For children with attention deficit/hyperactivity disorder and their parents, every day is a challenge. And in a best-case scenario, each child is seen by a doctor once a month. That's at least 30 days of challenges squeezed into one office visit.
To pediatricians like Phil Lichtenstein, MD, of Cincinnati Children's Hospital Medical Center, who treats dozens of children with ADHD, that's not acceptable. For the past six years, he's been using an online platform called mehealth for ADHD, which enables him to connect remotely with parents, teachers, coaches and other caregivers, review daily reports on a child's well-being and order changes in treatment that can produce results within days.
"It's a really useful tool and I think it just dramatically changes the playing field," says Lichtenstein.
ADHD and associated behavioral disorders are particularly taxing because of the amount of effort and paperwork that goes into diagnosing and treating children. A legitimate diagnosis requires that ADHD criteria be met in at least two locations – home and school are the obvious choices – but that involves a lot of communication between the doctor and those supervising the child. Typically, parents, teachers and others would have to fill out paper reports, which would then be sent to the pediatrician, who would then review them and make the diagnosis. That could take several days, if not weeks or months. The same would go for any treatment plan.
Because that type of workload is so daunting, pediatricians often "outsource" treatment of children with ADHD to pediatric psychiatrists, who themselves are in short supply and ever more demand.
Developed by Cincinnati Children's in conjunction with researchers at Duke University and UK-based Optimal Medicine and launched in 2013, the mehealth for ADHD clinical decision support platform enables pediatricians like Lichtenstein to diagnose and treat a child with ADHD through an online portal that augments the face-to-face visit. The portal is used by parents, teachers and others in daily contact with the child, all of whom fill out a fairly intensive questionnaire. Lichtenstein uses the results of those questionnaires to evaluate the child's condition and manage his or her treatment plan.
With so many children diagnosed with ADHD (11 percent of the nation's school-aged children, according to the Centers for Disease Control and Prevention) or similar behavioral disorders and so few doctors able to treat them, mHealth is emerging as a vital tool in making sure treatment is delivered when and where it's needed – rather than only during the office visit, which might not occur more than once every three months. Lichtenstein points out that ADHD medications can be adjusted every three to seven days if necessary, so it's vital to monitor children on an almost-daily basis to see if any changes in medication are needed and, when instituted, whether they work.
"In the old world, working with paper, it would be impossible to get this turn-around time," Lichtenstein says, and the child and his/her caregivers would suffer as a result. "In actuality, with something like this, you can make decisions without needing a face-to-face visit, and can actually manage treatment several times in between office visits."
In addition, the online questionnaires are analyzed by software to help the pediatrician spot symptoms, track them over time and better prepare a treatment plan. On the business side, software identifies billable activities and suggests the appropriate code to be used, helping clinicians to make sure their expenses are covered. And all the data is stored for auditing purposes, giving clinicians an their supervisors the opportunity to analyze how each child is being treated.
"It's just orders of magnitude more simple," he added.
Lichtenstein calls the mehealth for ADHD portal "a nice way to get your feet wet with online communication," and expects the technology – and the way it's used – to expand over time. He sees a day when videoconferencing might be added to treatment, allowing pediatricians to schedule more face-to-face visits and to "see what people are seeing beyond the questionnaires."
