transport, telemedicine & artificial intelligence: pt ... · telemedicine & transport •...

Pediatrics 2040 Conference – 10/5/2013 9:25 AM – Jason Knight, MD

© 2008 CHOC Children's. All Rights Reserved. 1

Transport, Telemedicine & Artificial Intelligence:P t & F tPresent & Future

Experience at theExperience at the Children’s Hospital of Orange Country

Jason Knight, MDPediatric Critical Care

Medical DirectorMedical DirectorCHOC Emergency Transport Services



Telemedicine & Transport• Physicians (pediatric intensivists) are able to offer their expertise to y (p ) p

“pre-CHOC environment”

• Previously limited to phone/voice• Previously limited to phone/voice

• Hoag Newport Beach & Hoag Irvine: RP-VITA

• Transport Team: RP-Xpress• CHOC performs ~ 4300 pediatric transports each yearCHOC performs 4300 pediatric transports each year• Transport numbers have doubled in past 6 years



RP-Xpress− First prototype was mounted

within ambulance

− Second prototype evolved p ypto portable concept

Al h & B t Sit− Alpha & Beta Site



The RP-Xpress



RP-Xpress Pilot Results• Stakeholder feedback:

− Physician available at critical decision juncture − Transport team: “We welcome physician expertise as we do not have MD’s

breadth of experience or decision-making.”breadth of experience or decision making. − Referring hospital: “I was glad to have a physician available for sign out/handoff

and receive early recommendations”− Patient’s parents/family: “I was reassured seeing the CHOC PICU doctor’s face,

knowing that my child is already receiving a higher level of care”knowing that my child is already receiving a higher level of care”

• Proof of concept:− Usable

Fit i t kfl d i ti t l− Fits into workflow and existing protocols



Doctor performs remote consult for assessment & stabilization prior to transport



Patient stabilized & ready for transport (patient now in Transport seat)



Transport & TelemedicineCase Example #1Case Example #1• 6 y.o. F, Peds inpatient x 48 hours at community hospital chief complaint: “weakness & lethargy ”hospital, chief complaint: “weakness & lethargy.”• Progressed to difficulty handling secretions and refusing to speak. They

performed a Head CT and lumbar puncture, which were nondiagnostic.

• Peds Hospitalist: “Help”

• Telemedicine Consult (RP-Xpress)

• Transferred to CHOC PICU



The RP-Xpress• Benefits: e e ts

1. Referring partners

2. Transport team2. Transport team

3. Patients and families

4. Other Uses: Consults, daily4. Other Uses: Consults, daily

rounds, teaching, social visits for

mothers at referring hospitalsmothers at referring hospitals



The Future of TelemedicineE i t• Environment:− Specialty transports− EMSEMS− Subacute Nursing facilities− Home visits

• Value:− Physicians do not need to leave hospital in order to

k t d id d timake assessments and provide recommendations



The Future of Telemedicine• Within Hospital:− Subspecialty consults− ER− ICU

• Mobile telemedicine unit that can navigate throughout the hospital = RP-VITA



RP-VITARP VITA



Transport & TelemedicineRP - VITA

Case Example #2• 13 y.o. M “found down” brought to Hoag ER by EMS, unconscious

• Intubated, Head CT = ruptured AVM with mass effect

• Telemedicine (RP VITA): Hoag ER MD & Hoag Neuro Radiologist discuss• Telemedicine (RP-VITA): Hoag ER MD & Hoag Neuro Radiologist discuss case, in real time, while looking at patient’s clinical exam & Head CT images, with CHOC PICU MD & CHOC Pediatric Neurosurgeon

• It’s Friday afternoon at 430 PM• It s Friday afternoon at 430 PM



RP-VITA• Self Navigating based on Se a gat g based o

mapping

• iPad capabilities

• Visual Cues

• Stethoscope

• Real Time Conversation with Physicians & Family (or with Conference(or with Conference Participants)



Transport, Telemedicine & Artificial Intelligence• Integrate data collected during (& after) Transport• Share data with Transport Programs nationwideS a e data t a spo t og a s at o de• Use data to:1 Change practice1. Change practice 2. Analyze Appropriate Utilization of Resources3. Affect Outcomes



Transport & Telemedicine

• QuestionsDiscussion• Discussion

• Ideas

transport, telemedicine & artificial intelligence: pt ... · telemedicine & transport •...

Documents