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 their patients.

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

Sherry Langston, a nurse practitioner, was hired to set up these additional virtual visits. Since Dr Martin had limited time to guide her, he authorized her to utilize the Steering Wheel (formerly T4), allowing her to move forward on the project with his oversight as needed.

In standard practice, parents were required to make appointments to speak in person to a specialist at Children’s Hospital, often waiting weeks for an opening and requiring hours of travel for some parents within the hospital service area. In cases of apparent bad test results regarding their unborn child, it was not unusual for expectant parents to experience panic and distress. When they were finally seen, they often discovered that the panic could have been avoided, as the baby was expected to be fine with the proper care.

Martin and Langston had a goal to set up a triage telemedicine service, providing parents more immediate 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, Langston utilized the Steering Wheel to launch the project. She worked her way through a selection of online modules that were tailored to her needs and that of the project. For Langston, the particular challenge was taking into account the business side of healthcare.

"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 all in and grew in many ways.” - Sherry Langston” 

Langston breezed through the modules focusing on end-users and value proposition. From the perspectives of health and patient experience, the project made total sense.

However, the greater challenge lay in the modules addressing stakeholders and workflow.

With a large number of stakeholders involved, the workflow was complex. Stakeholders included the parents of the unborn baby, the referring Obstetricians and Maternal Fetal Medicine providers, and the specialists at the hospital; each had unique goals and concerns about telemedicine.

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

One of the assumptions was that Obstetricians and Maternal Fetal Medicine providers would be looking to offer an additional and more convenient option to their patients when connecting them with Children’s Hospital. However, during stakeholder interviews, it became apparent 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 expectant parents at ease.

Langston also made an assumption that the hospital specialists would want to participate in a telemedicine program because it could generate new patients. However, this turned out to be not true either. For example, the CHNOLA cardiologists were already very busy with overbooked clinics and did not have time to take on additional consultations.

It became clear that to get this service off the ground, Langston needed to specifically identify who would be involved in the program, identifying referring obstetricians and specialists actually interested in providing this option. For example, she found out that new doctors that joined the hospital still had to set up their practice, 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 went from a convenience to a necessity.

"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 role 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.

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

Are you going to break their record?