Transformation of Pediatric Care Spaces
--- Pediatric Design of the Future
Marianna Jewell, Jamie Beyer, Dr. Jiten Chhabra, Hui Cai
Problem 1
Patients with chronic diseases have to make unnecessary
hospital visits, about matters which can be addressed by
remote bio monitoring techniques
The ability of tele medicine to help children suffering from
Asthma is not being utilized to its maximum capacity
What is Asthma
Increased responsiveness of lower airways to multiple stimuli;
episodic, and with reversible obstruction
Air flow obstruction
Airway hyper responsiveness
Airway inflammation
Numbers (2002)
8.9 million children
10.4 million outpatient visits
1.8 million ER visits
½ million hospitalizations
14.7 million school days were missed
$ 2 billion direct and Indirect costs
Facts (2002)
Asthma is the 3rd ranking cause of
hospitalization for children under 15 yrs.
Low-income populations, minorities & children living
in the inner city are more likely to have ER visits,
hospitalization and death due to asthma then the
general population.
Young children (<4yrs) had the highest rate of
hospitalizations; ( twice the rate than children of
the same age w/o asthma
Asthma Signs and Symptoms
Wheezing, Coughing, Frequents RTI’S, Exercise
intolerance Nighttime worsening, Chest tightness,
Shortness of breath,
Examination: Tachypnea, Tachycardia, Use of accessory respiratory
muscles, Cyanosis, Pulsus paradoxus, Symmetry of
breath sounds, Wheezing, Prolongation of expiratory
phase, Hyperinflation
Investigations: CBC, IGE, Curschmann’s spirals, Charcot-Leyden
crystals, PFT
Mild intermittent
Mild persistent
Moderate persistent
Severe persistent
Treatment: - Acute vs Chronic
Adrenergic agonists, Methylxanthines Anticholinergics
Glucocorticoids, Cromolyn sodium and nedocromil sodium,
Leukotriene modifiers
Peak Expiratory Flow Rates
Evidence Based Medicine
1) The monitoring of peak expiratory flow (PEF) and maintenance
of a symptom diary have been proposed as means to monitor
asthma severity. Daily PEF variability in combination with the daily
frequency of beta-agonist inhalation is very useful in the
management and early detection of acute asthma
2) A program run by the San Mateo Medical Center in San Mateo
County, California helps children manage their asthma through the
use of cell phones. Over a one-year period, these children
experienced no emergency room visits or hospital stays due to
asthma and they rarely came into the clinic for asthma-related
medical treatment.
3) After six months of participation in the program, the
number of emergency room visits decreased significantly
and the activities of daily living were improved in the telemedicine group. Most of the patients in the tele-medicine
group were able to continue measuring and transmitting
peak expiratory flow (PEF) value successfully, and at six
months had noticed an improvement in PEF.
Our Proposal
1) Develop and implement a flexible and open ended
interface to receive, analyze and transmit pediatric
asthma specific information at the hospital end.
2) Research a new parameters like, sub-auditory
wheeze frequencies as a remote monitoring tools for
Monitoring Pendant
Problems addressed
1) Ubiquitous health
2) Reduce number of complications
3) Patient empowerment and involvement
4) Conserve national resources
5) Implementation in the hospital
6) Systems Approach
Problem 2
Lack of accessible interactive educational materials at the
child's level in pediatric hospitals.
•Patients who had their medications electronically reconciled reported a greater
understanding of the medications they were to take after discharge from the
hospital, including medication administration instructions and potential adverse
•Misunderstanding prescriptions and dosages leads to adverse drug effects.
•Patients are encouraged to become "part of the health care team" along with their
physicians, nurses, and pharmacists, to prevent medication mistakes.
Microsoft Surface COW for
Medication Education
Interactive surface easy to use and easy to clean using disposable plastic
Place the medication on the surface and it will be recognized.
Tutorial of instructions, side effects, interactions, alternatives will be given.
 Videos and pictures for clear understanding
Information will be presented at age specific levels.
Choice of language offered.
Print out, email, or video to cell phone for home use
Technology will be more widely used and cost effective in 3-5 years
Flexibility for other applications proves a valuable investment.
Additional Problems Addressed
• Lack of complete knowledge of medications at
the care giver level.
• Lack of understanding on how to self medicate,
especially at the pediatric level.
• Errors due to allergies, interactions, incorrect
• Infections transmitted on highly used surfaces.
• Time of nurses and doctors better spent in other
Problem 3
Waiting room design does not address various
needs of users.
comfort, flexibility, information, interaction, and disaster
• This study demonstrates that hospital charts contain many copies of
the same information, such as medication lists, allergies etc. Due to
manual replication of data fields, there is no mechanism to ensure
that each copy of a data element within a chart actually contains the
same information. This aliasing of data through manual duplication
compromises the integrity of data within paper-based charts.
Decisions and therapy based upon contradictory or inaccurate data
are likely to lead to inefficient or erroneous care delivery; this has
significant implications for hospital liability and quality of patient
Geiger G, Merrilees K, Walo R, Gordon D, Kunov H An analysis of the
paper-based health record: information content and its implications
for electronic patient records. Health Technology Group, Institute of
Biomedical Engineering, University of Toronto
• Flexibility---"Magic chair"
Provide adjustable furniture, can provide different size of chairs and even
unfolded to universal bed that fits different age groups
• Efficiency---"Magic touch”
• Provide "Magic Touch" to incorporate the registration process for
repeated chronic patients. The finger-print identification process is
easy that allows the kids' self-registration. Patient history can be
pulled out

Transformation of Pediatric Care Space