Here's a look at significant trends and innovations in pediatric health care from the last 25 years.
By Megan McDonnell Busenbark
Extracorporeal membrane oxygenation (ECMO)—the use of a machine to take over the work of the lungs, and sometimes the heart, as a rescue therapy—has given patients a second chance at life over the last 25 years. "It has brought many children who were on the verge of not surviving back to life and helped them lead healthy lives," says M. Narendra Kini, M.D., M.H.A., CEO, Miami Children's Health System. "If you were to ask me the singular most impactful innovation in terms of incorporating technology, as well as making impact on survival, I would have to say in the top 5 would be ECMO," says Anthony Chang, M.D., MBA, M.P.H., chief intelligence and innovation officer, Children's Hospital of Orange County and founder of the International Society for Pediatric Innovation (iSPI).
With the growing use of tablets, smartphones and even home robots, telemedicine is changing the way people access care and engage with providers in real time. "It keeps patients closer to home, so they don't have to make a trip to their children's hospital to get specialty care," says Kelly Wolfe, public policy director, Children's Hospitals and Clinics of Minnesota. "With a medically complex population, it's about finding ways to meet patients where they are."
3. Electronic medical records (EMR)
Digitizing a patient's medical history so it can easily follow him or her across all health care settings, EMR has advanced diagnosis and treatment of patients. And now with mobile-enabled EMRs, providers can access patient records at a moment's notice—any time. "I have access to all patient records wherever I am," says Michael Docktor, M.D., attending physician in gastroenterology; clinical director of innovation; director of clinical mobile solutions, Boston Children's Hospital.
4. Digital engagement
Apps monitor and deliver health care and engage patients and families. From apps that enable families to access urgent care wait times and check test results, to easy check-in and discharge, the era of smartphone convenience has permeated every part of life. Learn children's hospitals' best tips for creating an app.
5. Big data
Big data in pediatrics is a massive combination of EMRs, patient-generated data sources and biospecimens aggregated from multiple institutions and thousands—if not millions—of children. With the increasing focus on evidence-based medicine in pediatrics, aggregating individual data sets into big-data algorithms is giving clinicians much more robust evidence on which to base care decisions—faster than ever.
Care and cure
6. Smart pills
These pills include a tiny sensor that, when ingested, transmit a signal to a patch the patient wears. From there, the information from the sensor is sent to the patient's tablet and then on to his or her doctors and parents so everyone knows the patient received the medicine he or she needed, when needed. Children's Health in Dallas is the first pediatric system in the United States to use smart pills to treat pediatric patients. The technology allows care teams to monitor heart rate, sleep levels and even physical activity. "This is part of the future of medicine," says Dev Desai, M.D., chief of pediatric transplantation at Children's in Dallas. "This is a great example of technology that is enabling better and more efficient patient care."
From eradicating age-old diseases like polio and the mumps, to preventing pneumonia and influenza—and now, cancer—vaccines have come a long way. Twenty years ago, Harald zur Hausen discovered the role of the human papillomavirus (HPV) in cervical cancer. The resulting vaccines for HPV—given during the teenage years to boys and girls—were first approved in 2006. It's estimated it may prevent up to 90 percent of cervical cancers.
8. Childhood cancer cures
As recently as the 1970s, the diagnosis of acute lymphoblastic leukemia (ALL) would carry a 20 percent to 30 percent mortality rate, according to Kini. Today, 95 percent of children diagnosed with ALL are cured, he says. "There are other tumors and cancers that are being managed, but ALL is a remarkable advancement," Kini says.
9. Extender-based medicine
Health care extenders are non-physician health care professionals who interact directly with patients, including nurse practitioners, medical assistants, health educators, social workers and registered dieticians. And in today's world of pediatrics, they are playing a bigger role in caring for patients. "With standardized guidelines, next-generation EMRs and advanced data analytics, you see that a physician's assistant or clinical nurse practitioner or other extenders can safely practice advanced medicine or specialty medicine with the guidance of a specialist physician," Kini says. "So the days of networks where a neurology extender can do neurology far away from the hospital and be backed up by a neurologist using telemedicine are here."
Genomics plays a role in many diseases, from cancer to heart disease, and experts in the field work to determine complete DNA sequences and perform genetic mapping to help understand, identify and even prevent illness. "Genomic sequencing in the last 10 years and for the next 25 will be huge for pediatrics," Chang says. "Considering the number of patients with under-diagnosed or undiagnosed diseases, it's going to be meaningful in terms of diagnostics."
11. Stem cells
Stem cells have the potential to turn into anything—a skin cell, a liver cell, a brain cell. And stem cell transplants have the power to treat a wide range of diseases in children, from cancers like leukemia, lymphoma and neuroblastoma to blood disorders, immune system diseases and bone marrow syndromes.
12. Surgical advances
Radical advances—from fetal surgery to the world's first bilateral hand transplant performed on a child at The Children's Hospital of Philadelphia last year—have transformed pediatric surgery. Cardiac catheterizations have even reduced the need for heart surgery, Kini says.
13. Respiratory supports
The adoption of surfactant—a molecule sprayed into the lungs of premature babies that helps them breathe and their lungs to grow—has saved babies who otherwise would have died. Another advance: using sildenafil citric (the same chemical as Viagra) to reverse pulmonary hypertension.
14. Accountable care organizations (ACOs)
ACOs—the groups of doctors, hospitals and other health care providers that tie payment to quality metrics and cost of care—have become more prominent in the last 10 years. "At the state and federal levels, there's a big push to keep or require hospitals to be accountable for the health of their patients and paying them for that, either in capitated payments or risk/reward type of arrangements," Wolfe says. "There's more onus on the provider to provide high-quality care in a value-based way."
15. Laws that protect
Laws that prevent smoking in public places reduced issues around exposure to secondhand smoke, such as bronchitis and asthma. Laws on the use of car seats, seat belts and helmets have reduced trauma. In fact, a 1998 study published in the Annual Review of Public Health showed that bicycle helmets prevent up to 88 percent of brain injuries. "These are examples of advances not in the technology or therapeutic realms but they are contributing to the health of children," Kini says.
The framework of care
Many companies are best known for the consumer experience they provide—take Disney and Starbucks, for example. And today, patients and families have come to expect more than care from children's hospitals—they want an experience. Providers now think of patients not as patients, but instead think of patients and families as consumers with access to mountains of medical information and control over their health care choices. So children's hospitals need to be consumer-centric in what they offer and in all they do.
17. Family-centered care
One of the biggest shifts in pediatric care is one that puts the family at the center of everything the care team does for the patient. This means working alongside families as true partners in the child's care. It means child life specialists focus on emotional, social and cognitive growth during a child's hospital stay. And the medical home model, where a partnership between the patient, family and primary provider—in cooperation with specialists and community support—make the patient and family the center point of care.
18. Population health
Understanding that social, environmental and behavioral factors determine more than half a person's health—health care makes up only 10 percent—population health is a movement toward creating conditions that address these factors. In terms of care delivery, it's a focus on quality outcomes, not the volume of care, but on the value and results of the care performed.
19. Creative innovations
Whether it's direct investment of capital in promising startup technology or offering expertise in collaborative ventures, children's hospitals are sparking innovation. By embracing entrepreneurialism, they accelerate the pace of innovation, cultivate new technologies and improve the quality of care.
20. Multi-institutional collaborations
"Future advances will be predicated on pediatric institutions working together collaboratively and not competing," Chang says. There are many examples of this today. Once accepted as unpreventable, children's hospitals have worked together to reduce central line-associated blood stream infection (CLABSI) rates for more than a decade. Hospitals have built comparative data resources and clinical registries to identify opportunities to improve care and interventions that result in better outcomes. A pediatric patient safety organization (PSO) supports the collaborative work of hospitals to decrease serious safety events, and hospitals are sharing evidence-based practices to reduce pediatric sepsis deaths. Together, children's hospitals are driving and spreading improvements with the goal of improving pediatric patients' health.
21. Improved accountability in philanthropy
The Bill & Melinda Gates Foundation is transparent about the investments it makes, sharing information about the strategy and financials behind the investments, as well as the outcomes. "It's innovation in the sense that it was a different brand of philanthropy for pediatrics and global health, and it brought about accountability for the philanthropic investment, which pediatric global health had not seen," Chang says.
22. Pulse oximetry
This simple, painless, fast test to determine the amount of oxygen in a baby's blood and the baby's pulse rate is a major advance in detecting congenital heart defects (CHDs). According to the Centers for Disease Control, approximately 18 in every 10,000 babies born in the United States each year have a critical CHD. And now, laws requiring CHD screening have been introduced or passed in at least 24 states.
23. Polymerase chain reaction (PCR)
PCR is a lab technique that reproduces small segments of DNA or ribonucleic acid (RNA) for testing. PCR is capable of diagnosing viruses, including everything from bronchiolitis and pneumonia to HIV, much faster. What used to take 24 hours now takes 90 minutes with PCR.
24. CT scans
While the technology has advanced to give providers high-resolution images for diagnostics, the radiation doses of this medical imaging have dropped—minimizing health risks and side effects.
25. Social issues
The rate of social change brings a brand new era of pediatric health care needs.
Neonatal abstinence syndrome (NAS): Every 25 minutes, a baby is born with NAS, according to the Centers for Disease Control. But treating babies born drug dependent is just not something providers were trained for in medical school. Now, children's hospitals around the country are developing protocols to treat these infants and help give them a better start to life.
Gender care: A growing number of children, adolescents and young adults do not identify with traditional definitions of male or female, or their gender identity is different from their sex at birth. Children's hospitals are taking notice and action. Five children's hospitals in the United States now have clinics dedicated to caring for young people with gender-identity concerns.
The next 25 years
Take a look in the crystal ball in the related article, Pediatric Leaders Predict Future Health Care Innovations.
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