Mar 26 2024
Digital Workspace

Q&A: How Phoenix Children’s Integrates Virtual Care with a Voice Command

The Arizona-based health system leveraged a familiar consumer device to connect patients and their families with much-needed support.

A growing number of U.S. households are familiar with smart home devices, using voice commands to check the weather or to order more cleaning supplies.

So, with the increasing ubiquity of such technology, how might it be used in a healthcare setting? David Higginson, executive vice president and chief innovation officer at Phoenix Children’s, decided to place Amazon Echo Show and Alexa devices in clinics to better integrate virtual care access for patients, clinicians and support staff.

For instance, instead of interpreters having to travel to provide their services in person, they can now hop on Zoom when requested by a clinician, boosting productivity and streamlining workflows. 

“It’s not something that IT just rolled out and people are scared to use. It's very accessible, which is how it should be,” he says.

Higginson spoke with HealthTech about how integrated virtual care can connect patients and their caregivers with key services without adding travel time, while also offering healthcare teams a user-friendly device that improves workflows in support of a more holistic, continuous approach to care.

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HEALTHTECH: What are the main drivers that push Phoenix Children's to stay innovative with telemedicine? How are you measuring success and addressing challenges?

HIGGINSON: We learned that some disciplines really do thrive on telehealth, whereas others don't. We integrated Zoom as our telehealth platform, which we picked primarily because our families were so used to that name.

I have heard some amazing stories from our patient family advisory councils. People who used to come to the hospital three times a week from three hours away could now use telehealth to reduce the number of times they had to appear in person. In the pandemic, many spouses shared, “I've been involved with my child's healthcare. I've been at every appointment virtually, and I've never done that before. Now I feel so much more connected to the experience, and I don't want to give that up.” So, when clinics were returning to in-person visits, we started thinking, how could we stay connected with the other caregivers of the family who can't physically attend? How could we bring other people in? How could we have a hybrid visit?

That's how the use of Amazon Alexa came to mind because I've used those devices, and they had just started integrating with Zoom. These devices don't break. You don't have to wheel them around. And most important, when a parent says, “Could you bring my wife or husband or whoever into the call,” the device has to be there and ready, and it has to be a three-second thing to get it to work. It can't be calling a bunch of people and scrambling around to make it work, or no one's going to do it. I can't tell you now the number of add-on people we can bring into the visit. It's gone from a couple of extra family members to interpreters, social workers and other people who need to interact but just for a short period of time.

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Our interpreters used to run around the hospital to every visit as needed. We never could get them to be more than 60 percent productive because a lot of their time was spent not on translation but on travel and waiting. Now their productivity rate is nearly 90 percent because they just drop into the Zoom meeting when they're needed, they translate, and then they drop back out. Our strategy is to try to stay connected to our families and meet them where they are rather than making them always come into the hospital.

HEALTHTECH: Please walk us through the use of Amazon Echo Show and Alexa devices at your clinics. What was the initial reaction to the proposal? What were some concerns, and how did you address them? 

HIGGINSON: I was searching for how to provide this in a low impact way to IT. How can we have it always available? They're very inexpensive. There's no ongoing cost, and if they stop working, you just unplug them and plug them back in. From a technology perspective, it was really a sweet spot. We approached Amazon at that time and found they were just at the infancy of a program called Alexa Smart Properties. They were aware of what we were working on and helped us.

We tested the devices in a couple of clinics first. It’s rare in IT that you have the clinical staff immediately adopt something and then run with it. Within two weeks, we were finding use cases that we hadn't thought of that they'd already come up with. A great example is for an allergy workup; we can be booked out for that. One day, the doctor got sick and couldn't come in. The team thought they would have to cancel all of these appointments. But instead, the doctor connected remotely with the nurse and the patient in clinic. On a dime, the clinic figured out how to use the Alexa device to bring everyone together and keep the appointment. With that degree of ownership and adoption, I knew we were onto something.

EXPLORE: Specialty care is leading the change in telehealth.

We then quickly rolled out the Echo Show devices across the rest of the organization and provided some limited training. We decided to commit to all 750 exam rooms at Phoenix Children’s Thomas Campus because we wanted that notion of it being always available.

Another use case that has really elevated this tool is for mental health screenings. In many children's hospitals, when you treat the patient for gastroenterology or general pediatrics, you do a screening to make sure that child is in a good, safe space. A big challenge is acting once you collect that information. So, we built an electronic tool where patients can do the survey and scoring right before they get to the visit, and then we assign color-coded zones for that patient, that way they may go straight to the emergency room for a serious need or immediately know they need a therapy appointment. As a GI doctor finishes the visit, they do a hot handoff to a mental health therapist on Zoom, who has already queued up the list of patients who have just screened positive for suicide risk. The therapists make sure patients don't leave without another appointment or without the help they need to deal with whatever crisis they're having in that moment. That has made a huge difference. We've now rolled out that process over multiple clinics — I can't tell you the number of families who have said, “This saved my child.” So, this kind of virtual environment works really well. That is really the ideal use case, where we've worked it into a process versus just having an ad hoc device.

HEALTHTECH: What else is in store for the use of Alexa at your clinics? How has having such a consumer-friendly tool used in a clinical setting changed processes or even mindsets among staff?

HIGGINSON: We've changed the processes with those ancillary clinical staff being able to potentially be remote all or some of the time. For staff in the clinic, it's just another tool that they have that they don’t feel intimidated by. It is now something that many of them are used to.

We're focused on the inpatient room now. We will soon have hospitals in many parts of the state, and if you need a neurologist who’s 30 miles away, we now have an opportunity to do a remote consultation for a patient without having a nurse wheel in a device and manage the whole thing effectively as an audiovisual assistant — which is not good use of a nurse's time and skill. We're working very hard on this idea: Can the consultant who is remote do a virtual knock on the door? We don't want yet another device in the room that's going to get broken. We’re trying to leverage the television as much as we can. And then, more important, we want to establish this workflow where a neurologist can be between clinic appointments, do a quick consult 30 miles away and not have to drive three hours in order to do that. That's a great opportunity for everybody: quicker care for patients and a better experience for our clinicians. It's a pretty difficult challenge, but that's what we're hoping to crack.

David Higginson
I would encourage people to be adventurous and try things out for themselves, as well as listening to the patients and their families first and foremost.”

David Higginson Executive Vice President and Chief Innovation Officer, Phoenix Children’s

HEALTHTECH: What advice do you have for organizations looking for innovative approaches to telemedicine? How can organizations that feel stagnant in their programs revitalize their efforts? 

HIGGINSON: Listen to your customers or your patients. For us, that parent and patient feedback every month, hearing what's working, what's not, the things that we never thought about but that were surfaced, that's where I'd always start — not the interesting, cool tech that you've seen that you want to implement. And sometimes it’s difficult for IT folks to resist that shiny object.

The second thing is to just give it a go. We didn't hire a consulting company. We just got some devices, and we tried it out. I think we often create so many barriers and so much expense before achieving an outcome. While that may be appropriate, I think you have to just give it a try — don't make it such a heavy lift and such a difficult initiative to take on. I would encourage people to be adventurous and try things out for themselves, as well as listening to the patients and their families first and foremost.

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