August 30, 2022

The Quality, Clinical, and Information Services (IS) teams who were among the international winners of the Healthcare Information and Management Systems Society (HIMSS) 2022 Davies Award of Excellence are sharing highlights from their case studies presented at HIMSS’ virtual site visit in July. Excerpts from their work shows how the technologies they have pioneered are helping to identify opportunities for collaboration with clinical teams across Texas Children’s to drive improvements in the delivery of our patient care and outcomes.

Pediatric Palliative Care: Optimizing the Electronic Medical Record (EMR) to Improve End-of-Life Care in Children

  • Dr. Jessica Casas, Assistant Professor of Pediatrics, Division of Palliative Care
  • Amy Jeppesen, Systems Analyst Lead, Information Services

Challenge: As an international referral center for patients with the most complex illnesses, Texas Children’s Hospital treats diverse and complex patients of all ages. Being a busy center comes with challenges, including the need to provide goal-concordant care to a wide variety of patients in all stages of the disease process. This is particularly important for seriously ill children.

Approach: The Pediatric Advanced Care team (PACT) partnered with Epic Informatics/IS and Quality Outcomes & Analytics to improve the quality of care for these seriously ill children, including end-of-life care, to ensure delivery of goal-concordant care every time for every patient. PACT led focus groups with stakeholders across the institution to learn about their needs and questions regarding caring for children at end of life. Evidence shows that end-of-life care outcomes are strongly related to communication between clinicians and patients.

Using stakeholder input, the team engineered the electronic medical record (EMR) to create a novel navigator that consolidates all end-of-life care activities: consents, advance directives, autopsy, organ donation, keepsakes, spiritual rites and bereavement. The team then carefully guided EMR users through the end-of-life navigator workflow.

Outcome: This EMR optimization minimizes unnecessary variation in end-of-life care, improves communication between teams and is improving appropriate post-mortem care. The new process elevates the care that seriously ill children receive to mirror the institution’s standards of excellence.

COVID-19 Vaccine Tracking with Integrated Medication Management Technology

  • Gee Mathen, Director, Clinical Application & Technical Pharmacy Services, Financial Services
  • Shawn Mathew, Informaticist, Clinical Pharmacy

Challenge: In 2020, the SARS-COV-2 pandemic brought about rapid mobilization of vaccine research, production and implementation, with Federal and state regulations mandating accuracy of vaccine inventory for institutional allocations.

Approach: The Texas Children’s Pharmacy Informatics team developed new and repurposed existing technological solutions to track procurement, distribution, administration, and vaccine waste. The team created a PowerApp named COVID19VaccTrac to track vaccine movement in the system through procurement, distribution, preparation, and waste.

Additionally, Codonics® Safe Label Systems® were repurposed from the operating room to the pharmacy to prepare color-coded vaccine doses. Complexities associated with multiple formulations for different age groups, dose types and manufacturers benefited from the color-coded design to safely administrator vaccines. Lastly, Epic© was used to document administrations for patients. Medication management technology captured data in each step of the medication use process. Data from multiple sources was integrated to provide real-time insights into inventory and patient vaccination statuses to drive decision-making by leadership for resource allocation.

Outcome: Collaboration with multiple disciplines and swift development of innovative technological solutions ultimately provided efficiency and a paramount level of care for our patients.

Improving High Blood Pressure Recognition in Pediatric Primary Care

  • Dr. Justin Zachariah, Associate Professor in Pediatrics (Cardiology), Baylor College of Medicine; Co-Chair of Research Operations, Texas Children’s Heart Center
  • Dr. Scott Watson, Pediatric Physician, Texas Children’s Pediatrics; Associate Medical Director of Clinical Informatics

Challenge: Pediatric Hypertension is often missed in primary care due to the complexity of evaluating normal blood pressure ranges for children at different ages.

Approach: Texas Children’s Preventive Cardiology and Texas Children’s Pediatrics leadership developed a plan to improve initial measurement accuracy and increase primary care recognition of high blood pressure during clinic visits. The project involved multi-step decision support tools to automate recommendation for manual blood pressure confirmation by staff members, allow for easier review and classification of blood pressure readings by physicians, and encourage American Academy of Pediatrics (AAP) guideline recommended initial evaluation steps for confirmed elevated readings.

Outcome: Initial data from our go-live showed clear improvement in recognition and referral rates for many previously unrecognized cases of elevated blood pressure.

Read more on Connect about HIMSS’ Davies Award and the award announcement.

June 1, 2022

The Front Door for Data and Technology (Front Door) has undergone a major transformation to meet users’ growing demand for data and create a more robust data exploration experience. You’re going to want to bookmark the new Front Door, located on Connect – navigation bar – Tools. The new portal was officially launched on May 25 by the Quality Outcomes & Analytics, Clinical Informatics, and Information Services (IS) teams.

The Front Door was formed in 2017 to serve as Texas Children’s portal for requesting data reports, access to existing reports and dashboards, E-changes (Epic optimizations and other clinical technologies), and computer technology (tools, software and help). In an increasingly data-driven world and organization, a greater demand for data and more desire from users to learn about and use self-service tools drove the need to reimagine the Front Door user experience.

“We formed a partnership six months ago and set out to understand users’ data consumption needs and modify Front Door in a way that will help people help themselves when it comes to data research, reports, technology requests and understanding clinical technologies,” said Dr. Carla Giannoni, Chief Medical Information Officer and Professor, Pediatric Otolaryngology.

The Front Door transformation team includes Dr. Giannoni, Toni Powell-Fontenot, Assistant Director of Quality Outcomes & Analytics, and Ashok Kurian, IS Director of Enterprise Systems.

Among their findings, the team learned that many users are seeking self-service education about nearly everything, including available reports, the components of those reports, and Epic features and functionality. Their main goal for the new site was to create a space to serve all informatics needs, where users can easily find guidance, facts and forms. Each page includes user-friendly summaries, how-to guidance and quick links that will take you where you need to go to get your work done. On Front Door you can:

  • access request forms for technology and data reports
  • learn about the data request process, all self-service data tools available to you, and how to create robust data requests based on your unique research and reporting needs
  • get links to a vast array of credible and valuable external education resources
Tips for navigating Front Door

When you enter Front Door you will get a taste for how the rest of the site works. Quick link icons connect you with the most-used tools and information, such as How to Get Your Own Data, the IS Request Center, and E-Change Request Form. FAQs are available for everything the team could think of to help you connect with the data and tools you need including request status, determining the type of request you need, and learning more about Epic clinical and data features. The Epic Video Library covers everything Epic, ranging from how to use Epic features such as SlicerDicer and Reporting Workbench to help with physician efficiencies such as writing notes. The Epic “It’s Possible” series are 60- to 90-second videos addressing how to work efficiently.

Quick links for common items are cross-referenced throughout the site. For example, you can always build your own unique dashboard or report based on your team’s needs, although “Data, Tools and Access” shows you what type of reports, dashboards and data sources are already available, and allows you to filter them by type, self-service access request required, source, and other helpful information. If you are contemplating whether to “build” or “request” a report that reveals several clinical data points, you might want to review “Thinking About Data: Tools and Access” for guidance. Other helpful quick links include HELP for the IS Service Portal and Quality and Safety Home.

“We appreciate everyone’s patience as we worked with Ashok’s team to migrate from the initial Front Door and construct and launch the new site,” said Fontenot. “We are excited about its functionality and potential, and we encourage you to take a spin, dive in and give us feedback.”

The Front Door will evolve as the team learns of more reports and tools that can help leadership and work teams with insight and forecasting, such as Epic Executive Dashboards.

Welcome in! Reach out to Toni Fontenot or Dr. Carla Giannoni if you have any questions about the new Front Door.

June 15, 2020

As we navigate the COVID-19 pandemic, more employees are working remotely these days, which has significantly increased the demand for telephone conversations between Texas Children’s and patient families. While video visits are the best option for telemedicine appointments, sometimes our providers and ancillary services need to reach out to families with a simple and quick phone call, like updating them on a medication or test result, without the need to schedule a video appointment or meeting where both parties have to log in at the same time.

Since our providers and ancillary team members are minimizing the amount of time they spend in the clinic with patient families and are conducting more telephone visits remotely, they primarily rely on their personal cell phones to reach out to families instead of using their Texas Children’s desktop phone.

“When our ancillary or clinical teams call families while working remotely, they are unable to mask their personal cell phone numbers and instead have to call from a blocked number reducing the likelihood that a family will answer their phone,” said Director of Entrepreneurship and Innovation Melanie Lowther. “Since 35 percent of our social workers and care coordinators have long distance numbers, they can’t forward their Texas Children’s desktop phone to their personal phone, which puts an extra wrinkle in that communication loop.”

To effectively address these challenges and make it easier to connect remotely with patient families, Texas Children’s Information Services recently expanded the organization’s work-from-home solutions. There are four solutions available, addressing different needs and work configurations, including a mobile function that turns a person’s mobile device into an extension of their desktop phone.

“While we already had a strong foundation in place, we had to modify the organization’s existing phone system to support the mobile application,” said Trey Jones, director of Digital Services for Information Services. “Before enabling this new technology, we validated the product stream to ensure we had enough incoming connectivity pieces to support the number of users that may want to access it.”

This new functionality within Texas Children’s existing phone system was truly a collaboration on many fronts that helped get this product up and running. Even before COVID-19, the organization had been reassessing its work-from-home solutions to better meet the needs of our employees and staff.

“We have a resourceful workforce, and this new mobile app will be beneficial for providers and especially for our ancillary groups who are in close contact with families several times a day,” Lowther said. “These tools are available to anyone who needs to make phone calls that look like they’re calling from their desk number, and receive phone calls through their desk number. These are universal solutions for everyone.”

December 16, 2019

Staying in the hospital for a prolonged amount of time isn’t easy, especially for children. That’s why Texas Children’s and a variety of community partners are constantly looking for ways to make the hospital a warm, welcoming, fun environment for patients and their families.

Texas Children’s most recent endeavor included a gift of 10 new computers outfitted with the latest gaming technology. The generous donation was made by CDW, a leading multi-brand technology solutions provider, in partnership with the Astros Golf Foundation.

Members from both organizations announced the gift on December 16 in the Child Life Zone, a state-of-the-art, therapeutic play area where patients and their families can escape from the day-to-day hardships of their hospital stay.

“CDW is excited to be here today and is appreciative of the opportunity of this sponsorship,” said CDW Area Sales Director Shaun O’Rourke. “We hope it will make a positive impact on the people you serve.

Brian White, sales director with the Astros Golf Foundation, said his organization facilitated the partnership between CDW and Texas Children’s, and was happy to do so.

“We are thrilled to be able to partner two great groups for such a good cause,” White said.

Paige Schulz, assistant vice president of Clinical Support & Research Administration at Texas Children’s, thanked the foundation and CDW for their support and assured them that patients and their family members will benefit from their generosity

Based on the reaction of the first group of patients invited to test out the computers, Schulz’s is right.

Carla Vongphackdy said her 11-year-old daughter Jayla traveled to Texas Children’s about a week ago from Baton Rouge and aren’t sure when they will be able to head back home.

“It’s been stressful,” Carla said. “Being in the hospital for extended period of time isn’t a lot of fun.”

So, when a representative from Child Life asked Jayla if she would like to come to The Zone and try out some new computers and gaming software, she immediately said yes.

Jayla and her twin brother play games on the computer a lot at home, Carla said. The game she played Monday – Rocket League – was one they’d been hoping to try out.

“Her brother is going to be pretty jealous,” Carla said. “I’m just happy she’s enjoying herself.”

Audrey Crawford, the grandmother of 8-year-old Ryland Griffith, said she is so appreciative for the distractions Texas Children’s has provided her grandson during his more than three-week stay at the hospital.

“I couldn’t have ask for a better place for him to be,” she said. “Everyone has been great.”

July 11, 2017

When a patient is transferred to or from Texas Children’s Hospital, several wheels are set into motion to make the process run smoothly for our patients and their families.

People from various areas of the organization jump into action to make the best decision on where the patient needs to go and how they should get there.

For decades, the transfer process has prevailed using little to no technology to transfer an average of about 1,300 patients a year to and from Texas Children’s Hospital in the Medical Center, West Houston and The Woodlands. On April 19, all that changed with the opening of Texas Children’s Nerve Center, a communications hub for everyone involved in the transfer process and beyond.

“This is another great day at Texas Children’s Hospital,” said Texas Children’s President and CEO Mark A. Wallace at the center’s grand opening ceremony. “This Nerve Center is distinctive, innovative, forward thinking and a great example of the amazing leadership we have here at Texas Children’s.”

Equipped with state-of-the-art technology, the Nerve Center is located in a large, high-tech room on the third floor of Texas Children’s Pavilion for Women. Half of the room is occupied by representatives from the hospital’s security and facilities departments. The other half houses representatives from the departments of Room Management, Transport Services and Critical Care.

View photos of the Nerve Center below.

When a call about a transfer comes into the center, representatives from all teams work together to assure an efficient, rapid and accountable, transfer occurs that provides the highest quality and safest care possible for Texas Children’s high risk maternal, neonatal and pediatric population.

“We have all the people in the room we need,” said Assistant Director for Transport Services Deborah D’Ambrosio. “It’s so much easier to coordinate, be efficient and supportive to families in referring hospitals.”

One notable change made with the opening of the Nerve Center was the splitting of responsibilities for transfers and transports. Transfers deal with patients who are either coming or going to acute care and transports handle patients who are much sicker and either need a physician or a higher level of care while being moved to where they need to be. At the Nerve Center, transfer calls go to one team and transport calls go to another. The team that handles the transport cases includes a transport charge nurse and a critical care physician.

“At the Nerve Center, you have one directive and no distractions by competing interests,” said Dr. Mona McPherson, the Nerve Center’s medical director. “Your sole focus is on the transport team and getting the patient where they need to be safely and quickly.”

In addition to getting everyone in the same room and a few organizational tweaks, the biggest change to Texas Children’s transport process was the implementation of technology that enables everyone in the Never Center to do their job better.

When you step into the Nerve Center, there are many different pieces and types of technology. Each workstation has four monitors displaying information vital to the transport process. There is a huge LED display at the front of the room showing a list of patients coming and going from Texas Children’s, the location of all Texas Children’s ambulances, each of the organization’s two, soon to be three helipads, and census data. And, there are several systems operating behind the scenes that connect everyone in the room with the most up-to-date information needed to make the best decision possible about a patient coming to or leaving Texas Children’s.

“We’ve taken a department that was using very little technology to one that uses a lot in various ways, all of which are able to improve their outcome,” said Melissa Witt, a registered nurse and a senior system analyst for Texas Children’s Information Services. “We’re already seeing good results.”

During the first month the Nerve Center was launched, the Transfer Team reduced their time from dispatch to pick up by 20 minutes. It used to take the team 50 minutes to get out the door. Now it takes them 29 minutes. In addition, the number of transfers has gone up, breaking a record in May with 151.

“We’ve had more than one community ER doc say, ‘Wow, this is the easiest I’ve ever been able to get a child into Texas Children’s,” McPherson said. “And that really is our mission central here. We want to make people want to call us, not because we’re just good and give excellent care, but because it’s really easy to get a patient in here.”

July 12, 2016

71316MostWired640Texas Children’s has received the 2016 “Most Wired” designation for outstanding health care-based technology from Hospitals Health Network Magazine – the flagship publication of the American Hospital Association. This is the third time Texas Children’s has won this award.

Health Care’s Most Wired Survey, conducted between January 15 and March 15, asked hospitals and health systems nationwide to answer questions regarding their information technology (IT) initiatives in the areas of infrastructure, business and administrative management, quality and safety, and clinical integration. The survey of 680 participants represented 2,146 hospitals – more than 34 percent of all U.S. hospitals.

“This designation is a tribute to the hard work of our Information Services team and clinical and operational partners at Texas Children’s,” said Myra Davis, senior vice president of Information Services. “We use this survey as a benchmark to measure our progress against our peers in the implementation of information technology and to ensure we are making the right technology investments to guide our strategy for improving patient care and safety.”

Texas Children’s was noted for several IS achievements including the implementation of Epic Rover, a mobile software application that uses barcode technology to prevent medication errors and improve the quality and safety of medical administration. This new technology was implemented in September 2015 and its effectiveness in promoting patient safety was recently highlighted in a Voice of Nursing blog.

Epic Rover is an extension of the electronic medication administration record (MAR) in Epic. Once this software is downloaded to an iPod Touch equipped with a scanner or sled, the barcodes on both the patient’s wristband and the prescribed medication are scanned at the patient’s bedside. The medication documentation then flows real-time into the MAR in Epic to ensure that the “five rights” are confirmed – right patient, right medication, right dose, right time and right route of administration.

Texas Children’s was also commended for using innovative alarm management technology to make alarms more meaningful and actionable for direct care providers while eliminating alarm fatigue within patient units. This new application resulted in the organization receiving ECRI’s 10th Annual Health Devices Achievement Award in 2016.

Other IS accomplishments include:

  • Optimizing clinical workflows – Since mobility is a critical factor in optimizing work flows, Epic’s mobile application suite allows providers to e-prescribe medications. Implemented in March 2016, this electronic feature improves the safe and secure transmission of patient health information among providers and optimizes patient experience by eliminating the need to drive to the clinic to obtain a prescription.
  • Advancing population health management – Health tools and registries were recently introduced within Epic for key patient populations such as those with asthma and diabetes. By leveraging data analytics, physicians can track and address patient needs, and easily pinpoint unmet needs and gaps in data or service delivery. Proactive steps can then be taken to ensure patients and their families receive the services they need to make a difference in their care and improve clinical outcomes.
  • Streamlining physician/patient communications – Voalte technology used by nursing, shared services and physicians has streamlined communication across the care continuum by enabling highly mobile staff to receive key notification alerts that require prompt action. The MyChart patient portal continues to grow in usage and capabilities. New options have been added making it easier for patient families to schedule appointments, send non-urgent messages to their care team and pay their bills online via MyChart billing.

“In health care today, health IT maturity is key in advancing outcomes and experience,” said Julie McGuire, director of Enterprise Systems for Information Services. “The Most Wired designation shows that Texas Children’s is leading not only in clinical care but in the use of technology to support and advance clinical care.”

The 2016 Most Wired Survey is published by Health & Hospitals Network. The July H&HN cover story detailing results is available at www.hhnmag.com.

June 1, 2016

6116WCIRREV640One of Texas Children’s main objectives is to provide the right care at the right time at the right place. Fulfilling that mission just got easier with the installation of a new Interventional Radiology Suite at Texas Children’s Hospital West Campus.

Equipped with a customizable interventional X-ray imaging system from Toshiba America Medical Systems, Inc., the new suite will enable physicians to provide a wider range of image-guided procedures to patients and families in the West Houston area without having to send them across town to Texas Children’s in the Texas Medical Center.

“This suite gives us the ability to have a full-service radiology department at West Campus, making the future of radiology at the community hospital even brighter,” said Texas Children’s Radiology-In-Chief Dr. George S. Bisset at a ribbon cutting event for the new suite. “I’m very excited about what this new addition will bring to the hospital, our medical staff, and most importantly, our patients.”

Texas Children’s Chief of Interventional Radiology Dr. Kamlesh Kukreja said interventional radiology helps physicians keep every child they see as healthy as they can be and as comfortable as possible during their visit to the hospital or clinic.

“I’m looking forward to this service growing significantly at West Campus,” Kukreja said.

The new state-of-the-art suite is equipped with Toshiba’s Infinix-i’s C-arm design that offers conformity to any patient, allowing for optimal angulations, streamlined positioning and customizable configuration. In addition, the Infinix-i’s ergonomic enhancement improves clinician speed and precision while reducing the potential for strain and injury. Another important feature is the real-time Dose Tracking System that provides real-time data on the delivery of radiation in the form of easy-to-read color-coded human map.

“In pediatrics, radiation exposure is a key concern and dose management continues to be an important focus assuring maximum benefits under the highest safety standards for the patients,” said Sadia Nasir, assistant director of radiology at West Campus. “The Dose Monitoring System, in combination with dose management and reduction technologies, such as, Spot Fluororscopy will allow the interventionists to instantaneously monitor and minimize patient’s X-ray skin dose in real time during the procedures.”

Matt Schaefer, vice president of West Campus, said the need for additional radiology services at West Campus has continued to grow ever since the community hospital opened its doors more than five years ago.

“The opening of this new, state-of-the-art Interventional Radiology Suite is simply another step toward meeting those needs and providing patients with the highest quality of pediatric care.” he said.

To learn more about Texas Children’s interventional radiology services, click here.