Daniel Plotkin


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Daniel Plotkin

  1. 1. Moving HIT Into Schools Daniel R. Plotkin eHealth Program Administrator Childrens Hospital Los Angeles A Pediatric eHealth Teledentistry Model in Rural California
  2. 2. eHealth Defined <ul><li>“ Telemedicine and eHealth are the use of electronic communication technologies as a method of delivering medical care, health education, and related services” </li></ul>
  3. 3. Teledentistry emerges from the fusion of dental practice and technology It involves the use of technology for the acquisition and exchange of clinical information and images over remote distance for dental consultation, treatment planning and oral health instruction/education Teledentistry
  4. 4. Founded April 1 st , 1901 - 4 beds First hospital in Los Angeles dedicated to children Today - 286 beds (40 NICU, 20 PICU, 15 Cardio ICU) Level I Pediatric Trauma Center 528 physicians, 92% board-certified USC Keck School of Medicine affiliated teaching hospital 33 Pediatric specialties International leader in treatment of most complex pediatric injuries and disease Childrens Hospital Los Angeles
  5. 5. CHLA Division of Dentistry Provides routine and specialized dental and orthodontic care to over 3,500 children and adolescents annually, primarily medically compromised/fragile Pediatric Dentistry General Dentistry Oral Surgery Craniofacial Prosthodontics Orthodontics Craniofacial Orthodontics Periodontics Dental Hygiene 16 rotating USC pediatric dentistry residents per year 6 UCLA General Practice Residents 4 Oral Surgery Residents Division Head: José C. Polido, D.D.S., M.S.
  6. 6. Program Background <ul><li>Invited by California Telemedicine & eHealth Center </li></ul><ul><li>(CTEC) to create an eHealth network model linking </li></ul><ul><li>Childrens Hospital Los Angeles with rural, underserved </li></ul><ul><li>communities in central California </li></ul><ul><li>Children of agricultural workers </li></ul><ul><li>A multi-disciplinary, sustainable and replicable eHealth model for the delivery of preventive oral health services and the general enhancement of pediatric oral health </li></ul><ul><li>Designed to connect with other developing eHealth networks in the longer term </li></ul>
  7. 7. Federal Funding United States Department of Agriculture - Rural Development Three grants awarded to school districts for establishment of eHealth Teledentistry clinics and dental/eHealth equipment acquisition Health Resources and Services Administration Grants to two school school districts to support the hiring of Certified Application Assistants/case managers focused on insurance status and to ensure treatment follow up. Limited funds also provided for emergency dental treatment
  8. 8. 3 School Districts in rural Tulare County Cutler-Orosi Joint Unified Superintendent: Carolyn Kehrli, Ed.D. Lindsay Joint Unified Superintendent: Janet Kliegl Woodlake Public Schools Superintendent: Tim Hire
  9. 9. Woodlake, Tulare County <ul><li>200 miles from Los Angeles </li></ul><ul><li>84% Latino population </li></ul><ul><li>11 th poorest community in California </li></ul><ul><li>Principal occupation is seasonal farm labor, primarily citrus </li></ul><ul><li>Approx. 30% families receive AFDC (Aid to Families with Dependent Children) </li></ul><ul><li>Approx. 40% families with children have no health insurance </li></ul><ul><li>46% children enter school non/limited English proficient </li></ul><ul><li>100% children eligible for free school meals </li></ul>
  10. 10. Barriers to Care <ul><li>Paucity of local providers </li></ul><ul><ul><li>and/or lack of pediatric training/expertise among providers </li></ul></ul><ul><li>Inability to pay for treatment </li></ul><ul><li>and common lack of information on available programs </li></ul><ul><li>Lack of health awareness/education among families, often due to cultural differences </li></ul><ul><li>Inability to reach the point of care </li></ul>
  11. 11. California Research and Education Network (CalREN) <ul><li>CalREN is the high speed, high bandwidth optical IT network, created by The Corporation for Education Network Initiatives in California (CENIC) </li></ul>Charter Institutions Stanford University University of California Caltech California State University University of Southern California
  12. 12. K-12 High Speed Network (HSN) K-12 HSN is a state funded effort to create an integrated high speed, high bandwidth network infrastructure linking county offices of education, school districts and K-12 schools in California
  13. 13. Currently, Network and Internet services provided to: 81% (7,646) of public schools 87% (863) of school districts 100% (58) of county offices of education   Today, this network provides connectivity to over 5 million K-12 students in California
  14. 14. California K-12 High Speed Network (HSN) www.k12hsn.org
  15. 16. <ul><ul><li>Provide comprehensive, preventive oral health care, under general remote supervision of faculty DDS at Childrens Hospital Los Angeles/USC School of Dentistry </li></ul></ul><ul><ul><li>Establish local referral, consultation network for restorative care </li></ul></ul><ul><ul><li>Share pediatric oral health resources and expertise </li></ul></ul><ul><ul><li>Create continuum of care – </li></ul></ul><ul><ul><li>Establish ‘Dental Home’ for those in need </li></ul></ul>eHealth Program: Clinical Objectives
  16. 17. eHealth Program: Educational Objectives <ul><li>Train local providers, clinicians, allied healthcare professionals </li></ul><ul><li>Continuing Education via eHealth </li></ul><ul><li>*CHLA/USCSD is licensed Dental Board CE provider </li></ul><ul><li>Educate children and families </li></ul><ul><li>Chair side instruction and development of culturally sensitive o ral health curricula </li></ul><ul><li>Increase awareness of graduate/post </li></ul><ul><li>graduate urban based dental students to great </li></ul><ul><li>opportunities in pediatric rural health </li></ul>
  17. 18. <ul><li>Utilization of HIT/eHealth systems and practices to encourage behavior modification in high risk patients and families leading to </li></ul><ul><li>life long health </li></ul>Change the Paradigm!
  18. 19. Program Activities <ul><li>Creation of integrated eHealth center in Division of Dentistry at Childrens Hospital. ‘Normal practice’ </li></ul><ul><li>2. Establishment of fully networked and equipped dental clinics in Woodlake, Lindsay and Cutler-Orosi school districts, connected to CHLA via CalREN/K12 HSN </li></ul><ul><li>3. Appointment of Registered Dental Hygienist to rotate through districts and lead program clinical and educational activities, in close collaboration with school district health and administrative personnel and the Division of Dentistry at Childrens Hospital Los Angeles </li></ul>
  19. 20. Cutler-Orosi Joint Unified School District, 2006
  20. 22. eHealth Clinic, Cutler-Orosi Joint Unified School District, 2007
  21. 24. Woodlake Public Schools, 2006
  22. 25. eHealth Clinic, Woodlake Public Schools, 2007
  23. 26. Initial Clinical Process Registration within CHLA systems (McKesson STAR) New Patient Visit Review of medical history Examination via eHealth with DDS Charting of oral conditions (CHLA based Dentrix software) - obvious caries lesions, plaque and gingival scores X-rays, photographs, cleanings, as prescribed by DDS (DDS at CHLA reviews x-rays and photographs via eHealth system) Personalized Oral Hygiene Instructions delivered to child Prevention interventions – Fluoride treatments Coordinate restorative care with local DDS Following parental consent, oral health screenings (ASTDD guidelines) performed to document need and identify patient eligibility for eHealth referral
  24. 27. Expected Outcomes <ul><li>Establishment of baseline and ongoing epidemiological </li></ul><ul><li>oral health data for target population </li></ul><ul><li>Measurable improvement in general oral health of target </li></ul><ul><li>population as shown by standard measurements </li></ul><ul><li>(caries experience, gingival indexes etc.) </li></ul><ul><li>Increased awareness of pediatric oral health issues </li></ul><ul><li>among community based healthcare providers </li></ul><ul><li>Adoption of improved oral health practices among </li></ul><ul><li>families and children </li></ul>
  25. 28. <ul><li>Childrens Hospital Los Angeles </li></ul><ul><li>USC School of Dentistry – Community Health Programs </li></ul><ul><li>California Telemedicine & eHealth Center </li></ul><ul><li>Tulare County Office of Education </li></ul><ul><li>Cutler-Orosi Joint Unified School District </li></ul><ul><li>Lindsay Unified School District </li></ul><ul><li>Woodlake Public Schools </li></ul><ul><li>Woodlake Family Resource Center </li></ul><ul><li>U.S. Department of Agriculture – Rural Development </li></ul><ul><li>HRSA </li></ul><ul><li>Henry Schein Dental (with Pelton & Crane) </li></ul><ul><li>First 5 Tulare County </li></ul>Collaboration ~ Integration
  26. 29. “ We believe that your program offers a bright ray of hope for our children and their families…” E. Sheli Silva, Administrator Migrant Education Program, Region VIII Tulare County Office of Education
  27. 30. Daniel R. Plotkin eHealth Program Administrator Childrens Hospital Los Angeles Phone: (323) 361-8740 [email_address] www.childrenshospitalla.org/ehealthprogram