Major League Hacking 2019 Hackathon Season

Pain Points

Pain points are the problems that you will be solving to benefit pediatric medicine. These pain points were captured by physicians, nurses, administrators, child life specialists, social workers, patients, families, and other front-line observers in pediatric medicine from the UPMC Children's Hospital of Pittsburgh community.

Pain Point #1: Stick to the Medicine Schedule

When patients are sent home after a hospital stay, many must follow a strict medication schedule to continue their healing and treatment. These medication regimens can be overwhelming — for example, patients who received organ transplants may need to take eight to 10 medications daily.

If a patient does not adhere to a strict schedule of medication and any other therapy after leaving the hospital, it can lead to recurrence of an illness, a return hospital visit, or even death. Younger children may have trouble accepting the medicine because of bad taste or large-sized pills. Teenagers may rebel and feel frustrated, feeling they don’t need to take the medicine. Or, with busy schedules, people can just forget.

What can we do to ensure that patients are properly following their medication schedules after leaving the hospital, taking the right medication at the right time?

Pain Point #2: Paint a Behavioral Health Picture

Psychiatrists and therapists treating children and young adults face challenges when monitoring the behavioral health of their patients on an ongoing basis. Without ready access to clinical information such as imaging studies or laboratory work available, these therapists are limited to reporting from patients or their guardians, which often cannot capture more than the patient’s most recent emotions and experiences and frequently ignores important factors like sleep habits.

Behavioral health issues in children can become serious, even life-threatening, if their behavior is not accurately monitored, especially after a change in medication or therapy.

How can psychiatrists get a more detailed picture of a pediatric patient’s behavioral health, especially after a change in medication or therapy?

Pain Point #3: Solve Social Isolation

More than 15,000 cases of pediatric cancer are diagnosed each year in the United States. A cancer diagnosis can be a lonely road as the treatment process is long, arduous, and exceptionally isolating. Patients and parents are focused on their treatment and therefore are often separated from their friends, siblings, other family members, and their communities of support for extended periods of time with few options for remaining meaningfully connected.

How can a pediatric health care provider support the emotional journey of a pediatric cancer patient and keep them connected to the people and things that matter most?

Pain Point #4: Synchronize Contacts

UPMC Children’s Hospital of Pittsburgh utilizes two electronic medical record software systems (one for patients in the hospital and another for primary care patients), a patient portal, and separate systems for patient registration and scheduling. Because of the multitude of systems used, keeping patient and family contact information current and updated across all systems is a significant challenge. Patient phone numbers, email addresses, and physical addresses change, creating delays in contacting families and other communication breakdowns between health care providers and families.

How can hospitals ensure patient demographics are updated in a timely and accurate manner and across all information technology systems?

Resource: Patient Demographics

Pain Point #5: Improve Patient History Process

To achieve an accurate diagnosis and start a patient’s path to recovery, it is important to obtain a thorough medical history. Patient interviewing is one of the first things taught in medical and nursing school. However, the quality and accuracy of these histories can be highly variable.

Physicians and nurses speak with parents and caregivers, primary care physicians, and also the patient, depending on a patient’s age and developmental abilities. A long, detailed series of questions address several things that can shape a patient’s health: medication history, allergies, immunizations, family and social life, pets at home, and more. Organizing this amount of information can be difficult. Diagnostic errors contribute to approximately 10 percent of patient deaths according to a 2015 study by the National Academy of Medicine.

How can pediatric health care providers collect a patient’s medical history in a way that is more accurate, standardized, reliable, and quick?

Pain Point #6: Design Breast Milk Storage and Delivery

Babies in UPMC Children’s Hospital’s Neonatal Intensive Care Unit (NICU) are some of the most complicated and vulnerable patients, and a mother’s breast milk can provide them vital health benefits. The NICU can have up to 45 babies every day who receive breast milk every three hours. It is a challenge to remain accurate, efficient, and timely with the hospital’s breast milk storage and delivery process.

The NICU has dedicated milk technicians who follow strict storage guidelines: fresh milk must be refrigerated immediately (unless it will be used within four hours), refrigerated milk must be used within 72 hours, and frozen milk needs to be used within 12 months. Milk technicians retrieve the milk from storage, prepare it so it’s the correct temperature, and deliver it to the patient for tube or bottle feeding.

Since it’s not feasible for a mother to stay in the hospital 24/7, she expresses milk that is stored in one of the hospital’s three refrigerated pantries for later use. Storage space can be an issue, so the mother may be required to take some of the milk home. However, if the NICU runs out of milk, they may need to remind the mother to bring more back in.

How can a pediatric hospital with a NICU create a clear, safe, and efficient process with mixed hardware and software for patients to receive their breast milk at the correct time and temperature?

Pain Point #7: Build a Better Hand-off

During a patient’s hospital stay, more than 150 people can be involved in their care: doctors, nurses, respiratory therapists, social workers, and the patient’s primary care physician. Hand-offs – or sign-outs – occur when a patient is moving from one area of the hospital to another and involve the exchange of important patient information from one clinician to another. For example, a hand-off occurs when a patient moves from the intensive care unit to the operating room for their procedure or, when a shift change occurs and a new group of nurses now care for the child.

Currently, clinical teams communicate this information verbally, through its electronic medical record, and through a hand-off checklist for nurses and physicians.  However, items of communication can often be missed or forgotten, read unclear or confusing, or not occur in a timely manner. This inconsistent communication can jeopardize patient care and impact quality and the patient experience.

What can pediatric health care providers do to ensure the highest quality continuum of care during patient hand-offs?

Resource: Patient Hand-offs

Pain Point #8: Reduce Variations in Clinical Practices

UPMC Children’s has nearly 1,000 doctors on staff, all treating a variety of patients. Some of these patients may arrive with the same conditions but receive varying tests, procedures, and prescriptions. Not only are different patients with the same condition often placed on different treatment plans, but the same patient may even hear conflicting directions from one clinician to another.

Standardizing treatment and prescriptions ordered for patients with similar conditions would improve quality of care, reduce costs to providers and patients, and enhance the patient experience.

How can pediatric health care providers reduce or eliminate this unnecessary variation in clinical practice?

Pain Point #9: Create a Post-Hospitalization Plan

When patients are ready to go home from the hospital, the clinical education specialists at UPMC Children’s educate the families on discharge instructions. This includes scheduling follow-up appointments, reviewing medications that are to be taken at home, and general education on the patient’s path to recovery.

However, a patient’s discharge from the hospital can be chaotic as parents are overwhelmed and exhausted, the patient is antsy to finally go home, and other siblings are itching to leave the hospital. This may not be the ideal time to share crucial information about the child’s care. Vital information may be miscommunicated or unintentionally ignored, endangering the patient’s wellbeing.

Not all education takes place at this time. Clinical education specialists also train the nurses to disseminate education throughout the patient’s stay.

Finding a system that would properly educate families upon a patient’s discharge would help ensure a healthier child and avoid re-admissions to the hospital. What would be an optimal and effective system for providing patient families with post-discharge care instructions?

Pain Point #10: Increase Awareness of Clinical Studies

Clinical research studies expand knowledge in pediatric medicine, therefore boosting medical expertise and quality of care. At UPMC Children’s, there are numerous ongoing clinical trials, ranging from an ongoing study about pain management for children with bone fractures to a study collecting urine samples on healthy children during their well visit.

Every day, thousands of children stop at one of UPMC Children’s Hospital’s locations: the main hospital campus in Lawrenceville or one of many satellite locations, urgent care centers, and primary care doctor’s offices. Representatives, such as research coordinators from the different studies, cannot be present at all these locations, all of the time. Most investigators rely on their personal network and word of mouth to communicate that their clinical study is available and are looking for participants.

Another huge road block in finding participants is that investigators cannot “cold call” and reach out to the patients on their own. They can only reach out to patients if the doctor providing care introduces the study and receives the parent or guardian’s consent. Families trust their doctor; his/her introduction of a potential research study can be crucial in convincing patients to participate.

How can physicians across all these locations be alerted that these research opportunities are available to help improve their patient’s care?

Pain Point #11: Decipher the Asthma Demographics

UPMC Children's currently maintains a database (de-identified information available on Google Cloud Platform during the hackathon) of demographic information for more than 1,000 children treated for asthma at the hospital, including the zip codes where they live. Using publicly available data like the air quality index could help find and track a correlation between what makes these children sick and where they live could have a strong impact on how asthma patients are treated.

How can researchers use this public data and patient demographic information to determine environmental influences on what makes asthma patients sick?