August 12, 2019

Let’s say you had a business and every three months it was guaranteed to lose 100 customers.
(Whoa!)
You operated this way because you couldn’t figure out how to prevent this from happening.
(Oh.)
And then one day someone showed you how to predict which of your customers might leave in the next three months – so that you can keep them.
(Yay!)

The happy ending in the above scenario is now happening at Texas Children’s Health Plan. The solution is a cloud-based software platform called Predictive Analytics.
Three Health Plan departments – Finance, Business Analysis and Member Engagement – are working together to meet members’ needs through this new capability.

How does it work?

Di Miao, senior decision support analyst, explains that hundreds of data points are fed to a machine learning model to determine the likelihood of a member leaving the plan. These might include location of residence, number of missed appointments, number of providers, etc.

All of those variables are entered into a system that produces a likelihood of which members may leave. That list of members is then given to the Member Engagement team.

“When we know a member has a high likelihood of leaving, we work hard to prevent that by providing them VIP status at member events or taking extra steps to meet their needs,” said Alejandra Lima, marketing event planner. “It isn’t a perfect science but at the very least we have an idea of who might not be as satisfied with our services as we would want them to be.”

Time will tell

As is the case with most new efforts, time will tell how well the project works. However, the potential is very promising.

“I’m so excited about this project,” said Miao. “It really does have so much potential to help us care for members better. Often times when you work in positions like ours and you build the model or pull the data, you never fully understand the impact.”

But in this particular case the impact is clearer.

Miao worked alongside Kyle Stringer, senior decision support analyst, and Sadhana Sharma Luetel, data architect, to create the model.

“The old way of doing things is that you have a theory or an idea and then you use data to prove it. But when there is more data, more computing power, and more mature machine learning techniques you can take that data and then use it to discover interesting patterns or new ideas,” Miao said. “That is a better way of working and a better way of taking care of our families.”

The Next Step

The team agrees that adding more manpower to the process is the next step. “It takes time and attention to cull through the names each month and choose who to focus on. Then – maybe most importantly – it takes time to keep up with those families, follow them and determine if they actually left or not.

Adding at least a part-time staff member to the efforts is the next steps to seeing the potential of the project all the way through.

Want to know more about the predictive analytics program or think your department can help? Contact Di Miao at dxmiao@texaschildrens.org or Alejandra Lima at axlima@texaschildrens.org.

August 6, 2019

This past year, Texas Children’s Motion Analysis and Human Performance Laboratory, located at Texas Children’s Hospital The Woodlands, was awarded a prestigious accreditation from the Commission for Motion Laboratory Accreditation (CMLA) – an independent body established to enhance and standardize the clinical care of people with movement disorders.

The lab is now one of only 14 accredited labs in the nation and one of only three in Texas.

“This was an incredible accomplishment for our entire team and a major milestone for the entire Texas Children’s system,” said Dr. Eric Dugan, director of Texas Children’s Motion Analysis and Human Performance program.

Watch a video about the Motion Analysis Lab.

CMLA accreditation is a rigorous, often lengthy process and requires top-to-bottom documentation of everything a motion analysis lab does, how it’s done and the level of quality achieved. This includes evaluation of personnel, administrative structure, clinical and technical data collection methods, quality assurance procedures, and institutional policies. This data is then reviewed by a panel of CMLA experts in orthopedic surgery, physical medicine and rehabilitation, physical therapy, biomechanics, and other related disciplines.

“In early discussions with the CMLA, their estimated timetable for us, from the lab going online to accreditation, was about five years,” said Dugan. “We did it in 18 months, and were one of the fastest ever to receive accreditation.”

Every day, Texas Children’s is getting bigger and better. That’s because our leadership and world-class health care experts are always looking for ways to improve processes, to forge new paths in research, and to ensure an unmatched level of quality care for our patients. And it’s evident in our outcomes and in measures like our recent U.S. News & World Report rankings.

The CMLA accreditation was certainly a factor in the Division of Orthopedics rising five spots to become the No. 10 pediatric program in the country.

“There are so many things that go into the U.S. News rankings, but CMLA accreditation had a positive effect on our position because it helps us ensure we’re offering a full capacity of care for patients with movement disorders,” Dugan said.

Helping remove barriers

The Motion Analysis and Human Performance Laboratory provides the platform for an integrated approach to patient care. The foundational service for the lab is for neuromuscular or clinical gait patients with some form of neuromuscular disorder, such as cerebral palsy or spina bifida. However, lab capabilities are already being expanded to include a comprehensive sports medicine component. Two programs in early phases of implementation are running analysis – to determine any deficits in strength and mobility, or to identify mechanical issues that could lead to chronic injuries – and concussion management, which helps children avoid returning to play too early and experiencing another brain injury and also any possible musculoskeletal injuries that could result from concussion-related changes to postural control.

Clinical gait patients come to the lab as part of pre-surgical or pre-treatment planning to help multidisciplinary care teams determine the best path forward. The evaluation process is intensive and begins with a physical exam with a physical therapist (PT). In this approximately one-hour session, the PT assesses muscle tone, strength, range of motion and other functional measures to get a clear picture of the patient’s condition. A series of 2-D videos and photos are then taken to document standing posture and foot alignment. Patients are then “markered up” head to toe with 70 reflective spheres adhered at specific points on the body. This allows the team in the lab – typically a PT, PT tech and a biomechanist (human motion expert) – to capture a full biomechanical picture of the patient. These experts then work with colleagues in surgery and physical medicine and rehabilitation to analyze the data and develop a treatment plan that fits the needs of each individual patient – patients just like Hannah Deverse.

Hannah was born at 32 weeks, so her parents had been told to expect some developmental delays. However, when Hannah turned one, she still couldn’t sit up or crawl. Her body was stiff and she screamed in discomfort. A neurologist diagnosed her with cerebral palsy.

Over the course of her life, Hannah would need surgeries to alleviate tightness, improve flexion and correct structural deformities. But more than a decade ago, awareness and technology weren’t far along and her parents often felt they were flying in the dark.

“When you have to make difficult decisions about treatment without knowledge, you can feel lost,” said Jessica Deverse, Hannah’s mother. “That was how we felt before we experienced Texas Children’s motion lab. We had two surgeries before the lab was available and two after. We were much more confident with data from the lab. We were presented with multiple options and never felt pressured to do any of them. When we did make a decision, the team answered every single question we had, and we had a clear picture of what the process would be, from beginning to end.”

The data gathered in their initial lab session at Texas Children’s helped experts in pain management determine that Hannah would benefit from a special intrathecal pump to alleviate tightness in her body.

“Have you ever tried to stretch and you just couldn’t reach your toes? It was like that but all over my body for my whole life,” Hannah said. “After I got the pump, I felt like I was walking on clouds. I’d never felt that way before. I asked, ‘Is this how it’s supposed to feel?” because my whole life my body had been so tight.”

Lab analysis also allowed Hannah’s care team to make integral decisions about surgery. Initially it was thought she would need surgery on both knees. But because of the pump helping to control spasticity, the team changed course and decided to operate on only one knee, a surgery performed by Dr. Jeffrey Shilt, chief surgical officer at Texas Children’s Hospital The Woodlands and Texas Children’s chief of Community Surgery, and co-medical director of the Motion Analysis Lab.

“It’s really important that parents know just how much more confident you can feel about making a surgery or treatment decision after seeing and reviewing the data with the team from the motion lab,” Jessica said. “As parents we are often faced with making decisions that will impact the future wellbeing of our children. When you have a child with a disability, the weight of some decisions can be overwhelming because it has drastic lifelong implications. I wish everyone faced with these decisions had this information and this team to work with.”

When Hannah was a baby, her parents were told that she may never walk. Hannah’s proven detractors wrong. Today, she’s 16 years old and has her sights set on getting her driver’s license.

“I’m the only person in my group of friends who doesn’t have a license yet, which is hard on me!” she said. “But I know I’ll get there.”

July 15, 2019

Texas Children’s Hospital is seeking an innovative solution to at-home hospital care for patients who are discharged from the health care setting but are still healing. Instead of providing patients with a binder of instructions, Texas Children’s Cancer & Hematology Center is working with a group of college and graduate students to create an interactive video game that encourages positive health habits in the home. The effort is part of the Healthcare Games Showdown™, which is going on throughout July and is being hosted by the world-renowned Texas Medical Center Innovation Institute.

“Leveraging game design to encourage healthy behaviors in the home is a great way to engage children and promote positive health outcomes,” said Business Development & Innovation Manager for Women’s Services Haley Jackson. “We are excited to learn from this innovative project!”

Jackson, Quinn Franklin, Assistant Director of the Psychosocial Division of the Cancer and Hematology Centers; and Dr. Monica Gramatges, Co-Director of the Center’s Survivorship Program, are advising the TCH student team with the support of Senior Vice President Myra Davis, Chief Quality Officer Dr. Eric Williams, Vice President Jackie Ward and Texas Children’s Cancer and Hematology Centers Director, Dr. Susan Blaney.

The group is working with a team of four digital media and computer science students – Jacqueline Nguyen of the University of Texas Dallas, Carlos Puerta of the University of Houston, David Musick of the University of Houston and Jonathan Nelson of Huntington University – to develop a prototype for an augmented reality game that focuses on the importance of hand washing and oral hygiene.

The concept for the game revolves around an animated world that can be unlocked by patients, families and/or caregivers when they complete a handwashing or oral hygiene activity. Players will be sent alerts on their smart phone device when it’s time for an action to be completed. Each time the player completes a task, their animated universe becomes more complex and elaborate.

“Health care video gaming allows us to foster playfulness and learning through a medium that our patients are naturally drawn to,” Franklin said.

During the development period, patients will be viewing the game and providing feedback as it is created. Marty McMahon, our Texas Children’s Gaming Activity Coordinator funded through a collaboration with Child’s Play, is also supporting this effort as a technical mentor for the students.

A live-stream following the progress of all three teams participating in the Healthcare Gaming Showdown is being hosted weekly by comedian and voice-over actor, Scott Gibbs, together with Ink Rose and Kevin Wu. Click here to learn more about the games and how to tune in to the live-stream.

“At Texas Children’s Hospital, our mission is to create a healthier future for children,” Davis said. “Using augmented reality and video games is an excellent means with which to continue our mission.”

July 9, 2019

Dozens of patients and their families recently attended the 2nd Annual Complex Care Clinic Resource Fair, held at Texas Children’s Meyer Building. The event is one of several the clinic hosts throughout the year in an effort to build a community for families with children who have ongoing complex care needs.

“Medically complex children are the sun around which their entire family orbits, and it can be frustrating to see how alone and isolated these families feel,” said Amanda Harris, a medical social worker at the clinic and one of the event’s organizers. “Aside from providing helpful resources, we wanted to create an opportunity to just let these families – including siblings and grandparents – be around other people who are facing similar situations and to see that there are other people just like them.”

There were activities, such as face-painting, and canvases were set up for families and patients to create original artwork for display in the clinic. Children also had an opportunity to pet and interact with ponies that were provided by SIRE (Self-improvement through Riding Education), a local occupational therapy group that specializes in equine therapy.

There were numerous community partners present, including a school advocacy group to answer parents’ questions and offer advice on how to make requests for special accommodations at school, as well as the Deaf-Blind Multihandicapped Association of Texas, a group that advocates and intervenes for patients with co-occurring symptoms to help improve their quality of life.

Families also had access to internal resources, such as Texas Children’s Medical-Legal Partnership, a collaboration between Texas Children’s Hospital and Houston Volunteer Lawyers that provides low-income patient families with free legal advice and representation. There were also representatives present from Texas Children’s Autism Center and Developmental Pediatrics to talk about resources and services available, as there is often overlap between these patient populations.

About Texas Children’s Complex Care Clinic

The dedicated team of experts in the Complex Care Clinic provides comprehensive, high-quality care for nearly 1,200 of Texas Children’s most medically complex patients. These patients include:

  • Former premature infants
  • Children with complex seizure disorders
  • Patients with technology needs, such as tracheostomies or gastrostomy tubes
  • Congenital heart disease patients
  • Patients suffering from rare genetic or neuromuscular disorders

“There are so many wonderful stories people hear about the miracles that happen every day in our pediatric or neonatal intensive care units, but a lot of people might not realize those stories don’t always end when the patient is discharged,” said Dr. Heather Moore, clinic chief. “For the patients we see, that’s just the beginning of the journey, and they’re going to need ongoing, highly coordinated care.”

The clinic – located at the Texas Medical Center campus and West Campus – is a true one-stop shop for patients and families, functioning as the primary care physician (PCP) office for well visits and touch point visits for proactive preventive care. The clinic also provides all urgent care needs. In an effort to reduce emergency room visits and hospitalizations among this vulnerable population, experts are available to assist families 24/7, and calls go directly to an on-call physician or nurse practitioner.

The full team includes:

  • Four physician PCPs and three nurse practitioner PCPs
  • Two masters-level medical social workers who remove barriers around transportation needs, housing, food insecurity, guardianship issues, transitioning to adult care, as well as providing assistance in instances of child or domestic abuse
  • Masters-level clinical dietitians embedded within the clinic who manage tube feeding regimens and oral feeding diets, while also assisting clinic providers to ensure access for patients who need enteral supplies and feeding therapies
  • Four clinical nurses, who triage patients for medical needs via triage line, change gastrostomy tubes and place nasogastric tubes, administer immunizations, suction and escort to the Emergency Center if necessary
  • A child and adolescent psychiatrist, providing both behavioral health and family therapy
  • A care coordination team comprising six nursing coordinators and six patient navigators (an administrative support role) that interfaces with specialists, therapists, insurance carriers, and medical supply and home nursing companies, and others to help streamline care and remove gaps or redundancies

There are plans to add new staff in the near future, including additional PCPs, a dedicated hospitalist and Physical Medicine and Rehabilitation doctors. A planned expansion to The Woodlands is also in the preliminary phases.

“Many of our patients have special transport needs and it takes a tremendous amount of effort to get around,” said Moore. “We’re trying to provide everything our families need in one place that’s closer to home, while also reducing any gaps in care. Our goal is to provide the most comprehensive care available and to make life easier for them.”

This month’s installment of Medically Speaking features Texas Children’s orthopedic surgeon, Dr. John Heydemann, discussing the rising prevalence of obesity in American adolescents and the increased level of difficulty it creates in the treatment of pediatric orthopedic injuries or deformities.

To clearly relate the two, he highlights four specific treatment areas or conditions that are often exacerbated by, or that can contribute to, obesity. These are:

  • Trauma, including increased fracture rates, higher risk of loss of reduction and increased risk of complications
  • Blount’s disease, a growth disorder of the shin bone that causes the lower leg to be angled inward
  • Slipped capital femoral epiphysis, a hip condition that occurs in adolescents and teens
  • Back pain, potentially due to children leading more sedentary lifestyles

Learn more about the services provided and conditions treated by Texas Children’s Division of Orthopedics.

Fighting obesity at Texas Children’s

In addition to contributing to or complicating the treatment of orthopedic injuries, obesity drives significant health outcomes in Texas Children’s patients. Obesity is one of the biggest drivers of preventable chronic diseases and in childhood can lead to high blood pressure and cholesterol, increased risk of type 2 diabetes, asthma and sleep apnea, and joint problems, not to mention the associated psychological ramifications, such as anxiety and depression.

But obesity it a health problem Texas Children’s Hospital is attacking head on.

This year, Texas Children’s included a system-wide BMI goal as part of our Fiscal Year 2019 care quality objectives. The target was to record BMI for 85 percent of the patient population, ages 2 to 19. In addition to recording BMI, an additional target was set to refer or implement counseling and/or education for more than 40 percent of patients with BMI greater than the 85th percentile.

So far this year, Texas Children’s is exceeding those goals. Through March 2019, we’d recorded BMI for more than 87 percent of our patients, and more than 73 percent of those with BMI in the 85th percentile or higher have been referred to or received the resources they need to combat obesity.

About Medically Speaking

Medically Speaking, a video series from Texas Children’s Service Line Marketing, features some of the brightest minds from several Texas Children’s specialty and subspecialty areas. The series is meant to be a helpful educational resource for parents and a convenient way for physicians and other caregivers to stay up-to-date on the latest in pediatric medicine. Viewers can watch talks on a variety of interesting topics, including advancements in surgery, breakthroughs in research, new clinical trials, and novel and back-practice treatments for specific conditions.

Don’t miss future Medically Speaking episodes featured here on Connect, or view additional episodes now.

PLEASE NOTE:
This presentation is not intended to present medical advice or individual treatment recommendations, and does not supplant the practitioner’s independent clinical judgment. Practitioners are advised to consider the management of each patient in view of the clinical information. All content is shared for informational purposes only, and reflects the thoughts and opinions of the original author. No physician-patient relationship is being created by the use of this presentation. The presentation sets out recommendations based upon similar circumstances and is provided as an educational tool. The presenters are not attorneys, and to the extent this presentation provides commentary on current laws and regulations affecting health care activities, it is not intended as legal advice.

July 1, 2019

Since implementing Texas Children’s Patient Access Initiative, Texas Children’s continues to make great strides to ensure our patients and their families get in the door easier to access our high quality services.

One of the many impactful changes benefitting patient families has been their ability to easily and quickly schedule their appointments online as a result of new features the organization has implemented. To date, more than 10,000 appointments have been scheduled online via MyChart and DocASAP.

In May 2018, Texas Children’s launched direct scheduling that allows current patients to schedule return appointments online through MyChart. Since its implementation, over 7,909 visits have been scheduled online and many patients and their families describe the scheduling process as “easy and convenient.”

“I was surprised that Texas Children’s now offers this option,” wrote a Texas Children’s family. “It was very convenient and the process for scheduling appointments was very simple and streamlined.”

In addition to direct scheduling via MyChart, over 2,814 appointments have been made via DocASAP, Texas Children’s online scheduling partner, since November 2018. Offered in both English and Spanish, this online scheduling tool is available to new patients, current patients, and referred patients at Texas Children’s three hospital campuses including our specialty care locations in Houston and Austin, and Texas Children’s Pavilion for Women.

“I am excited about the progress we’ve made to better serve our patients and their families,” said Sarah Ringold, assistant director of Perioperative Business Operations at Texas Children’s and project manager for the online scheduling team for Patient Access. “It is amazing to be able to offer families the flexibility of scheduling online, and to continue to improve the online scheduling tool to make it more and more effective for our patients.”

Other patient access milestones

Texas Children’s implemented other enhancements to improve patient access across the system. Below is an update on where we are today:

  • MyChart activations: Texas Children’s continues to see an increase in the number of patients signing up for MyChart. In October 2017, the organization had approximately 61 percent of distinct patients sign up for MyChart. As a result of system wide efforts to raise patient awareness and engagement, we have now exceeded over 74 percent activation rate for MyChart throughout the system as of June 2019.
  • Electronic Waitlist: Since implementing this MyChart feature that automatically sends texts and email notifications when appointments become available sooner, 3,794 patients have accepted an appointment on average 39 days earlier than their prior appointment. The total patient volume includes Texas Children’s Pediatrics (TCP), all subspecialties, sleep studies and therapies. Due to its success, TCPs in Austin and College Station will go live with this convenient electronic tool by the end of the summer.
  • Referrals: The referrals team continues to work through enhancements to the referral process in an effort to improve patient access. In April and May 2019, Texas Children’s received over 6,000 referrals from external providers that were processed through the central transcription team – the highest number of referrals from external providers to date. In addition, TCP surgical referrals and medicine referrals referred to Texas Children’s specialties also reached their highest levels at 91 percent and 87 percent, respectively. Current initiatives are in process to increase scheduling conversion and appointment capture rates for various specialties.
About Texas Children’s Patient Access Initiative

Launched in August 2017, Texas Children’s Patient Access Initiative is an on-going, collaborative effort to improve patient access across the organization. Since then, Texas Children’s has made significant progress to ensure patients easily and conveniently get in the door so we can provide the care they need, when they need it.

Click here for a list of other tools and features we’ve implemented across the system to improve access, care coordination and patient experience at Texas Children’s.

May 28, 2019

The National Institute of Health awarded a team of Texas Children’s scientists a $2.2 million grant in 2018 to study and develop computer and tissue-engineered models to predict the recurrence of congenital heart diseases. The study aims to change the way heart diseases are managed to improve the quality of life of children. Learn more by visiting our 2018 virtual Annual Report.