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 Etiology: Allergic Idiosyncratic

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. 2) Research a new parameter, sub-auditory wheeze frequencies as a remote monitoring tool for asthma

12. Problems addressed • Better care delivery • Reduce number of complications • Patient empowerment and involvement • Conserve national resources • Implementation in the hospital

13. Problem 2 Lack of accessible interactive educational materials at the child's level in pediatric hospitals. ? ?

14. Proposal • Microsoft Surface Computer on wheels for medication education • Place the medication on the surface and it will be recognized. • Interactive surface easy to use and easy to clean using disposable plastic skins • Tutorial of instructions, side effects, interactions, alternatives will be given. • Information will be presented at age specific levels.

15. Proposal • Choice of language offered. • Print-out for home use will be produced. • Mock up will be produced with a traditional computer and an RFID attachment. • Will be more widely used and cost effective in 3-5 years. • Flexibility for various other applications proves a valuable investment.

16. Evidence

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

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

19. 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

20. 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