Remember Howard Memorial
We launched the Pediatric Moonshot to reduce healthcare inequity, lower cost and improve patient outcomes for children locally and globally by creating real-time, privacy-preserving applications based on access to data in all 1,000,000 healthcare machines in all 500 children’s hospitals in the world. During the first three years of our mission, we had talked with over 30 children’s hospitals around the world but never to a non-children’s hospital or clinic in a rural county in the US.
Current state of rural healthcare for children nationwide
Over half (56.6%) of all rural counties lack even a single pediatrician, let alone a pediatric cardiologist, oncologists, or neuro-radiologist. Three states have no pediatric emergency medicine clinicians anywhere.
Rural healthcare for children in California
A few months ago, we spent time with the emergency medicine team at Howard Memorial in Willits, CA. As of 2023, Willits has a population of 4,969 and is in Mendocino county where the population is ~88,000, with the largest employer in Mendocino county being the local government. Compare that to the city of Palo Alto, CA, located in Santa Clara County, with a population of ~ 2,000,000 and major employers being Google, Apple and Intel. Stanford Children’s Hospital in Palo Alto has 361-beds devoted entirely to pediatrics. The pediatric cardiology group alone is made up of 144 professionals.
In stark contrast, Howard Memorial has 25 beds with none dedicated to pediatrics. The staff has no one specialized in pediatrics, let alone pediatric cardiology or emergency medicine. As a result, Howard Memorial transfers about 20 children per month to four ERs: UCSF, Stanford, UC Davis and Shriners Burn Unit in Sacramento, CA.
We were surprised to learn about the current state of pediatric emergency medicine image sharing from the perspective of the staff at Howard Memorial.
Below is a recap of our conversation with the Howard Memorial staff. The italicized texts are direct quotes from the staff.
Why do today’s cloud-based image sharing applications not work?
Training every single ER Tech that rolls through how to use the current solution is way too convoluted.
We tried to figure out some sending with PowerShare, and we just couldn’t get it figured out. At the receiving hospital, it doesn’t do any good if I can send it and you can’t see it.
It’s obscene what is happening today. We’re not sharing images, and it’s crazy, it makes no sense. Everything gets tied down in security, and we don’t even know where it gets tied down exactly, and then it just gets pushed off like it’s not important.
Why do you use CD-ROMs?
When we have multiple pediatric trauma patients, we’re going to split them. We’ll give Oakland Children’s a couple, we’ll give UC Davis a couple, and we may give UCSF a couple because we know it’s going to be overwhelming if we send all six to one facility.
Some places like Stanford don’t want PowerShare, period.
What is the transfer process?
Driving from Howard Memorial to the San Francisco Bay Area takes at least 3 hours and is about 140 miles away.
If the patient is the patient is incubated, are we’re having to pack oxygen going over Highway 20 and trying to hit UC Davis is way harder and riskier than shooting up the 101 freeway to hit Oakland Children’s. If we are going to hit San Francisco rush hour traffic, then Oakland Children’s is much faster.
We have to consider all these factors when we decide where to send the patients. And if the image doesn’t make it with the patient in transit? At that point, there’s no way to share the imaging — it’s just a phone call.
Why does the CD-ROM not make it in transit?
The ambulance gets two envelopes: one with the patient record and one with the CD-ROM. They end up taking the one with the patient record and forgetting the CD.
Even if you do every single thing right, there still is a chance that somebody is not handing off the correct envelope. There’s is a chance that from the aircraft to the ambulance to the hospital, something got missed, something got lost, and then what do you do? I I’m here to tell you we have literally sent employees down to the city to the hospitals with another CD-ROM.
When you’re scanning crown to rump, it’s devastating if that CD doesn’t make it.
What’s the implication of not having real-time ER image sharing?
Trauma surgeons need this information, but instead, they are being read an impression. They often say just take a photo on your phone so we can make the right decisions and have the right team ready to receive the patient.
We do a lot of isolated ortho here (at Howard Memorial) so we have been on the receiving end of CD ROMs. You plug it in and you don’t have the right Adobe set up to be able to play it. So we say forget it, let’s just re-image.
The ER determines the transfer wasn’t necessary and discharges the patient at 2 AM. The parents have a three- to four-hour drive back home. They can’t afford to stay in a hotel, so they end up staying in their cars in the parking lots.
Imagine the future.
Anything you can do to streamline this process we would love. We should not be re-radiating children, ever.
A trauma surgeon should be able to view the images on their cell phone so they could be out shopping and still be able to flip through the images and know exactly what they need to get prepared for and be ready in the next 45 minute.s
We need a simple, streamlined nationwide image-sharing network. We can share images of dogs and cats — shouldn’t we do the same for children in an emergency?
