Daniel R. PlotkinDaniel R. PlotkineHealth Program AdministratoreHealth Program Administrator

Childrens Hospital Los AngelesChildrens Hospital Los Angeles

Moving HIT Into Moving HIT Into SchoolsSchoolsA Pediatric eHealth Teledentistry

Model in Rural California

eHealth DefinedeHealth Defined

“Telemedicine and eHealth are the use of electronic communication technologies as a method of delivering medical care, health education, and related services”

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

TeledentistryTeledentistry

Founded April 1st, 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 AngelesChildrens Hospital Los Angeles

CHLA Division of DentistryCHLA 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 DentistryOral Surgery Craniofacial ProsthodonticsOrthodontics Craniofacial OrthodonticsPeriodontics Dental Hygiene

16 rotating USC pediatric dentistry residents per year6 UCLA General Practice Residents

4 Oral Surgery Residents

Division Head: José C. Polido, D.D.S., M.S.Division Head: José C. Polido, D.D.S., M.S.

Program BackgroundProgram Background

Invited by California Telemedicine & eHealth Center (CTEC) to create an eHealth network model linking Childrens Hospital Los Angeles with rural, underserved communities in central California

• Children of agricultural workers

• A multi-disciplinary, sustainable and replicable eHealth model for the delivery of preventive oral health services and the general enhancement of pediatric oral health

• Designed to connect with other developing eHealth networks in the longer term

Federal FundingFederal 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

3 School Districts in rural Tulare County3 School Districts in rural Tulare County

Cutler-Orosi Joint UnifiedCutler-Orosi Joint UnifiedSuperintendent: Carolyn Kehrli, Ed.D.Superintendent: Carolyn Kehrli, Ed.D.

Lindsay Joint UnifiedLindsay Joint UnifiedSuperintendent: Janet KlieglSuperintendent: Janet Kliegl

Woodlake Public SchoolsWoodlake Public SchoolsSuperintendent: Tim HireSuperintendent: Tim Hire

Woodlake, Tulare CountyWoodlake, Tulare County• 200 miles from Los Angeles• 84% Latino population• 11th poorest community in

California• Principal occupation is seasonal

farm labor, primarily citrus• Approx. 30% families receive

AFDC (Aid to Families with Dependent Children)

• Approx. 40% families with children have no health insurance

• 46% children enter school non/limited English proficient

• 100% children eligible for free school meals

Barriers to CareBarriers to Care• Paucity of local providers

and/or lack of pediatric training/expertise among providers

• Inability to pay for treatmentand common lack of information on available

programs

• Lack of health awareness/education among families, often due to cultural differences

• Inability to reach the point of care

CaliforniaCalifornia Research and Education Network (CalREN)

CalREN is the high speed, high bandwidth optical IT network, created by The Corporation for Education

Network Initiatives in California (CENIC)

Charter Institutions

Stanford UniversityUniversity of California

CaltechCalifornia State University

University of Southern California

K-12 High Speed Network K-12 High Speed Network (HSN)(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

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

California K-12 High California K-12 High Speed Network (HSN)Speed Network (HSN)

www.k12hsn.org

Provide comprehensive, preventive oral health care, under general remote supervision of faculty DDS at Childrens Hospital Los Angeles/USC School of Dentistry

Establish local referral, consultation network for restorative care

Share pediatric oral health resources and expertise

Create continuum of care – Establish ‘Dental Home’ for those in need

eHealth Program: Clinical ObjectiveseHealth Program: Clinical Objectives

eHealth Program: Educational ObjectiveseHealth Program: Educational Objectives

Train local providers, clinicians, allied Train local providers, clinicians, allied healthcare professionalshealthcare professionals Continuing Education via eHealth*CHLA/USCSD is licensed Dental Board CE provider

Educate children and familiesEducate children and families Chair side instruction and development of culturally sensitive oral health curricula

Increase awareness of graduate/postIncrease awareness of graduate/postgraduate urban based dental students to greatgraduate urban based dental students to greatopportunities in pediatric rural healthopportunities in pediatric rural health

Utilization of HIT/eHealth systems Utilization of HIT/eHealth systems and practices to encourage and practices to encourage

behavior modification in high risk behavior modification in high risk patients and families leading to patients and families leading to

life long healthlife long health

Change the Paradigm!Change the Paradigm!

Program ActivitiesProgram Activities1. Creation of integrated eHealth center in Division of

Dentistry at Childrens Hospital. ‘Normal practice’

2. Establishment of fully networked and equipped dental clinics in Woodlake, Lindsay and Cutler-Orosi school districts, connected to CHLA via CalREN/K12 HSN

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

Cutler-Orosi Joint Unified School District, 2006Cutler-Orosi Joint Unified School District, 2006

eHealth Clinic, Cutler-Orosi Joint Unified eHealth Clinic, Cutler-Orosi Joint Unified School District, 2007School District, 2007

Woodlake Public Schools, 2006

eHealth Clinic, Woodlake Public Schools, 2007

Initial Clinical ProcessInitial 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

Expected OutcomesExpected Outcomes

• Establishment of baseline and ongoing epidemiologicaloral health data for target population

• Measurable improvement in general oral health of target population as shown by standard measurements (caries experience, gingival indexes etc.)

• Increased awareness of pediatric oral health issues among community based healthcare providers

• Adoption of improved oral health practices among families and children

Childrens Hospital Los AngelesUSC School of Dentistry – Community Health ProgramsCalifornia Telemedicine & eHealth CenterTulare County Office of EducationCutler-Orosi Joint Unified School DistrictLindsay Unified School DistrictWoodlake Public SchoolsWoodlake Family Resource CenterU.S. Department of Agriculture – Rural DevelopmentHRSAHenry Schein Dental (with Pelton & Crane)First 5 Tulare County

Collaboration ~ IntegrationCollaboration ~ Integration

“We believe that your program offers a bright ray of hope for our children and their families…”

E. Sheli Silva, AdministratorMigrant Education Program, Region VIIITulare County Office of Education

Daniel R. PlotkinDaniel R. Plotkin

eHealth Program Administrator

Childrens Hospital Los Angeles

Phone: (323) 361-8740

dplotkin@chla.usc.edu

www.childrenshospitalla.org/ehealthprogram