Transformation of Pediatric Care Spaces

1. Transformation of Pediatric Care Spaces --- Pediatric Design of the Future TRANSFORMERS: Marianna Jewell, Jamie Beyer, Dr. Jiten Chhabra, Hui Cai

2. Problem 1 Patients with chronic diseases have to make unnecessary hospital visits, about matters which can be addressed by remote bio monitoring techniques The ability of tele medicine to help children suffering from Asthma is not being utilized to its maximum capacity ? ?

3. What is Asthma Increased responsiveness of lower airways to multiple stimuli; episodic, and with reversible obstruction Air flow obstruction Airway hyper responsiveness Airway inflammation

4. Numbers (2002) 8.9 million children 10.4 million outpatient visits 1.8 million ER visits ½ million hospitalizations 14.7 million school days were missed $ 2 billion direct and Indirect costs

5. Facts (2002) Asthma is the 3rd ranking cause of hospitalization for children under 15 yrs. Low-income populations, minorities & children living in the inner city are more likely to have ER visits, hospitalization and death due to asthma then the general population. Young children (<4yrs) had the highest rate of hospitalizations; ( twice the rate than children of the same age w/o asthma

6. Asthma Signs and Symptoms History: Wheezing, Coughing, Frequents RTI’S, Exercise intolerance Nighttime worsening, Chest tightness, Shortness of breath, Examination: Tachypnea, Tachycardia, Use of accessory respiratory muscles, Cyanosis, Pulsus paradoxus, Symmetry of breath sounds, Wheezing, Prolongation of expiratory phase, Hyperinflation Investigations: CBC, IGE, Curschmann’s spirals, Charcot-Leyden crystals, PFT

7. Classification Mild intermittent Mild persistent Moderate persistent Severe persistent Treatment: - Acute vs Chronic Adrenergic agonists, Methylxanthines Anticholinergics Glucocorticoids, Cromolyn sodium and nedocromil sodium, Leukotriene modifiers

8. Spirometry

9. Peak Expiratory Flow Rates

10. Evidence Based Medicine 1) The monitoring of peak expiratory flow (PEF) and maintenance of a symptom diary have been proposed as means to monitor asthma severity.Daily PEF variability in combination with the daily frequency of beta-agonist inhalation is very useful in the management and early detection of acute asthma 2) A program run by the San Mateo Medical Center in San Mateo County, California helps children manage their asthma through the use of cell phones. Over a one-year period, these children experienced no emergency room visits or hospital stays due to asthma and they rarely came into the clinic for asthma-related medical treatment. 3) After six months of participation in the program, the number of emergency room visits decreased significantly and the activities of daily living were improved in the tele-medicine group. Most of the patients in the tele-medicine group were able to continue measuring and transmitting peak expiratory flow (PEF) value successfully, and at six months had noticed an improvement in PEF.

11. Our Proposal 1) Develop and implement a flexible and open ended interface to receive, analyze and transmit pediatric asthma specific information at the hospital end. 2) Research a new parameters like, sub-auditory wheeze frequencies as a remote monitoring tools for asthma

12. ASTHMA CONTROL ROOM

13. Monitoring Pendant

14. Problems addressed • Ubiquitous health • Reduce number of complications • Patient empowerment and involvement • Conserve national resources • Implementation in the hospital • Systems Approach

15. Problem 2 • Lack of accessible interactive educational materials at the child's level in pediatric hospitals. • Evidence: • Patients who had their medications electronically reconciled reported a greater understanding of the medications they were to take after discharge from the hospital, including medication administration instructions and potential adverse effects. • Misunderstanding prescriptions and dosages leads to adverse drug effects. • Patients are encouraged to become "part of the health care team" along with their physicians, nurses, and pharmacists, to prevent medication mistakes. ? ?

16. Microsoft Surface COW for Medication Education • Interactive surface easy to use and easy to clean using disposable plastic skins • Place the medication on the surface and it will be recognized. • Tutorial of instructions, side effects, interactions, alternatives will be given. • Videos and pictures for clear understanding • Information will be presented at age specific levels. • Choice of language offered. • Print out, email, or video to cell phone for home use • Technology will be more widely used and cost effective in 3-5 years • Flexibility for other applications proves a valuable investment.

17. Additional Problems Addressed Lack of complete knowledge of medications at the care giver level. Lack of understanding on how to self medicate, especially at the pediatric level. Errors due to allergies, interactions, incorrect prescribing. Infections transmitted on highly used surfaces. Time of nurses and doctors better spent in other place

18. Evidence

19. Problem 3 Waiting room design does not address various needs of users. comfort, flexibility, information, interaction, and disaster support ? ?

20. Evidence • This study demonstrates that hospital charts contain many copies of the same information, such as medication lists, allergies etc. Due to manual replication of data fields, there is no mechanism to ensure that each copy of a data element within a chart actually contains the same information. This aliasing of data through manual duplication compromises the integrity of data within paper-based charts. Decisions and therapy based upon contradictory or inaccurate data are likely to lead to inefficient or erroneous care delivery; this has significant implications for hospital liability and quality of patient care” Geiger G, Merrilees K, Walo R, Gordon D, Kunov H An analysis of the paper-based health record: information content and its implications for electronic patient records. Health Technology Group, Institute of Biomedical Engineering, University of Toronto

21. Proposal • Flexibility---"Magic chair" • Provide adjustable furniture, can provide different size of chairs and even unfolded to universal bed that fits different age groups • Efficiency---"Magic touch” • Provide "Magic Touch" to incorporate the registration process for repeated chronic patients. The finger-print identification process is easy that allows the kids' self-registration. Patient history can be pulled out