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Long-Distance Medicine

MUSC is a leader in telemedicine, providing important services while also pioneering new, innovative programs to improve health care across the state

The future of health care has reached an inflexion point, and there are several problem areas in the health care system that need to be addressed: a shortage of physicians, escalating costs of delivering health care and an increasing elderly population. Telemedicine offers an innovative solution to these problems.

In the beginning, there was light

MUSC’s telehealth initiative began with several independent programs, each receiving individual funding. In 2005, a telehealth obstetrics program was started at McLeod hospitals to enhance maternal and fetal care. Then, in 2008, MUSC began to use telehealth to care for stroke patients, and one year later, the psychiatry department started their own program. By 2013, there were 12 different programs at various levels of maturity using telehealth to provide better care for patients.

At this stage, the state was looking to invest in alternative care delivery methods to address the state’s health disparities and deliver care across the state. Working with Raymond S. Greenberg, M.D., then MUSC President, MUSC secured funds to form the South Carolina Telehealth Alliance (SCTA).

With new funding in place, MUSC was all-in. The telehealth program began to pick up speed and expand to other program areas.

“It was clear that hospital leadership, university leadership and the president were all fully engaged at a remarkable level,” says James T. McElligott, M.D., MSCR, Telehealth Executive Medical Director. “Every chair of every department was told they were going to have a telehealth plan. MUSC was jumping at this opportunity.”

MUSC has demonstrated continued telehealth success

Growing from 12 telehealth programs to more than 70, the MUSC Health Center for Telehealth also includes partnerships with over 30 SC hospitals, including McLeod Health, Prisma Health, Beaufort Memorial Hospital and Spartanburg Regional Healthcare System.

“There has been a lot of expansion with different services,” says Shawn Valenta, MHA, RRT, MUSC’s Center of Telehealth administrator. “There is also an expansion of infrastructure to support that growth.”

For instance, the telehealth stroke program started in 12 hospitals and now exists in 30, with ten more coming on board next year. Additionally, telehealth started in eight non-affiliated primary care clinics and is now found in more than 100.

This success has been recognized on the national level. The Health Resources and Services Administration (HRSA) designated MUSC’s Center for Telehealth as one of only two National Telehealth Centers of Excellence. In May of this year, SCTA was also awarded the American Telemedicine Association President’s Award, the only one in the country, for their innovations in health care delivery.

The Center for Telehealth has a great team ensuring that SCTA continues to meet and exceed the needs of the state.

“It’s hard work but we have a great team,” says Valenta. “We are all very fortunate to be doing what we’re doing. Everyone who works here is very passionate about what we do.”

Bringing health care closer to home

The Center for Telehealth mission statement is “Telehealth for efficient, effective care,” and the program has seen exponential growth and has identified several innovative strategies across the state to deliver health care. Below are examples of new and upcoming telehealth initiatives that include utilizing telemedicine to monitor diabetes, perform post-op follow-ups for transplant patients and provide invaluable palliative care.

Diabetes: empowering patients to be involved in their own care

According to the American Diabetes Association, there are 576,211 people living with diabetes in South Carolina. Monitoring a patient’s glucose level is key to controlling diabetes; however, reliable data is often difficult for doctors to obtain. In the past, doctors have relied on patients to purchase a meter, test their glucose values, and bring either the meter with the recorded values or a written list of values to their next visit. But often, patients forget the meter, fail to record their levels, or never get the meter in the first place. This results in “blind estimation” of their glucose levels and makes controlling their disease difficult.

Remote patient monitoring provides a way to overcome these obstacles.

“It gives reliable data to the providers to have confidence in the decisions they are making,” says Elizabeth B. Kirkland, M.D., MSCR, assistant professor and co-medical director of Technology Assisted Case Management for Low Income Adults with Type II Diabetes (TACM2). “Our goal is to improve diabetic control for low income, rural adults in SC with type II diabetes who otherwise have difficulty accessing primary care.”

Participating patients are given a device that allows them to monitor their blood-glucose levels at home. The device has an embedded SIM card that transmits all measurements to a secure server, where two program nurses, Dawn Dericke and Caroline Wallinger, monitor the data and notify the point person at each individual primary care office to let them know which patients need attention.

“What we found is that there are dramatic improvements in A1C levels in the first six months,” says Kirkland. “The next six months showed, generally, that there was not a lot of change, but it is sustaining at a lower rate. It is encouraging that we’re making changes that are able to hold over time.”

Kirkland attributes this success to patients being able to manage their own disease. Remote monitoring also reduces the barrier of having to continually go to the doctor’s office, saving patients time and money.

In the future, this program will focus on three of the most heavily impacted counties in South Carolina. The goal is to determine if remote monitoring of diabetes and hypertension impacts downstream cardiovascular outcomes. It is expected that results from this work may inform policy making decisions.

Transplant: tapping into a growing network

MUSC’s telehealth program continues to grow by tapping into the Center for Telehealth at larger sites for transplant care. MUSC is the only solid organ transplant program in South Carolina and, as of 2017, was the tenth busiest kidney transplant program in the country. Because of this, MUSC provides a service that is not replicated anywhere else in the state.

“We’re still in the infancy, but I think that MUSC has a fantastic footprint that we’re beginning to utilize,” says Daniel Stanton, MHA, MBA, transplant administrator at MUSC. “When you’re talking about a sub-specialist, it’s a really effective way to connect the patient and provider.”

Previously, MUSC utilized satellite clinics across the state for follow-up care, where physicians were physically sent to observe patients. Telemedicine has significantly improved this process and allows the team to conduct post-op visits remotely. The post-op care allows physicians to ensure that patients are taking the appropriate medications and that they are working, to check critical lab results and to physically see how the patient is recovering.

So far, the program has seen no-show rates drop dramatically while still providing the same level of care. If patients need further testing or follow-up procedures, they can be scheduled with local clinics, making it more convenient and cost-effective for patients.

One of the biggest beneficiaries of the telehealth transplant program is the living donor population. These donors come into the program healthy and require a different type of post-op follow-up; telehealth provides a convenient method to deliver that care.

“Of all of our patient populations, it’s probably the most appreciated, utilized and convenient for healthy donors,” says Stanton. “It’s fairly unique because it’s a healthy individual that has undergone surgery to help someone else out. It really is a perfect match for the patient with our technological capabilities.”

The current telehealth transplant program is focused on kidney transplants. Because of the success of this program, the transplant team will be looking to utilize telemedicine for other organ transplants, such as heart, liver and lung transplants. Furthermore, the team is developing a pre-transplant evaluation that can be done remotely to further minimize the number of trips to MUSC for the procedure.

Palliative care: serious care for serious illnesses

Palliative care focuses on relieving symptoms and stress in patients with serious illnesses to improve the quality of life for both the patient and their family. MUSC has a robust palliative care team that is pioneering a new project with the Center for Telehealth.

“It’s a big deal for South Carolina because there is a national shortage of palliative care physicians,” says Patrick J. Coyne, MSN, ACHPN, ACNS-BC, FAAN, FPCN, program director of the Palliative Care Program at MUSC. “It’s a new, exciting program. It will be one of the pioneers in the country.”

The palliative care team received a 3-year, $1.26M grant from the Duke Endowment last summer. This grant provides money to train and educate partner providers, as well as social workers and chaplains, to deliver true interdisciplinary palliative care, rather than strictly medical care. The program hasn’t gone live yet but aims to go live in July. Since receiving funding, six sites that lack palliative care teams have been enrolled and are undergoing preparation for care delivery.

One of the steps that the team is working on during this ramp-up phase is credentialing the physicians at each participating site.

“There’s a lot of work to do before you go live,” says Lauren Seidenschmidt, manager of the Palliative Care Program. “You have to get your physicians licensed at each participating site. There isn’t an all-encompassing South Carolina credential that covers you at each hospital – you have to get credentials at every single site.”

The team is optimistic about the future of this program.

“I envision it going nationwide, being able to provide palliative services to other states that are lacking,” says Seidenschmidt.

“We’ve been contacted by other states in rural areas, like South Dakota, asking when they can sign up for this,” adds Coyne. “We’re not there yet, but we see an opportunity in the future to be able to meet the needs of people in rural or underserved areas.”

The future looks bright

There is still a lot of work to be done as the Center for Telehealth continually strives to meet patients where they are.

“Now we’ve built it, we’ve proven that we can do it and do it well,” says McElligott. “I think the next five years will be about focus, depth and outcomes. I’m really excited about it.”

Using digital tools, the Center for Telehealth is looking to expand several programs, including at-home care for chronic conditions such as congestive heart failure and virtual urgent care for low-acuity conditions such as conjunctivitis and rashes.

Overall, digital engagement of at-risk populations increases patient contact with physicians and engages people with their own health. The data acquisition of these programs allows the Center for Telehealth to continuously improve health care delivery.

Progressnotes Summer 2019


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