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Room for Growth

Image of a child's fingers on an electronic device surrounded by crayons scattered on a yellow background with a heart drawn on it.

Adopting mobile health technology in pediatric telehealth

By Sver Aune

Smartphones paired to mobile devices can send health data directly from patients to their doctors. For example, mobile health (mHealth) technologies can take an electrocardiogram (ECG), track blood sugar or monitor medication adherence. Collected data can then be sent to a patient’s health care team.

Yet mHealth offers more than just data collection. It can be a valuable tool in the delivery of long-distance health care to patients. New technologies may incorporate remote monitoring of health data, videoconferencing with patients or syncing with electronic health records.

Home-based telehealth is promising for management of pediatric patients with complex or chronic medical conditions that require frequent follow-up with specialty care. By combining telehealth with the concept of the “patient-centered medical home,” physicians can work with patients and their families to improve the delivery of care.1

As stated by S. David McSwain, M.D., interim chief medical information officer and medical director for telehealth optimization at the Medical University of South Carolina (MUSC), “One of the most promising areas in telehealth development is the ability to connect patients in their homes with a coordinated care team that also incorporates their primary care physician.”

Community investment

Abnormal heart rhythms in children are fleeting and often occur outside the hospital, making them difficult to detect and diagnose. Children with supraventricular tachycardia, the common rhythm disturbance in the pediatric population, may need medical or surgical treatment for the condition.2 But not everyone can afford a smartwatch with ECG capability.

A grant to MUSC from the South Carolina Telehealth Alliance covers the device and subscription costs of Kardia (AliveCor, Inc.), a sensor device that pairs with a smartphone application to run a one-lead ECG. The device is FDA approved but usually is not covered by insurance. Families with children who report symptoms are loaned the tool for 30 days. A patient experiencing physical symptoms can use the tool to automatically record an ECG; the application then sends the ECG to the patient’s cardiologist for reading.

During the first six months of the loan program, 33 patients received the Kardia device. Eight were diagnosed with an abnormal finding which required further treatment—seven with premature ventricular contractions and one with supraventricular tachycardia.

MUSC pediatric cardiologists Nicole Brooks Cain, M.D., and Hamilton Baker, M.D., hope to demonstrate that the technology can be integrated into pediatric cardiology practice. According to Baker, it is scalable for larger programs as well.

“This type of a program could be used for numerous devices as this market grows to prevent those higher-priced telehealth products from only being available to those with means to purchase them,” said Baker.

In the second phase of the project, the Kardia device will become available to school nurses. Although they will not use the device in emergent or urgent situations, nurses can capture rhythm readings if a child is experiencing any symptoms.

Virtual visits

Pediatricians at MUSC are testing a mobile health platform designed to help children with severe asthma and their families stay connected to care.

According to the National Heart, Lung, and Blood Institute, regular assessment of asthma patients is key to controlling their disease. Children with severe asthma often take daily maintenance medication and use rescue inhalers to manage flare-ups, but they may need more frequent contact with an asthma specialist to manage their symptoms, which can be difficult if the specialist is far away.3

The preservation of face-to-face contact is the central idea behind the Smartphone Asthma Monitoring System (SAMS). SAMS includes two major components: medication tracking and video chatting for virtual visits with a nurse educator. Pediatric patients are given Bluetooth inhalers to track their maintenance and rescue inhaler use, and they are encouraged to fill out daily symptom surveys. Symptom and medication use data are downloaded from inhalers to a smartphone and then sent by SAMS to a secure internet portal, where a health care team can view the data in real time.4

When MUSC clinicians first started collecting this data, they learned that patients wanted more connection with their care team, according to Ronald J. Teufel, M.D., MUSC Children’s Hospital Director of Pediatric Hospital Medicine and the clinician leader of the SAMS project. They thus added video chat capability in an effort led by Sachin K. Patel, Chief Technology Officer for MUSC Digital Health Solutions.

Anita Shuler, lead nurse educator for SAMS and a respiratory therapist at MUSC Children’s Hospital, conducts regular video chats with pediatric patients and their families. Shuler assesses patient symptoms, encourages regular inhaler use, provides inhaler technique instruction and outlines which asthma symptoms may require medication adjustment.

“SAMS is designed to follow national guidelines for assessing asthma patients, and then we use that data to either work on adherence with the patient or change their inhaled corticosteroid dose,” said Teufel.

Virtual visits with pediatric patients are not designed to replace in-person visits with the pediatrician. Rather, SAMS allows the asthma specialist to provide added care as needed. At present, virtual visits are scheduled in advance, but Teufel and his team will begin collecting data to help determine the best time to intervene with a virtual visit.

mHealth integration

As mHealth technology is refined, efforts to adopt it on a wider scale are ongoing. For example, the telehealth approach to pediatric asthma care is being deployed through the MUSC Center for Telehealth’s school-based program. Such approaches are still in early phases, but they provide a model for how pediatric telehealth can grow into the future.

References

1. Burnet D, et al. Med Care. 2014;52(11 Supp 4):S56–S63. doi:10.1097/MLR.0000000000000238.

2. Hanash CR, Crosson JE. J Emerg Trauma Shock. 2010;3(3):251–260. doi:10.4103/0974-2700.66525.

3. National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Heart, Lung, and Blood Institute (US); August 2007. https://www.ncbi.nlm.nih.gov/books/NBK7232/.

4. Teufel RJ II, et al. JMIR Pediatr Parent. 2018;1(2):e8. doi:10.2196/pediatrics.9796.