Progressing complex pediatric care with Bethany Children’s Health Center and MEDITECH

January 23, 2024 |  Population Health, C-level, Pediatric Care

Doctor greets young patient at complex pediatric care facility

According to a study by the NSCH, 1 in 5 children in the United States has a special healthcare need, amounting to around 14 million children. This tells us a substantial percentage of our population requires services formulated to their stage of life, which pediatric clinics and hospitals across the nation manage. However, for children with medical complexity who require specialized treatment plans that often result in a long-term stay, the provider options begin to dwindle.

Complex Pediatric Care facilities, such as Bethany Children’s Health Center, take holistic care to the next level. When pediatric units are unable to address a child’s complexities, they look to our discipline to answer the call.

Care models driven by population health strategy

To form insightful and successful care models, you must know your population.

Bethany Children’s Health Center stands as a beacon of hope for the community around Bethany, Oklahoma, a suburb of Oklahoma City’s metro area, as the sole inpatient pediatric rehabilitation facility in Oklahoma. This positions us to not only serve the children of Oklahoma, but also those underserved in other states who require specialized care. Filling a gap in community service resources, we strive to cover the entire medical journey to support our patients and their families, from our inpatient 24-hour care services to outpatient services after discharge.

To achieve the high level of care these conditions require, Complex Pediatric Care facilities thrive on the expertise of multidisciplinary teams, assembled and versed in each unique patient’s story. Unlike a typical 3-4 day stay that most acute hospitals with pediatric wards report, patients in complex care hospitals require more time to evaluate, diagnose, and treat. To put these needs into perspective, a patient’s average duration at Bethany Children’s amounts to around 23 months. 

During their stay, Bethany Children’s takes all measures to support our patients’ physical and mental health. Children deemed well enough to attend classes are transported to the local school by staff, providing a welcome sense of normalcy. It also presents them an opportunity to socialize and engage with other peers, proactively working against regressions that can occur when children are unable to reach typical social milestones in a hospital environment.

The goal will always be to nurture our patients back to a healthy baseline so they can return home, but to accomplish this goal, families also need the resources to maintain their child’s condition and prevent readmission.

The transition back into the community perseveres when our patients and families leave enlightened. Depending on the individual’s journey, Bethany Children’s supports our patient’s next steps through our transitional care unit or pediatric medical rehab unit until they can maintain that baseline at home, aided by our outpatient therapy services.

Due to a lack of in-home agencies equipped to care for our patients’ complex needs, Bethany Children’s took matters into our own hands. A large part of our services includes training and prepping caregivers, which often include the child’s parents, to confidently care for their child in the home. One such program, Home Vent, maintains around 30-40 participants at a time.

Investments around our campus include areas dedicated to easing the transition, such as our Smart Home setup. The smart home is equipped with all types of assistive technologies that can be integrated into the daily routine to help enhance an individual’s own agency. There, individuals and families can explore the wide range of medical technologies available to simplify everyday life and evaluate how they could be implemented in their own homes.

Our long-term care extends far beyond the walls of our facility thanks to the training we offer, and we continue to honor that commitment to education by collaborating with the Pediatric Complex Care Association.

The power of a collective

The Pediatric Complex Care Association creates advocacy, research, and educational opportunities for its members, facilitating a collective approach to advancing Complex Pediatric Care. As reflected in the industry as a whole, those in our discipline are often understaffed, undercompensated, and lack the technology to support future ambitious endeavors. Many of these facilities are also negatively impacted by the lack of community-based resources to partner in the care of these patients. These challenges amount to a need for resources, technology, and staff that go above the traditional pediatric needs. 

Unfortunately, best practices, published or otherwise, are few and far between due in part to the lack of research being done in the complex pediatric care population. The PCCA seeks to fill this void by bringing together the facilities who have hands-on experience treating these cases. By sharing knowledge across the field, we can begin to form our own best practices, stepping collectively into the technological age.

Bethany Children’s success in diversifying our services and achieving the agency to invest in them took time and practice to realize. We hope to set an example and help other Complex Pediatric Care facilities form a path to full digital independence, aided by an intuitive EHR such as MEDITECH Expanse. Having the nationwide representation of like-minded providers and facilities would facilitate data collection supporting benchmarking, defining standards of care, and research endeavors in children and young adults with medical complexity. Many facilities maintain hybrid systems and find difficulty generating information to streamline care and contribute to research.

Just because it isn’t being done doesn’t mean that it shouldn’t be, and we’re in a prime position to test the boundaries for our field with the integrated MEDITECH Expanse EHR.

Collaborating with MEDITECH

When searching for a new EHR, our main pillars envisioned a platform that supports our research goals for the PCCA, facilitates stronger interoperability, and champions our virtual programs. MEDITECH Expanse fulfilled those guidelines and opened up a world of new possibilities. Bethany Children’s Health Center is working with MEDITECH to tailor our EHR implementation and build a platform equipped to maximize our potential.

Almost immediately, our clinicians will begin to experience enhanced connectivity. The nature of managing long-term, interdisciplinary care plans alludes to the power of a cohesive system. By bringing together all the disciplines onto the same documentation, we can empower every end user and relieve the documentation burden. It gives back time which can be better spent at the bedside, forming essential connections with our vulnerable and often anxious young patients, maximizing their potential.

On the outpatient side, remote patient monitoring offers an answer to the trends we’ve been witnessing across the nation. The shortage of home nurses plus lack of resources in rural areas leads to the need to train the caregiver-parent to become the bedside provider-parent. Bethany Children’s has already invested in ventilators that can connect to an EHR platform, so we can truly enhance our remote patient monitoring abilities. We also provide caregiver training to help overcome hindrances that could occur while managing their child’s conditions through virtual care.

Already our clinicians are eager for the benefits of intuitive, personalized documentation, and we’re even more excited for what’s to come. 

Another unique challenge that PCCA hospitals face is that the long-term stays of our patients account for a vast amount of historical data, especially when patients bring a medical history with them from multiple health systems. It leads to an extensive, time-consuming process of review and subsequent synthesis for completing discharge papers, which require a unique workflow to complete. Interoperability allows us access to the data, but that’s one small step in the act of actualizing it. We’re excited about MEDITECH’s integration with Google’s Search and Summarization capabilities, and its ability to synthesize all that information into an overview. The ability to leverage AI in this manner is a gamechanger when caring for children and young adults with medical complexity.

Our end goal is a single EHR, versatile enough to answer every unique need in a field like ours. Our partnership with MEDITECH supports Bethany Children’s Health Center’s position as an innovative leader in the field of pediatric rehabilitation and 24-hour complex care. We see ourselves as being positioned to provide for the needs of our community and beyond, whether it’s our providers, our fellow PCCA facilities, or the kids and families we interact with every day. 

Transformational progress has just begun.

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Written by Darin K. Brannan, MD, MPH, FAAP, Chief of Clinical Innovation, Bethany Children’s Health Center

Dr. Brannan is a Board-Certified Pediatrician who completed his medical training at the University of Oklahoma Health Sciences Center. He received his MPH at the University of Oklahoma College of Public Health while completing his Pediatric Residency at the Children’s Hospital of Oklahoma and is Board-Certified in Clinical Informatics. While in private practice, he began working part time at Bethany Children’s Health Center in 1998 and eventually closed his practice to work full time at Bethany Children’s. Since then, he has fulfilled the roles of medical director, director of clinical informatics, senior director of clinical informatics, and continues to care for children with complex medical conditions in the outpatient clinic. Areas of special interest include bone health, nutrition, informatics, remote patient monitoring, virtual medicine, and using technology to make humans work smarter.
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