…To make kids better today and healthier tomorrow.

9.9.13

Program Development

Children’s Telemedicine

Program

Children’s Physician Group

at Children’s Specialty Services

Subspecialist at Egleston

Children’s Physician Group at North Druid

Hills

Marcus Autism

Additional Clinic Space

Subspecialist at Scottish

Rite

Stephanie Blank Center for Safe and

Healthy Children

• 501(c)3 – Not for Profit

• Network of Partners

• Minimal Partnership Fees: Field-Based Telehealth Liaisons Support for Credentialing Scheduling System Centralized PACS System 24/7 support for network

partners Access to Network

Our Program Our Network Partner

Clinical Services OfferedCurrent Specialties and Number of

Physicians:• Allergy and Immunology (1)• Autism (1) • Cardiology (1)• Child Protection (3)• Concussion/Neurosurgery (1)• Endocrinology (1)• Fetal ECHO (9)• Gastroenterology (1) • Nephrology (2)• Pulmonology (2) • Sports Medicine/Concussion (1)

Coming soon:• Autism (1)• Apnea (1)• Ear, Nose, Throat (1)• Transplant (1)• Neurology-Keto patients only (1)• Pulmonology (1)

Telemedicine: Working Together for Better Care

Patient Volume

2009 2010 2011 2012 20130

200

400

600

800

1000

1200

88

461

823971

767

Total/OverallNumber of Patients Seen

Through October 2013

CSHC

Specialist

Marcus

Total

0 200 400 600 800 1000 1200

92

355

524

971

91

231

445

767

2012 - 2013Through October 2013

Number of Patients Seen

20132012

Number of Patients Since Inception: 3,110

CONCUSSION:The Facts and Controversy

David M Popoli, MD

Pediatric and Adolescent Sports Medicine

Medical Director for Telemedicine

The Statistics

• 2008 (ED data)– 60 million youth 5-14 yr in organized sports– 3.8 million concussions from sport and

recreation– Underestimated due to under-reporting (1)

• 2009-2010 (H.S. Reporting Information Online)– 192 High Schools– 1056 Concussions

Objectives

• Define concussion• Explain concussion pathway• Discuss treatment and prevention• Georgia Return to Play Act 2014• Discuss controversies

Definition

• Consensus Guidelines 2012• Characteristics

1. Direct or impulsive force2. Rapid onset 3. Functional4. Clinical symptoms5. No abnormality on standard imaging

This is Not a “Bump on the Head”

The Big Picture

What’s Really Happening

Twist/Stretch

“Leaks” Electrical discharge Recharge

Mechanical Injury leads to Chemical Change

Assessment – What You’ll Be Told

• Symptoms • School performance• Activity tolerance• Sleep• Appetite• Mood

Assessment -- Symptoms• Loss of Consciousness• Amnesia, retrograde or anterograde• Disorientation • Appearing dazed• Acting confused• Forgetting game rules or play assignments• Inability to recall score or opponent• Inappropriate emotionality• Physical incoordination• Imbalance• Seizure• Slow verbal responses• Personality changes• Headache

• Headache• Nausea or vomiting• Difficulty balancing• Vision changes• Photophobia• Phonophobia• Feeling “out of it”• Difficulty concentrating • Tinnitus • Drowsiness• Sadness• Hallucinations

Assessment – What You’ll Be Told

Assessment – What You’ll See

• Mental status• Coordination/Balance/Walking• Strength• Sensation

Technology and Concussion Management

• Computerized neuropsychological testing• Telemedicine/telehealth

Computerized Neuropsychological Testing

Computerized Neuropsychological Testing

0102030405060708090

100

Baseline Post Injury1

Post Injury2

Post Injury3

Verbal Memory

Visual Memory

Processing Speed

Reaction Time

6 Days Post 16 Days Post 23 Days Post

Per

cent

ile

Telemedicine/Telehealth

• Improved clinical reach• Improved education/awareness• Convenience• Cost• Piece of mind

Current Sites

20

*Map and total does not include Child Advocacy Centers

• Participating with 43 presenting sites throughout Georgia*

• 11 specialties with 23 physicians- Future: 14 specialties 27 physicians

• Types of presenting sites- Hospitals- Primary care offices- Schools- Public Health Departments- DFCS offices

Our Community…

21

Research – Abstract accepted by Pediatric Academic Society “Resource Savings, Family and Societal Benefits of a Statewide Pediatric Telemedicine Program”.

• Patients served live in 63 of the Georgia’s 159 counties • 40% of all counties • All outside of the MSA

• 83% of our patients are covered by Medicaid /CMO’s• Overall cost of miles saved: $171,083 (0.55/mile)

2012 Statistics…Per visit: Median(Round Trip)

Range(Round Trip)

Miles Saved 333 72-524

Cost of miles saved $177 $39-$273

Hours Saved Traveling 5.8 2.0-9.0

School days*Children greater than 5 y/o

76% of our patients would have missed school to travel to Atlanta

Work Days Missed*One adult present

>75% of our parents would have missed a full day of work to travel to Atlanta

Management

• Physical and cognitive rest• Academic accommodations• RTP stages • Imaging* • Medication*

Academic Accommodations Algorithm

Georgia Return to Play Act• All public and private schools which provide youth athletic activities

are required: – Provide information to parents on the nature and risk of concussion and head

injuries– Establish a concussion management and return to play policy to include:

• An Information sheet prior to the beginning of each athletic season• Youth athlete must be removed from play if exhibiting symptoms• Youth athlete must be cleared by a healthcare provider before return to play

• Public recreational programs are also required to provide information to parents on the nature and risk of concussion and head injuries

• Georgia Department of Public Health shall endorse one or more concussion recognition education courses to inform Georgia citizens of the nature and risk of concussions in youth athletics

• Effective date: January 1, 2014

Return to Play

Stage Exercise Goal1 None Recovery2 Light Aerobic Increase HR3 Sport-Specific Add movement4 Non-Contact Drills Coordination5 Controlled-Contact

DrillsRestore

Confidence6 Full Contact Practice Game Ready7 Competition Play

Cumulative Effects

Prevention

• Mouthguards• Helmets• Rules/regulations• Style of play

More Information

• Children’s Healthcare of Atlanta• Centers for Disease Control and Prevention