the first consumer-friendly, digital home monitoring system that seamlessly integrates with the patient’s electronic medical record (EMR). Initially piloted in NICU patients with complex congenital heart disease, the HIPAA-compliant, secure system reduced emergency department visits in this population by 40% and reduced length-of-stay by an average of 8 days.
Building an Accessible System for Patients & Caregivers
When UVA Children’s began concepting the system, it was clear we needed a system that worked well for both patients and providers. To that end, we assembled a large team of software developers, EMR technicians, clinicians, and families.
Patients and caregivers download and run the system on their personal smartphone, tablet, or laptop. We provide iPads with the system preloaded to those who don’t have their own personal device. We educate caregivers and patients on using the system while they’re still in the hospital and send them home with any equipment they need, such as a scale or feeding pump.
Critically, the program is written at a third-grade reading level. When possible, a Bluetooth connection automatically records vital signs. Otherwise, patients are prompted to enter readings but never asked to interpret them. Tutorials are included in case a patient forgets how to record a vital sign.
“The system is designed so that if a patient enters a data point that doesn’t make sense, there’s a hard stop that asks if they’re sure,” Vergales explains. “So far, we haven’t had a single patient who couldn’t interface with the system, and that’s huge.”
Remote Rounding: Matching How Providers Work
By automatically integrating into the patient’s EMR, the system exactly mirrors the workflows clinicians use with hospitalized patients.
“That’s a really cool step we hadn’t been able to accomplish before,” Vergales says. “After patients go home from the NICU, we round on them the same way we would in the hospital.”
For certain clinically significant data points, the system automatically pages the physician as soon as the patient or caregiver enters it.
“We designed this variable by variable,” Vergales explains. “We don’t want a parent to enter a feeding wrong in the middle of the night and page the doctor; that’s inappropriate. But if they enter an oxygen saturation in the middle of the night that is incredibly low, we do want to be notified right away.”
Expanding the System: Customizing by Condition
As they expand the program to more patient populations, the group thoughtfully chooses which vital signs to monitor based on patient needs.
With focused attention on monitoring feeding, patients with cystic fibrosis experience better growth at home and avoid long hospital stays. The teams have also been able to coordinate care for patients in palliative care programs as well as those with high-level medical complexity.
The group is currently launching the platform for pediatric patients with severe asthma.
More than 30 children’s hospitals now use the platform.