April 7, 2020

Service and Significance

“You are going to give your life for something. What will it be—a career, a sport, a hobby, fame, wealth? None of these will have lasting significance. Service is the pathway to real significance.”  – The Purpose Driven Life by Rick Warren

No one is going through this alone. We are all part of a family – our families at home, the Texas Children’s family, the families in our communities and perhaps a church family. I believe that together, we are being asked to redefine ourselves – not individually – but collectively.

Consider this … who are we? What do we need to do for each other? How can we serve better together? How can we do more? This week, remember that there isn’t just power in numbers. There is also purpose.

While Texas Children’s employees work locally to keep COVID-19 at bay, members of our system’s global health team are working just as hard to keep the disease from spreading in areas that are far more vulnerable to the pandemic.

“Low- and middle-income countries in places like Africa and Latin America are already stressed and strained with weak health systems and vulnerable populations,” said Dr. Heather Haq, Chief Medical Officer for the Baylor College of Medicine International Pediatric Aids Initiative (BIPAI) at Texas Children’s Hospital. “We will see devastating effects if COVID-19 becomes widespread in these areas.”

BIPAI at Texas Children’s Hospital is one of the largest global maternal and child health programs in the world with a presence across sub-Saharan Africa as well as Latin America and Romania. Our mission in these countries is the same as it is here in the United States – to care for sick children and women, and to educate more people to do the same.

Tremendous progress has been made in these communities over the years in the areas of HIV/AIDS cancer, tuberculosis, malaria, sickle cell disease and malnutrition; however much work needs to be done to ensure that COVID-19 does not undo these gains. Although the disease has yet to reach these areas in full force, it’s coming, and Texas Children’s and Baylor are standing ready to help fight its effects. Partnerships forged between Texas Children’s, government officials and local leaders are already helping forge a productive path forward in the face of this global crisis.

“We are extremely thankful for the continued commitment Texas Children’s and Baylor have to their global partners,” said Dr. Mogomotsi Matshaba, Executive Director of BIPAI’s operations in Botswana. “We need your expertise, guidance, moral support and financial assistance to get through this trying time.”

BIPAI at Texas Children’s Hospital is working around the clock to provide technical assistance and resources to help our global partners prepare for and respond to COVID-19 while maintaining access to essential services like continued access to antiretroviral therapy for people living with HIV. The BIPAI network holds daily calls to discuss strategies to protect the health care workforce, contain the spread of COVID-19, and continue to serve patients. In addition, they hold weekly video conferences focused on pertinent clinical information on COVID-19 and have established a COVID-19 resource library for global sites.

Texas Children’s and Baylor also are participating at national levels with local and regional leaders to shape policies aimed at curbing the impact of COVID-19 and protecting the work that’s already been done to strengthen their nations’ health care systems.

“It’s imperative we protect the gains we’ve made,” said Dr. Adeodata Kekitiinwa, BIPAI’s Executive Director in Uganda. “COVID-19 has the potential to wipe out years of work in areas where we are seeing significant gains.”

HIV/AIDS is one of the areas where great strides have been made. A setback such as the spread of COVID-19 – the effects of which are not yet known in people living with HIV – could be detrimental. In addition, children who need care for ailments such as malaria and malnutrition might not get the services they need if travel is restricted in countries or if resources are diverted to help those with COVID-19. Compounding the issue is that resources for critical care are already scarce in these areas. Uganda, for example, has only 55 ventilators for the entire country – that’s one ventilator per 1.3 million people. Other countries have even fewer.

“Unfortunately, the severe shortage of critical care means that many people in these settings who get sick with severe COVID-19 disease will die, until advances are made in treatments or a vaccine becomes available,” said Haq.

Phoebe Nyasulu, Executive Director of BIPAI’s operations in Malawi, said the severity of the situation means that COVID-19 has to be faced head-on and that it needs to be looked at from a global lens versus a country-by-country issue.

“With the help of BIPAI, Texas Children’s and Baylor College of Medicine, we are more confident we will be able to respond to COVID-19,” Nyasulu said. “We will get through this together.”

As COVID-19 continues to dominate the news, cause widespread closures and cancellations, and disrupt our normal way of life, it can be especially challenging for patients and their families who depend on us for their care. As we adjust to this new change, there’s one thing that has not changed – our commitment to ensuring our patients and families have convenient access to the care they need, when they need it.

One of the ways to help stop the spread of COVID-19 is to limit the number of patients and visitors at all of our locations across Texas – including hospitals, specialty care clinics, Pavilion for Women community clinics, Texas Children’s Pediatrics, Texas Children’s Urgent Care and The Centers for Children and Women. To keep everyone safe, many in-person visits can now be converted to a phone or video appointment. Texas Children’s e-Health team – in collaboration with other departments across the system – has rapidly expanded and enhanced e-Health services to make it easier and more convenient for patients to connect with a Texas Children’s provider without leaving their home.

“Providers are very eager and excited to offer virtual visits to ensure the continuity and convenience of care to children and women especially during these challenging times,” said Dr. Robert Ball, maternal fetal medicine physician and medical director of e-Health. “As more physicians are trained and enabled to provide virtual care to their patients, we are rapidly transforming the landscape across Texas Children’s.”

Texas Children’s providers and patients are taking advantage of the benefits of e-Health capabilities. On March 23, providers began having telephone appointments with patients. In the first three days alone, almost 2,500 patients were able receive care via telephone from the safety of their home across Texas Children’s Hospital, Texas Children’s Pediatrics and Texas Children’s Health Plan. On March 26, almost 1,000 providers across the hospital were introduced to training to be able to give face to face care through video visits to their patients. This is also expected to take off rapidly and be a “customer obsessed” solution for our patients. The roll out of video visits across care locations change how Texas Children’s delivers care, not just during this emergent time, but for the long-term.

With the demand for e-Health services on the rise due to COVID-19, our e-Health team, nurses and leaders have worked collaboratively to develop other strategies to meet our patients’ needs. Below is an overview of some of the enhancements that have been recently implemented:

COVID-19 Nurse Triage Line – This new feature allows parents of current patients to call 832-822-6843 (832-82COVID) if they think their child has symptoms or has been exposed to COVID-19. The line is available 24 hours a day, 7 days a week and operated by specially trained pediatric nurses. The nurses will triage calls, provide basic COVID-19 information, or schedule a video visit with a provider for further evaluation. The COVID-19 nurse triage line is for pediatric patients only.

Virtual Visits – To keep our patients, their families and our staff safe, many pediatric and women’s services in-person visits are now being converted to a phone or video appointment. If a patient’s appointment is a fit for either option, clinic team members will contact patients directly to provide more details. We encourage patients to continue to schedule appointments with their Texas Children’s providers, and to visit texaschildrens.org/appointment for more information about current options.

Texas Children’s Pediatrics (TCP): TCP has changed its scheduling work flow to have a physician review all appointment requests for the health and safety of all patients arriving at TCP locations across Houston, Austin and College Station. If a patient’s health screen indicates symptoms or exposure to COVID-19, TCP will convert the patient to a phone or video appointment. e-Health options are new for TCP practices and is growing quickly. Between March 12 and March 27, TCP completed 567 video and 1,653 phone appointments.

Texas Children’s Health Plan (TCHP): TCHP has also been focused on getting key provider communications pushed out, with the most important messaging being around supporting the delivery of telemedicine services. The Centers for Children and Women are conducting their visits via phone and have added nine trained providers to the ranks of approved physicians licensed to conduct video visits. Additionally, Texas Children’s telemedicine platform Anywhere Care has seen an uptick in patient visits. For more information about Anywhere Care, click here.

“The COVID-19 pandemic has really impacted the way we provide care,” said Texas Children’s Chief Information Innovation Officer Myra Davis. “This health crisis has presented an opportunity for us to leverage the benefits of e-Health. Historically our outpatient care has been provided at Texas Children’s locations, and e-Health has created a paradigm shift where we our meeting patients where they are.”

Ball has seen the benefits that e-Health offers to our providers and patients, especially those patients and families where physical access to a Texas Children’s facility can be difficult.

“I think e-Health has been an incredible game changer for us,” Ball said. “Everybody deserves a Texas Children’s provider, and this is an effective tool that we can use to create this opportunity for them.”

E-health Resources

Please visit Texas Children’s Coronavirus Connect page where you will find links to internal documents with updated information about COVID-19, as well as our e-Health Training and Resource page that includes information on telephone and video visit requirements, consenting, and FAQs.

April 1, 2020

In the wake of the global COVID-19 pandemic, Texas Children’s remains dedicated to ensuring we are a source of information and expertise.

When COVID-19 first appeared in the Greater Houston area, Texas Children’s immediately began to prepare for what was later categorized as a pandemic. In early March, our leadership activated a modified incident command structure, convening teams for Planning, Logistics and Operations at the Medical Center Campus, West Campus, The Woodlands Campus and at the Health Plan. This positioned us to respond quickly and agilely as the global health issue evolved.

We also immediately launched targeted outreach to our Texas Children’s patient families. In early March, we emailed about 400,000 current Texas Children’s patient families to answer common questions, ease uncertainty, and introduce our information-rich COVID-19 website that launched on March 13.

“Our overall goal for the website was to create a central location for our patients to gather information during this difficult time, and provide the community-at-large with resources, expert sources, system updates, and any additional information about COVID-19,” said Brand Marketing Specialist Elisa Lange. “We also want the community to know that we are open and prepared to continue providing quality care for any patient who needs us.”

The website includes the latest updates, available resources, frequently asked questions, and detailed videos from providers across our system, sharing specialty-specific information and general guidance about caring for at-risk patient populations during this pandemic. There also is information about Texas Children’s preparations and ongoing response to global events, and guidance for talking to children about COVID-19 and its impacts. The videos have been shared across all of our social media channels and continue to be sought by online visitors.

“One of the best ways to connect with our patients and families daily has been through social media,” said Christy Warring, director of External Communications and Digital Marketing. “It has been a lifeline for patients as our teams continue to post tips, resources and Texas Children’s updates. Followers are even able to reach out to us on on social media platforms with questions and comments.”

In addition to online information, we began sending COVID-19-related texts and emails to our patients to keep them updated about appointments, visitation at our facilities and eHealth options, like phone and video consults.

eHealth has been an important channel for patient care and communication during this time, but this strategy was already in motion to broaden access for our families. We have worked to expand and enhance eHealth services for several months to make it easier and more convenient for patients to connect with a Texas Children’s provider without leaving home. Given the current climate, it’s a welcome option for our families. Just in the month of March, we had more than 1,500 video visits and nearly 7,000 phone visits.

The system’s proactive outreach extends to Texas Children’s Health Plan members as well. We are promoting access to Anywhere Care, which allows members to receive care via video visits, and Health Plan members also receive updates via direct mail, social media, texts and email.

But one of the most effective ways to reach our members and their families has been through community partnerships. The Health Plan recently partnered with Aldine Independent School district and Gallery Furniture to disseminate information about COVID-19 and how to stop the spread of the disease.

“We are here to inform our members and providers about COVID-19 overall and doing all we can to make sure they are getting the most up-to-date information from us,” Warring said. “Our goal is to ensure they know how to get help through our call centers, telemedicine, and most importantly that we are here to help them if they need to call on us.”

On his blog this week, Mark Wallace shares an inspiring Brene Brown podcast and reminds us all to fill in the gap for each other in the days and weeks to come. Read more