How MUSC is scaling telehealth across South Carolina

What began as a handful of telehealth pilots at The Medical University of South Carolina to help patients in need has grown into a statewide network that offers 77 unique telehealth services, from tele-ICU to remote monitoring for patients with diabetes.

The Charleston-based academic medical center now provides telehealth services at 275 sites across South Carolina, including rural hospitals, community clinics and schools.

Most of this growth happened over a relatively brief span—between 2014 and 2018, telehealth interactions increased from around 1,000 to almost 300,000 per year.

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How did MUSC build a robust, statewide telehealth network in four years?

At ACHE’s Congress on Healthcare Leadership in March, MUSC leaders said federal and state funding helped. MUSC receives significant dollars from the South Carolina legislature to advance telehealth services across the state. In addition, in 2017, MUSC was named a National Telehealth Center of Excellence by the U.S. Health Resources and Services Administration. The financial support from this award enables MUSC to serve as a national clearinghouse for telehealth best practices and work to advance the telehealth scientific knowledge base.

Just as important, MUSC has adopted a strategic and structured approach to expanding telehealth services. Too often, grassroots IT projects fail and die out because of a lack of implementation planning, said MUSC’s Jillian Harvey, an associate professor. “Small-scale pilots … never really get integrated into the health system, so a lot of times there are silos, duplicate efforts and redundancies.”

MUSC leaders have seen their fair share of telehealth successes and failures. Wins include a tele-stroke program that has ensured all South Carolinians are within an hour’s drive of expert stroke care and a school-based telehealth program that lowered pediatric emergency department visits for asthma in a county with significant health disparities.

On the flip side, an inpatient pediatric gastrointestinal pilot failed because it wasn’t “well mapped out,” said Dee Ford, MD, an MUSC professor. “There was a lot of confusion about who was supposed to do what.”

Building on lessons learned from these pilots, MUSC leaders recognized the need to take a measured, organization-wide approach to telehealth.

A Strategic Priority

Since 2011, telehealth has been part of MUSC’s planning process. All clinical service lines are expected to incorporate telehealth into their strategic plans.

Staff from the MUSC Center for Telehealth, which launched in 2013, meet with physician leaders to discuss and strategize about virtual solutions. “We try to engage and show them what the opportunities are, what telehealth tools we have, and then let them guide the conversation,” said Shawn Valenta, the administrator of the MUSC Center for Telehealth.

In the early days of the MUSC Center for Telehealth, leaders set a lofty goal: “Everything we do within our walls, we should do outside our walls.” This “meant that we would work with any provider that was interested and invest … time and effort to help them get [telehealth] programs off the ground,” Ford said.

After some failed pilots that tried to replicate clinical services over distance via telehealth, leaders realized they had to change their goal. “If all we’re doing is using technology to replicate a broken system, then we’re completely failing,” Valenta said.

Value-Based Model

MUSC has since adopted a value-based model to guide telehealth investments. “We now think about telehealth [in terms of] how we use it to make healthcare either more efficient or more effective,” Ford said.

Towards this end, MUSC leaders have identified seven types of telehealth services that will add value:

· Hospital support services, including tele-ICU.
· Business health, or partnering with employers to support employee health.
· Multispecialty telehealth clinics in rural areas.
· Health disparity reduction.
· Cost avoidance, such as using telehealth to reduce readmissions.
· Support for skilled nursing facilities, prisons and other facilities.
· Primary care support via remote patient monitoring, e-consultations and other approaches.

Encouraged by CIO Michael Caputo, Valenta attended a seminar about the Information Technology Infrastructure Library (ITIL), a framework of best practices for implementing IT services. Valenta walked out a believer in the ITIL principles and set about creating a structured telehealth framework called MUSC’s Telehealth Service Implementation Model (T-SIM).

The Center for Telehealth now follows the four phases of T-SIM when assessing, planning and implementing telehealth services:

Strategy. This phase includes working with clinicians to define the scope of the proposed telehealth service, focusing on the problem they hope to solve as well as assessing the primary value (for example, to address health disparities or generate revenue) of the service.

Each proposed service is also assessed for the impact (positive, negative or neutral) it will have on five key stakeholders—patients, referring physicians, consulting providers, payers and MUSC. “If there is a negative effect on any of those stakeholders, [we know] it’s not going to scale and sustain,” said Valenta.

For instance, if a telehealth service is found to add significant time to a busy physician’s day, MUSC staff will rethink or forgo the project rather than spend time and resources implementing a service that is not sustainable.

Design. During the build phase, clinical protocols and workflows are developed for the telehealth service, administrative issues are ironed out, and performance metrics are established. Multiple stakeholders, including informaticists, legal experts and compliance staff, are consulted to address complex issues that arise.

MUSC places an emphasis on thinking about “technology last” to keep the team focused on the problem, Valenta said.

Transition. “The transition phase is taking the big leap from design to operations,” Valenta said. Telehealth staff members provide training and support on technology and workflow issues throughout go-live.

Operations. “In operations, the training wheels are off, and our focus is on making sure we have extremely reliable, high-quality services that focus on the patient/provider experience,” Valenta said. Processes are in place to manage incidents that arise and continually evaluate and improve the telehealth service.

External Partnerships

To create a statewide telehealth network, MUSC needed to partner with other healthcare organizations, including competitors. “Telehealth can cross over traditional market boundaries,” Harvey said. “The patient may be located at a distance in a competing healthcare organization … so you have to think about how you’re going to build relationships with those competitors.”

Today, the vast majority of MUSC’s telehealth sites are not owned by MUSC.

To jump-start these partnerships, MUSC helped create and became the headquarters of the South Carolina Telehealth Alliance (SCTA), which is a state-funded collaborative of telehealth stakeholders. SCTA helps ensure interoperability among partners as well as shared goals and joint projects.

“Every year we refresh our SCTA Strategic Plan,” Valenta said. “It makes sure everyone is moving in the same direction.”

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