Collaborative Team Approach Provides High-level Pediatric Neurology with a Broad Regional Reach

By: Thomas Crocker
Monday, June 13, 2016

WellSpan Pediatric Neurology extends academic-level care for epilepsy, concussion, pediatric headache, developmental disorders and other neurological conditions of childhood across the communities of Central Pennsylvania. This allows patients to receive advanced specialty care near their homes.

Pediatric neurologists William Benko, MD; Jena Khera, MD; and Todd Barron, MD, Medical Director of WellSpan Neurosciences, as well as certified registered nurse practitioners Amy Brickner and Matthew Hendell, offer a wide range of diagnostic and treatment options for pediatric neurological disorders. These include integrated, systemwide approaches to managing headache and concussion, in addition to inpatient and ambulatory electroencephalography monitoring and vagus nerve stimulation for epilepsy.

Demand for pediatric neurology services in Central Pennsylvania is growing. In 2015, WellSpan Pediatric Neurology specialists saw more than 7,000 patients in their practice; nearly 22 percent were new patients.

“We want to ensure patients are seen quickly, which is important for this population,” says Lori Clark, Vice President of Neurosciences at WellSpan Health. “We have taken steps to keep pace with patient demand. One is hiring a fourth pediatric neurologist, who will join us in July 2017 and practice in Ephrata; this will allow us to extend services to the communities we serve in Lancaster County. Another is partnering with the Epilepsy Foundation of Western/Central Pennsylvania to hold clinical visits via telemedicine technology with certain epilepsy patients who live great distances from our practices.”

Leveraging Telemedicine to Benefit More Patients

WellSpan Pediatric Neurology conducts tele-epilepsy follow-up visits with children from two patient-centered medical homes in Central Pennsylvania. Each exam features collaboration among many providers. The process begins at the local practice, where a medical assistant takes the patient’s vital signs and transmits them to a WellSpan Pediatric Neurology clinical assistant. A WellSpan pediatric neurologist then conducts the exam with the patient and family, with a representative from the Epilepsy Foundation of Western/Central Pennsylvania present on the call. The pediatric neurologist provides a clinical summary to the local practice at the end of the appointment.

“During a recent exam, a parent raised concerns about the inability of the child’s school to handle his or her seizures,” Dr. Barron says. “The representative from the foundation volunteered to go to the school or send someone to help train the nurse in seizure management. It was a nice, synchronous approach to the parent’s concern.

“I think telemedicine will be increasingly integrated into health care moving forward,” Dr. Barron continues. “Certain patients will always want or need a hands-on clinical experience, but for those who live, say, two hours away and have always had normal exams, it may be more valuable to have a conversation via telemedicine. In adult neurology, we have successfully implemented telemedicine services with four partnering hospitals for acute stroke evaluations and care.”

Pointing the Way toward the Future

WellSpan Pediatric Neurology provides another model for multispecialty neurological care in the form of its neurodevelopmental clinic in York. Held one Friday per month — and likely to expand to two days a month in the future — the clinic is a one-stop, early-intervention destination for families with children discharged from the Neonatal Intensive Care Unit (NICU).

“These children, particularly those born around 25 or 26 weeks of gestation, are at greater risk for intellectual disability and may have developmental challenges,” Dr. Barron says. “We involve nutritionists, rehabilitation therapists, early-intervention providers and NICU nurses to ensure these patients receive the services they need to thrive. The clinic also provides depression screenings for parents. We follow most children through age 3, unless they have longer-term needs.”

WellSpan plans to institute approaches to stroke, migraine and movement disorder care based on the neurodevelopmental clinic’s multidisciplinary model. These changes will be incorporated as part of expected growth of WellSpan’s neurological services in the next few years.

“Expanding telemedicine and multidisciplinary services are two important areas of focus for us,” Clark says. “One of our strategic goals is to provide access to care throughout the region we serve, and we’re well on our way to doing this.”

Powerful Partnerships

The specialists of WellSpan Pediatric Neurology know their most effective allies in caring for children with neurological conditions are primary care physicians (PCPs).

“We don’t think of patients as mine or yours — they’re ours,” says Todd Barron, MD, Medical Director of WellSpan Neurosciences. “We’ve created an environment where our pediatric neurologists are accessible to PCPs, and we want clinicians in the community to view us as resources for both patient care and information. We have a true dialogue with PCPs. If, for example, we see a patient who isn’t growing appropriately, we’ll notify the PCP that short stature is a concern. The PCP is the patient’s medical home, and now pediatric neurology is part of the neighborhood.”

No effort better illustrates the collaboration between pediatric neurologists and PCPs than WellSpan Pediatric Neurology’s approach to concussion management.

“We want to ensure concussion patients always receive the most appropriate level of care, and for less complicated cases, it’s seeing their PCP or a provider at WellSpan Urgent Orthopedics,” says Lori Clark, Vice President of Neurosciences. “Our pediatric neurologists have trained PCPs in management of concussions. If symptoms don’t resolve, PCPs can refer their patients for a higher level of care with pediatric neurologists or sports medicine clinicians, as well as rehabilitation therapists. We have a truly integrated approach to caring for children with concussion.”

To refer a patient or learn more about services, call WellSpan Neurosurgery at 717-812-5400.