CHOC’s MI3 Internship Program: A Life-Changing Experience for a Teen Innovator

Experience gained during a CHOC Children’s innovation internship is already paying off for one high school student.

MI3-intern

Karishma Muthukumar, 17, has applied the skills and knowledge cultivated during her participation in CHOC’s Sharon Disney Lund Medical Intelligence and Innovation Institute (MI3) internship program to develop a medical innovation of her own.

She created OutLoud, an emoji-based communication board for paralyzed patients who cannot move or communicate except through eye movements. OutLoud relies on brain-computer interface technology and artificial intelligence to enable users to select emojis that express their language and feelings.

Karishma conceived the idea while volunteering in a brain injury center after her first year as an MI3 intern.

The internship program allows high school and college students to explore the field of innovative health care specific to pediatrics. Interns get the chance to meet weekly with mentors to explore new innovations and updates occurring within the medical field. They can shadow physicians on clinical rounds and participate in field trips to medically evolving research labs and museums.

“Before attending CHOC’s MI3 internship program, I didn’t even know the definition of artificial intelligence,” Karishma says. “It gave me an opportunity to expand my ideas and learn about new medical innovations.”

An environment so conducive to learning, innovating and creating set the stage for Karishma to develop her own innovation.  And next, the internship program provided her with a platform to present the concept to other innovators at Pediatrics 2040, an annual conference founded by CHOC that explores innovations and trends in medicine.

The experience led Karishma to be named a 2018 Young Innovators to Watch through a national scholarship program sponsored by Living in Digital Times and Lenovo. As a winner, she earned a trip to the world’s largest trade show—the Consumer Electronics Show—in Vegas, where she presented OutLoud .

And not only did CHOC propel Karishma as an innovator, but it’s also influenced her future career plans: She hopes one day to become a pediatric neurologist.

Learn more about the MI3 internship program at CHOC

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Sisters Create Diabetes App to Help Patients Communicate with Caregivers

After living with Type I diabetes for most of their childhood, Reece and Olivia Ohmer were already well-versed in educating their family about how they were feeling and caring for themselves. But both girls eventually became bogged down by responding to frequent and complex check-ins and reminders from parents and caregivers, and knew other kids with diabetes likely felt the same. Looking for a better way to communicate with their parents and physicians, the sisters created a diabetes emoticon app, which they are presenting to pediatric specialists, researchers and other health professionals during the Young Innovator Workshop of the Pediatrics 2040 conference hosted by CHOC Children’s.

A mockup of the diabetes emoticon app in development.
A mockup of the diabetes emoticon app in development.

Reece and Olivia created a variety of illustrations to easily answer the most common questions and text messages patients may receive from their parents. For example, if a parent texts “Did you test your blood sugar? Did you have a snack?” the child could quickly and easily reply with emoticons showing a blood glucose meter and a snack.

A student group at the University of Michigan called the “Michigan Hackers” is developing and testing the app, which they hope to make available on iTunes in the first quarter of 2016.

The Ohmer’s Journey

The Ohmer family has had an interesting journey with diabetes. Olivia, the youngest member of the family of four, was diagnosed with the disease when she was three years old. At the time, her older sister Reece would hold her hand during every insulin injection. Three years later, Reece was diagnosed with the same disease.

“When we had our first diagnosis, I didn’t know where our lives were going to go,” says mom Amy. “Instead of taking the situation and looking at it as a burdensome way to live, Olivia and Reece have taken their diagnoses and have done something remarkable.”

The pair has big plans for the future.  In addition to rolling out their diabetes emoticon app, each hopes to pursue a career in the medical field. Reece hopes to go into pediatric medicine to help other kids, while Olivia is interested in becoming a researcher.

“We haven’t found the cure for diabetes yet, so if nobody else can find it, then I want to do it,” she said.

The sisters hope to empower other patients to help one another, Reece added.

“Just because we’re kids doesn’t mean we don’t have good ideas.”

Learn more about other young innovators involved in CHOC’s Pediatrics 2040 Conference.

CHOC Patient Inspired to Become CHOC Doc

Vanessa Avina, with her father and Dr. Chang.
Vanessa Avina, center, with her father and Dr. Chang.

At 6 years old, Vanessa Avina was more interested in viewing the monitor for her echocardiography (heart ultrasound) than watching a cartoon during her doctor’s visits. Her CHOC pediatric cardiologist Dr. Anthony Chang recognized her curiosity and through the years nurtured her interest in the field of medicine. When Vanessa was 17, Dr. Chang encouraged her to participate in the hospital’s Sharon Disney Lund Medical Intelligence and Innovations Institute’s (MI3) internship program. Vanessa jumped at the chance and is now—two years later—majoring in pre-med biology at California State University, San Bernardino.

The MI3 internship program is designed to offer the brightest high school and college students in Southern California with meaningful experiences in medicine. Interns have the opportunity to shadow CHOC physicians as they conduct rounds in the hospital and see patients in the clinics. They research and present exciting topics related to the future of pediatric medicine, and attend special field trips, including this year meeting Dr. Eric Topol. A practicing cardiologist, professor of genomics and director of the Scripps Translational Science Institute in La Jolla, Dr. Topol is one of the top 10 most-cited researchers in medicine. His special interest is digital innovative technologies designed to reshape the future of medicine.

Vanessa particularly enjoyed meeting Dr. Topol and learning how he focuses on the most important development in health care today – putting the patients at the center of everything clinicians do. She’s quick to point out that her mentor, Dr. Chang, and the other CHOC physicians she has met share that viewpoint.

“It’s clear that CHOC physicians put patients and families first, and partner with them to advance treatment and care.   I experienced that as a patient and I have witnessed that time and again throughout my internship,” said Vanessa.

While Vanessa isn’t quite sure what field of medicine she wants to pursue, her experience with CHOC has solidified her interest in pediatrics. “I’ve learned so much from so many CHOC subspecialists.  They’ve truly sparked my interest in so many different specialties, from infectious diseases to oncology. They’ve especially inspired me to continue to realize my dream of practicing pediatric medicine, bringing hope to children and their families,” explained Vanessa.

A college sophomore, Vanessa knows she has a long road ahead of her, including medical school, residency and fellowship. But the 19-year-old, who will be the first in her family to graduate from college, is determined to become the kind of physician her mentor, Dr. Chang, would want her to be.

“Dr. Chang is an incredible doctor. He’s so smart and innovative. He also has an amazing bedside manner. He has been such an inspiration to me, motivating me to continue on with my dream of working at CHOC,” said Vanessa.

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iRounding For Real-Time Results

CHOC Children’s is the nation’s first pediatric hospital to implement iRounding, a digital survey tool on an iPad that allows staff to identify and respond to CHOC families’ needs in real time. CHOC received the 2014 Ventana Research Award for its pioneering use of this technology.

CHOC iRounding

For years, hospitals have relied on paper surveys mailed home after a visit to assess patient satisfaction. While very important, this survey method also has limits. Paper surveys can only ask questions. But at CHOC, iRounding has started very important conversations.

“We want to know what is important to our patients and families, and iRounding is about so much more than checking boxes,” said Carmen Namenek, manager of CHOC Primary Care Clinic Operations and Community Education. “This portable tool allows our staff to engage with patients and families, and gather more robust data than we can with traditional survey methods.”

She said families’ top concerns are not always what the staff thinks they are. At one CHOC outpatient clinic, the staff thought waiting time was most important. But iRounding revealed that families would rather wait a little longer in order to see the same provider at each visit.

Automatic, real-time iRounding reports allow CHOC staff to act more quickly to resolve and follow up on opportunities for improvement. Positive comments may also be shared immediately with physicians and staff.

This digital tool is far more flexible than its paper counterpart. With iRounding, staff may quickly spot trends and modify or add questions if the survey focus changes. And as issues are resolved, spot checks may be conducted with families to make sure the new changes are working. CHOC staff found iRounding an invaluable tool to assess family perceptions during recent changes to hospital parking and laboratory registration procedures.

“Most of all, eliminating the costly, time-consuming manual process of collecting data has freed our staff to do more of what they do best,” Namenek said. “Now they are spending more time building relationships and providing the very best care for our patients and families.”

Implemented in 2013 in part by a grant from Tustin Toyota, iRounding is now taking place at all CHOC locations, including CHOC Children’s at Mission Hospital. CHOC also participates on a national advisory board dedicated to sharing best practices and further leveraging iRounding technology within the pediatric healthcare setting.

Learn more about CHOC’s programs and services.

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Physician Tenacity, Experimental Treatment Help Baby With Rare Disease

A toddler with a devastating rare condition has a chance for health, thanks to an experimental treatment and the tenacity of a CHOC Children’s physician.

Galya Chan, 2, is showing marked improvement after nearly nine months of regular infusions of cyclodextrin, a compound that has helped mice with Niemann Pick C disease, the condition also affecting Galya.

Dr. Raymond Wang, a CHOC metabolic disorders specialist, says Niemann Pick C affects one in every 150,000 people and causes cholesterol to accumulate in the brain, lungs, liver and spleen, leading to deterioration and early death.

Even worse, there is no Food and Drug Administration-approved treatment for the condition.

A sick preemie

After a premature birth, Galya developed an extremely enlarged liver and severe jaundice. A battery of tests led to a full exome sequence, which revealed Niemann Pick C – and no available treatment plan.

“The diagnosis is horrible, but it’s better to know than to not know,” says Brian Chan, Galya’s father.

But Dr. Wang was aware of researchers studying the effects of cyclodextrin in animals with Niemann Pick C. The compound had shown to reduce cholesterol levels in their bodies, help animals survive without symptoms longer and have more overall longevity.

“The problem is there’s no company that’s willing to get behind the treatment for humans,” Dr. Wang said. “There aren’t enough patients with this condition for companies to see the potential and profit for this. It comes down to individual physicians who want to make a difference.”

Taking another route

So, with Galya’s parents in agreement, Dr. Wang began the long process to seek special permission to treat the baby with cyclodextrin.

Writing a treatment protocol especially tailored for Galya, Dr. Wang filed an investigational new drug application with the FDA. CHOC’s Institutional Review Board, a body that examines proposed research, also reviewed the proposed use.

Four months later, Galya became the youngest of just 11 patients nationwide to undergo this treatment.

Currently, Galya undergoes weekly intravenous cyclodextrin infusions. She also receives monthly intrathecal infusions, which are administered through a lumbar puncture to reach her central nervous system.

Each time, Galya is admitted to CHOC’s pediatric intensive care unit. Infusions last six hours, and she stays 15 more hours for observation.

Encouraging outcomes

But the time and effort is paying off: markers of Galya’s cholesterol storage levels have dramatically decreased since she began treatment nearly nine months ago, data shows.

Before receiving the cyclodextrin, those markers were tremendously elevated, more than six times the normal level. Today, her storage levels have dropped more than 80 percent and now hover just above normal, with progress expected to continue. Also, Galya’s liver softened and its volume decreased by about 10 mL.

Galya’s results are so good that Dr. Wang is working to adjust her treatment protocol to receive intrathecal infusions twice monthly.

Moving forward, Dr. Wang and his colleagues will continue to study Galya to determine if the treatments are also healing her lungs, and it’s likely the cyclodextrin treatment will continue indefinitely – or until a different treatment is developed.

“Once we found out the diagnosis, it was sad,” says Brian, Galya’s father. “But now we can put our energy into helping Galya and working to find a cure.”

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