Case: CHNOLA Telemedicine

Propelled by the coronavirus

Background

Dr. Aaron Martin is a pediatric urologist at Children’s Hospital New Orleans. In his role as the Telemedicine Medical Director at Children's Hospital, he strives to make care more convenient for all our patients at Children's Hospital.

For his Urology patients, Dr Martin had already set up telemedicine visits. He was looking for ways to expand these services to all specialties, including prenatal care.

Problem

CHNOLA telemedicine

Sherry Langston, a nurse practitioner, was hired to set up these additional virtual visits. Since Dr Martin had limited time to guide Sherry Langston, he let her participate in the online T4 Accelerator program. That way she could run with the project and he could oversee her efforts.

Expecting parents panic in case their unborn baby gets a bad test result. The problem Dr Martin’s project set out to address was that if these parents wanted to see a specialist to get more details at Children’s Hospital, they often had to wait several weeks for an appointment. In addition, many had to travel for hours to come to the hospital. When they were finally seen, it happened too often that the panic could have been avoided, as the baby was expected to be fine with the proper care.

The goal was to set up a triage telemedicine service, to give parents quick access. The virtual visits could be used to decide if further diagnoses and an in-person visit would be necessary before the baby was born.

Solution

On her first workday, Sherry Langston started the project in the online T4 accelerator program. She worked her way through a selection of online modules, that were tailored for her needs and that of the project. Never having had to look at the business side of healthcare, it was all new to her.

“The business side of things was very new to me. I learned a great deal and, more importantly, learned how to view situations from a different perspective – a perspective that was not 100% healthcare. I am grateful for and appreciate your time and patience with me as I took it al in and grew in many ways.” - Sherry Langston” 

She breezed through the modules about the end-users and the value proposition. From a health perspective and patient experience, the project made total sense.

Where things became more challenging, was with the stakeholders and the workflow.

The workflow was complex and there were many stakeholders involved. From the parents with the unborn baby, the referring Obstetricians and Maternal Fetal Medicine providers, and the specialists at the hospital, they all had their own worries and concerns about telemedicine.

Together with her trainer, Dr Floor Blindenbach, Sherry wrote out her assumptions for each of these players and diligently started to test these.

One of the assumptions was that Obstetricians and Maternal Fetal Medicine were looking to offer an additional and more convenient option to their patients to connect them with Children’s Hospital. However, during these interviews, it soon became clear that these physicians were lukewarm to the idea of virtual visits. Most referred very few patients to the Children’s Hospital, and if they did, they wanted their patients to see the specialist in person. They felt that was important to put these expecting parents at ease.

On the hospital side, the assumptions about the specialists wanting to participate because of the new patients it would bring in, turned out to be not true either. For example, the cardiologists were already very busy with overbooked clinics and did not have time for even more consultations.

It was clear that to get this service off the ground, Sherry needed to be more specific in who would be involved. She had to focus on those refereeing obstetricians and specialists who were interested. For example, she found out that new doctors that joined the hospital still had to set up their clinics and for them, it was attractive to fit in virtual visits from the start.

Then the coronavirus crisis happened.

Outcome

The coronavirus crisis changed everything. With social distancing rules in place, the need for telemedicine became a must.

"We have gone from 30 providers to almost 200 doing virtual visits and from 250 virtual visits per month to 250 per day …. With the prenatal framework previously set and introduced to those providers by Sherry’s work with you, it has now become a project that has folded into their current workflow and existing team.” – Dr Aaron Martin

As Dr Martin wrote, “I wanted to give you an update on our telemedicine advances pushed rapidly forward by COVID19. At Children’s alone we have gone from 30 providers to almost 200 doing virtual visits and from 250 visits per month to over 250 per day. It has been a relatively smooth transition by simply ramping up our preCOVID model.

We have also been responsible for rolling this out to the 4 adult hospitals in our system pushing us to thousands of virtual visits in less than 2 weeks from 0. I bring this up to you because it has changed Sherry’s roll and most of ours quite frankly. The good news is there is more cooperation and interest in prenatal telemedicine than ever before and believe it or not cardiology has been one of the early adopters.

 With the prenatal framework previously set and introduced to those providers by Sherry’s work with you, it has now become a project that has folded into their current workflow and existing team. Sherry has now been able to ramp up her urology telemedicine clinics and is carrying the department in many ways. What a difference a month makes?!”

For more information, see also the news clip coverage on this case.

From all the teams in our accelerator program, Dr Martin and Sherry Langston now hold the record for the fastest scale up!

Are you going to break their record?