As the vice president of virtual health and innovation at Children’s Health, Julie Hall-Barrow doesn’t want to build the biggest digital healthcare system in Dallas. But she does want to build the most comprehensive digital and mobile healthcare program for children and pediatric care at Children’s Health, one of the nation’s largest pediatric healthcare providers and among the busiest in terms of admissions and emergency department visits.

Last year was a busy one for Children’s Health overall and for its digital healthcare program. Children’s Health operates four medical centers, more than 40 inpatient and outpatient facilities and employs more than 1,000 physicians. In 2016 Children’s Health treated 927,686 patients including 167,923 emergency room visits and 235,758 patients through its network of 18 offices dedicated to treating newborns, infants and children up to 18.

In a city where more than a quarter of children live in poverty, there is a pressing need for pediatric healthcare services—a prime reason Children’s Health is ramping up multiple forms of digital healthcare delivery. That includes the extensive use of telehealth, smart pills and an investment program that provides seed money for promising healthcare technology startups. “We are doing all this to extend care into the community,” Hall-Barrow says.

As the vice president of virtual health and innovation, a post she has held since October 2015, Hall-Barrow delivers a long list of the reasons why Children’s Health is making digital healthcare a system-wide priority.

About 29% of children in Dallas live in poverty and 18% are uninsured, Hall-Barrow says. Dallas also is a city with significant pediatric medical needs including 36% of all children that are overweight, 28% that are malnourished and a region where 30% of toddlers aren’t fully immunized.

Those types of statistics are the prime reason Children’s Health is putting in place more telehealth programs. “Through technology, Children’s Health is connecting care to patients where they live, work and play,” she says.

Julie Hall-Barrow

In late 2013, Children’s Health launched the first dedicated neonatal telemedicine service in Texas, enabling neonatologists at Children’s Health to examine newborns virtually at other neonatal care facilities around the state. The service provides physicians at other hospitals with 24-hour access to neonatologists on Children’s medical staff to consult on care for the region’s most seriously ill babies and for interpreting medical data and images, confirming diagnoses and conferring on treatment plans.

In addition to providing virtual pediatric emergency medicine consultations through its telemedicine network, Children’s Health also has launched a new series of digital programs to improve long-term health outcomes and connect patients to medical professionals outside of the hospital, including a new asthma management app, My Asthma Pal. Other initiatives include a school-based telehealth program, used by 57 schools throughout Dallas-Fort Worth, as well as a remote patent monitoring program for liver and renal transplant patients.

Last year Children’s Health also launched Family Health Virtual Visit, a web-enabled kiosk program, and Family Health on Call, an updated mobile app and treatment service.

Family Virtual Visit is being piloted in a Dallas-area pharmacy, Doughertys Pharmacy. The web-enabled kiosk enables patients to speak with an on-call Children’s Health clinician for treatment of minor issues, update prescriptions and medical records, and receive immunization authorization from a Family Health employee or the pharmacist.

Children’s Health also has updated Family Health on Call, a mobile healthcare program for patients that want to be treated at their home or office. A free app available from the Apple App Store or Google Play allows the user to book a same-day or next-day appointment at home or the office for conditions including flu, strep, bronchitis, sinusitis, eye, ear, nose and throat infections, urinary tract infections, sprains, minor broken bones, cuts and skin infections.

Mobile office visits costs $199 and can include on-site testing, diagnosis and initial treatment, first dose of many medications and prescription delivery. Other fees include $75 for an additional patient at each location, $25 for flu shots and flu tests, and $50 physicals.

“We have one goal in mind: to extend care beyond our hospital walls and into the communities,” Hall-Barrow says.

In particular, Children’s Health is working with schools across Texas to reach more children in need of care by using various forms of telehealth. Since launching in October 2014, Children’s health has conducted 11,395 virtual doctor visits at more than 112 schools in 18 districts. So far this year, the Children’s Health school-based telehealth program has conducted 5,053 visits, compared with 5,137 total visits in 2016.

Children’s Health also is expanding its digital and mobile health programs in other ways. For example, Children’s Health in December launched a digitized pill program that tracks the frequency with which pediatric organ transplant patients take their medications.

There is no cost to patients or insurance carriers for receiving the digitized pills, says Hall- Barrow.

So far more than 83 patients have been enrolled in the program and patients have reported no technical issues around the transmission of data from the digital pills. To enroll, a child must be capable of swallowing a pill, which not all pediatric patients can do, she says.

Post-transplant medication compliance is important for organ transplant patients because their medication schedules can be complex, which can lead to some patients taking their medications late or forgetting a dose, Hall-Barrow says. Digitally tracking whether a medication has been taken and at what time can alert a physician about the need to intervene if the patient is not following her medication schedule, and manage better outcomes for their patients. An organ transplant patient being treated for high blood pressure, for example, is at risk of having her organ damaged if she fails to follow her medication schedule and her blood pressures rises, Hall-Barrow says. Without the digitized pill, an increase in the patient’s blood pressure is unlikely to be detected until her next doctor’s appointment.

The digitized pills, which patients receive through Children’s Health’s pharmacy, are encapsulated, a process that combines a medication with an ingestible sensor about the size of a grain of sand in a capsule. Encapsulating the sensors reduces the risk of patients forgetting to swallow a separate pill containing the sensor, but no medication, or opting not to ingest the sensor each time they take their medication, Hall-Barrow says.

The sensor can track physical activity and rest patterns. Once ingested, the sensor documents when a medication is taken and communicates that information to a patch worn by the patient on her body. Data from the patch is encrypted and is transmitted to a tablet computer provided to the patient by Children’s Health. Patients can use the data to monitor their medication schedule. Data is also transmitted to the patient’s physician.

Another patient population to which Children’s Health is considering expanding the use of digitized pills is oncology patients, for which medications play a key role in patient outcomes, Hall-Barrow says.

“Digitized pills are not a hard sell to kids which are more accepting of technology than adults,” Hall-Barrow says.

The smart pill initiative is the latest in a series of digital healthcare upgrades at Children’s Health. Another priority is providing seed money for digital healthcare startups. Since December   Children’s Health has invested undisclosed amounts in several Dallas-area digital healthcare companies including Mendathome.com, a mobile medical treatment company; GoNoodle.com, a developer of online children’s activities; and PiecesTech.com, a developer of software that interprets patient data in real-time.

Digital healthcare is relatively new at Children’s Health but the health system’s program is diverse and growing, Hall-Barrow says. For example in about two years Children’s Health has conducted more than 1,711 virtual doctor visits for urgent care types of maladies, including 1,019 so far in 2017. More than 3,000 patients have participated in the health system’s remote patient monitoring program and 1,688 users have downloaded the Children’s Health app for managing asthma.

“Our programs allow physicians and clinicians to communicate with each other and to patients from anywhere,” Hall-Barrow says. “We also provide apps and mobile technology for physicians to monitor patients at their home, for patients to self-manage their conditions, and with smart sensors that can read users biometrics and transmit data for physicians to review.”

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