Childhood burn care: A telemedicine success story

Using telemedicine in dermatology

When it comes to burn patients, particularly children, recovery is ongoing because skin can’t grow and change as quickly as the body develops. Skin is a vital organ and is the first line of sensation and defense against external factors. It’s the body’s heating and cooling system. But when skin is severely burned, it loses much of that function and requires reconstructive surgeries, rehabilitation, tissue expansion, pressure garments and ongoing check-ups. It’s because of this extensive and time consuming treatment that Shriners has been one of the first hospital networks in the country to employ telemedicine practices.

Caregivers at Shriners collaborated with the IT department to determine ways they could leverage technology to reduce stress on the lives of families and patients needing routine check-ups. The team suggested employing telemedicine technologies so families could minimize travel time, yet meet with world class physicians at Shriners hospital locations in the U.S. , Mexico and Canada.

What is telemedicine exactly? “Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. It includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.”  These days, healthcare providers are taking telemedicine to new heights, with the market seeing growth of a whopping 237 percent within a five-year period, according to a new Kalorama report. In fact, the American Telemedicine Association says there are currently about 200 telemedicine networks, with 3,500 service sites in the U.S. alone.

Shriners is on the leading edge of that growth, having implemented cutting-edge telemedicine technologies more than 10 years ago and now working with global network partner Level 3 Communications. 

The future of teledermatology

“Telemedicine is a must-have in today’s healthcare environment,” Richard Kagan, M.D., chief of staff at Shriners’ Cincinnati hospital says. “If you’re not doing telemedicine, you’re traveling on a gravel road while everyone else is taking the highway.”

Dr. Kagan has worked with Shriners for more than 25 years and knows first-hand the importance of having a robust telemedicine program.

“Telemedicine is all about enhancing the patient experience. Our patients are children who have been through a traumatic set of circumstances. By using telemedicine, we are able to significantly reduce the amount of medical disruptions in children’s lives, giving them more time to do the normal things that kids do – go to school, play with friends, and spend quality time with their families.”

Easing ongoing burn care

Easing ongoing burn care

Nicole Gannon returned to her home in Emporia, Kan., after a day trip to Kansas City, Mo., for a check-up with her doctors in Cincinnati via two-way video conferencing. The cheerful 15-year-old is thankful that she gets to sleep in her own bed tonight instead of at the family hospital housing in Ohio.

The type of treatment Nicole requires is extensive, and she often has to fly out-of-state to meet with doctors who specialize in working with patients like her - burn survivors who have undergone tremendous trauma, both physically and mentally. But thanks to Shriners Hospitals for Children, Nicole can utilize the telemedicine program to meet with a world class pediatric burn specialist without making the daylong journey to the hospital in Cincinnati.

“It’s so much more convenient to be able to go to Kansas City and spend less than a day with my doctor versus a multiple-day trip that makes me miss more school,” Nicole says.

When you hear the word “Shriners,” you may think of television commercials or fundraising drives. But talk to any burn survivor and they’ll tell you that Shriners is about giving children with severe burns the ability to heal, grow and prosper in their lives. Shriners Hospitals for Children is a network of 22 hospitals across the country, each dedicated to giving children the world-class, life-changing care they need - not only burn care, but also medical treatment in the areas of orthopedic conditions, cleft lip and palate, congenital nevus and other congenital skin/soft tissue deformities, and spinal cord injury.

RELATED: Teledermatology enables efficient patient triage

Nicole came to Shriners after spending nearly six months at a Kansas hospital following a house fire that burned nearly 90 percent of her body. At the time of the fire, she was just six months old. Her mother, Brandy, was burned over 45 percent of her body. Both were on the verge of death - Brandy was put into a medically induced coma for one month and Nicole received hospital care for nearly a year - eventually, they both pulled through, thanks to their dedicated caregivers.

“Shriners was a godsend. We didn’t have insurance, and I was really worried about that, considering the extent of Nicole’s injuries. But when we first started dealing with Shriners, that was the furthest thing from their mind. They were all about the game plan - here’s what she needs. Shriners doesn’t just send you home once a procedure is carried out. They become part of your family. They go above and beyond - they help you help your child,” Brandy says.

Melissa Raines of Asheville, N.C. has three children under Shriners’ care after they were involved in a kerosene can explosion that left each of them with severe third-degree burns. Ethan, 16 years old and the oldest of the three, sustained the worst injuries, with more than 50 percent of his body affected. His younger sisters, Hannah, 11, and Abby, 5, also sustained severe burns. All three have undergone several procedures and continue to receive care from Shriners as they grow up.

“It was one of the most horrific experiences of my life, but thankfully, Shriners took all three of them and turned a tragic experience into one of hope,” said Melissa. “They have continued to be a source of stability and support ever since, and have gone out of their way to make this healing process as easy as possible.”

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With three children, Melissa said that travel to Shriners’ Cincinnati hospital was cumbersome, but thanks to the hospital’s telemedicine network, she has been able to cut her travel significantly.

“Instead of driving seven hours each way, we can visit the nearby Shriners hospital in Greenville and be there and back in a fraction of the time it takes to see our doctor in person. Plus, we get the same level of care we would get if we went to Cincinnati – it’s really like our doctor is in the room with us.”

Asked what the experience is like, Melissa said it’s really no different than a normal visit to the doctor.

“It’s set up like a normal hospital room, except for the huge TV monitor and the camera, which allows our doctor and nurses to talk to us face-to-face and take a look at the kids’ progress. There’s of course a nurse on our side who helps with everything, and so far, it has all gone really smoothly.”

Deploying the program

Deploying the program

Deploying a telemedicine program is no easy task because the experience provided to the patients must be as authentic and engaging as the in-office experience.

“When patients use telemedicine to meet with their doctors, the experience should feel as if the doctor is right there in the room with them,” says Gene D’Amore, vice president of Hospital Operations and CIO at Shriners. “It has to happen in real-time, in front of a high-resolution screen and over a reliable, secure network. With these types of patients and the critical nature of their injuries, there’s no room for compromise or error.”

According to Mr. D’Amore, the key to an effective telemedicine program boils down to three things:

• a strong network partner that provides fast and reliable connectivity,

• an advanced teleconferencing system connected to key locations in the markets served, and

• staff that’s not only receptive to the telemedicine concept, but also is willing to learn and operate the equipment needed to successfully run the program.

“Telemedicine can be daunting at first - both from a budget and implementation standpoint,” Mr. D’Amore adds. “But in the case of Shriners, there are clear benefits to integrating telemedicine solutions into the care continuum. With a wide movement of payment reform that now covers telemedicine visits in 44 states, adoption of these technologies will likely accelerate. The technology is here, the infrastructure is here, the next step is for technology leaders to collaborate with physicians and care staff to make it happen.”

RELATED: Takeaway: Best practices for telemedicine in dermatology

To take full advantage of the possibilities of telemedicine and create the right network environment to realize the advantages on behalf of physicians and patients, healthcare providers also need to conduct a thorough review of the core competencies of their internal IT team, clearly defining any potential gaps and needs from outside vendors.

At Shriners, Mr. D’Amore considered a number of network partners and architecture options before moving forward with Level 3 to ensure the right level of service and connectivity to meet the needs of all their hospital locations.

“The reach and performance of the network were top priorities. However, Level 3 also sat side-by-side with us from the outset to design, build and deliver a network that has the capabilities to address our current needs, but also grow with us as new medical technologies, such as telemedicine, and network demands continue to change,” Mr. D’Amore says.

Nicole Gannon can attest to the benefits. And thanks to Shriners, Nicole has been able to grow up and do the things kids her age do. She loves playing sports like volleyball, hangs out with her girlfriends, plays the cello and much to her mother’s chagrin - is learning to drive.

“I white-knuckle it every time we drive together, but then I think to myself, if it weren’t for Shriners, I wouldn’t have the opportunity to even experience this milestone with my daughter,” said Brandy.

“It feels good to know that Shriners always has our backs,” added Melissa. “They’re always innovating to make sure their patients not only have the best care, but also the most convenient care, which means so much to my family.”