A Herea Model of People Process and Technology

Ms Charlene Tan-smith1

1Canterbury District Health Board, Christchurch Hospital, Christchurch, New Zealand

The South Island paediatric ketogenic dietary therapy service has been providing care since 2016 for children with refractory (drug-resistant) epilepsy. Suffering hundreds of seizures per day medicalised ketogenic dietary therapy is used to reduce or eliminate seizures by inducing and maintaining ketosis through forms of ketogenic diet ranging up to 90% fat composition.

The service model is a specific herea (weaving together) of people, process and technology in a hub and spoke across the South Island and centred at Christchurch Hospital. Results have been increasing the quality of life for patients and caregivers and significant cost savings to the health system.

This high complexity low-frequency patient community has seen seizure-related overnight stays in hospital reduced by 86% and overnight stays in HDU reduced by greater than 90%. International benchmarks are being met or exceeded where 10% of patients experience freedom from seizures and 50% greater than 80% reduction.

The people strand of the herea consists of a registered dietitian lead, keto allied health assistant, pharmacist, neurologists, and phlebotomist.

The process is the Low and Slow method developed by Jennifer Fabe of McMasters Children’s Hospital, Hamilton Health Sciences, Toronto, Canada. As opposed to an in-patient rapid initiation the Low and Slow is a safe outpatient process, titrating patients up to their individual level of ketone production and response over a period of weeks.

The KetoSuite technology used to balance recipes and meals to patients individual prescriptions of fat, protein and carbohydrate is a locally developed world-first suite of auto-balancing web apps.


Charlene has been a registered dietitian since 2005 working both in private and public practice with most of that time at Christchurch Public Hospital, CDHB. She has specialised in paediatrics since 2006. Previously a nutritionist for the Ministry of Health at the Child Health Services in Singapore she is currently the South Island Clinical Lead for Ketogenics, working with the team to treat children with refractory epilepsy. She has a fresh perspective on treatment delivery, use of digital tools, and is currently a doctorate candidate researching acceptability of medical app technology.

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