Skip to content Skip to navigation

Co-Development of a Solution for Care Management in the Pediatric ICU: One Team’s Experience

April 27, 2013
by Mark Hagland
| Reprints
An exciting initiative has been moving forward at Boston Children’s Hospital, with important implications for pediatric ICU care management industry-wide

Exciting things have been happening these days at Boston Children’s Hospital, where clinician leaders have been moving forward to implement advanced solutions to support the integration of data from patient monitoring devices into real-time care management in the intensive care unit (ICU) and cardiac intensive care unit (CICU) care areas.

The effort at Boston Children’s was led until recently by Peter C. Laussen, M.D., and Melvin C. Almodovar, M.D. Dr. Laussen, who spent 20 years at Boston Children’s, the last 10 of them as chief of cardiac critical care, in September 2012 moved to Toronto to become chief of the department of critical care medicine at that Canadian city’s Hospital for Sick Children. Dr. Almodovar, medical director of the CICU at Boston Children’s, continues in his leadership role there.

Together, Drs. Laussen and Almodovar brought in programmers and designers from the Burlington, Mass.-based Arcadia Solutions. Through their collaborative partnership, the people at Arcadia Solutions and Boston Children’s have developed a combination of solutions called T3, which stands for “Tracking,” Trajectory, and Trigger,” and helps critical care physicians and nurses to track all information coming out of patients’ bedside monitors; calculates trends in the data and displays a patient’s real-time trajectory; and triggers actions to avert crises and to make the most efficient use of the resources available in the critical care units.

The partnership with Arcadia has also led to a variety of additional capabilities, including a “stability index algorithm,” a tool that generates a numeric index to indicate the extent to which a patient’s physiologic measurements deviate from clinician-chosen parameters; complete data visualization or morbidity and mortality reviews; a historical data repository, to provide researchers with access to all the historical data for large-scale analysis; and integration with additional demographic information, and with intermittent (aperiodic) blood pressure data.

Given that physicians can have more than 10 devices at each patient’s bedside whose data they need to track and analyze, the implications of the development of such solutions are considerable. In order to provide insights into all of this, Drs. Almodovar and Laussen spoke recently with HCI Editor-in-Chief Mark Hagland. Below are excerpts from that interview.

Can you share with our readers a bit of the history of this co-development? You were both involved in the development and implementation of the T3 solution, correct?

Melvin C. Almodovar, M.D.: Yes, that’s correct. T3 was conceived three-and-a-half years ago, and it started through a partnership with Arcadia.

Melvin C. Almodovar, M.D.

Peter C. Laussen, M.D.: How this all began is that, nearly four years ago now, Mel and I agreed that our biggest problem in the ICU was being able to integrate these massive amounts of physiologic data streams, being able to integrate and interpret the data, as well as analyzing it and being predictive in how we manage patients. So our first step was to try to find a partner externally that would be able to support our vision. Arcadia Solutions had approached us to develop some kind of collaboration; and that approach had come about through circumstance, when Mel met the company’s COO at the time at a function, and that gentleman came in and met with Mel and me. So we shared our vision with them, and Arcadia went away for a little while, and then they came back and said they’d like to explore this further.

We were fortunate at Boston Children’s, in that I had an endowed chair, and was able to use funding from that endowment to hire Arcadia initially to develop a sort of proof of concept.  Arcadia thought about the problem and came back to us with possible solutions; and we realized at that point that a solution was achievable, and that we could capture the data and store and analyze it, in a much more meaningful way. So we began working together, while funding the work on a fee-for-service basis for their involvement. This was a new area for them as well, so they hired some very key personnel, and for the next three, four years, we’ve worked extremely closely with a wonderful T3 team of program developers and managers to where we have an end product that’s been in place since June of last year [2012] in the 29-bed cardiac ICU and in the 30-bed medical/surgical ICU at Boston Children’s.

Peter C. Laussen, M.D.

And now you’ve begun using it at the Hospital for Sick Children as well?

Laussen: Yes, we’re now using it in our 42-bed ICU here as well.

Let’s drill down a bit on the capabilities of the solution.

Laussen: First of all, the name T3 was chosen to represent what the tool does: it’s a tracking, trajectory, and trigger tool, a web-based software platform that captures continuous physiologic data feeds from the bedside through an HL7 feed. The data is then captured and stored on a separate server, which then enables us to do various calculations and to perform integration with the data, and then the data is fed back to a platform that allows us to look at the data in a different way. It’s sort of like using Google Maps or iTunes playlist; we can continuously look at different pieces of data, and really understand relationships between critical physiologic data at the bedside; that’s the tracking component of it.