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Today on Healthcare PittStop I have with me pediatrician and Director for Telehealth at the Medical University of South Carolina, Jimmy McElligott. Jimmy, welcome to Healthcare PittStop. I was hoping to talk to you about telehealth, how you got into telehealth, and what you are doing, which is really fascinating for the state of South Carolina. How did you get into telehealth in the first place?

Thank you for inviting me Alan. It’s really a privilege. I started out early in my career—I’m an academic pediatrician here at the Medical University of South Carolina—being focused on health disparities. I dabbled in global health and vaccine delivery mechanisms, “greater good” types of things. But it increasingly seemed that folks didn’t want to fund much research into health disparity anymore. They really wanted interventions, and they really wanted things done. There weren’t that many options, short of building your own medical school or something. Telehealth was sort of the shining option itself. I followed that trail, some initial grants, those kinds of things, and pretty quickly got the bug. I realized how much opportunity was here, and then became more of an advocate rather than it being just an academic pursuit. I started to get involved at the state level and externally and internally at my institution, trying to organize a more formalized effort to bring telehealth to our state.

A lot of times there’s a patient or an experience that brings home the value of that. Did you have any memorable patients that showed you the value of telehealth?

Absolutely. Telehealth itself is really just using some tools to take care of a patient over a distance. So I started out with school-based telehealth. I was connecting from my office to schools in a rural county and a couple in an urban area to see if it would work. Basically we would connect and use video conferencing plus some other instruments—like an electronic stethoscope and a camera to see ear germs up close and those kinds of things—to take care of a child far away. Like all physicians, I was nervous about the quality I would provide with these limitations and tools. But it was one particular patient, a very young child of about five or six who was really sick with asthma—he’d had been in the ICU several times and had multiple problems. People were looking into why he got that sick with asthma. One of the things I realized as I connected with the school, in addition to his primary care provider and the specialists that were involved, was that I could get much more done by seeing him for a few minutes out of the day a couple times a week than I could in my usual approach, which was to see him every three months for twenty minutes in my office. And that was the magic of it. It wasn’t about comprehensiveness or the limitations of technology. It was about fitting my care around his life and his environment. So, the first two weeks or so that I took care of him, I pulled him out of class a lot, until I got things straight. I realized his true barriers were getting his insurance filed and learning how to use his inhaler appropriately and just little things like that, one step after another coordinating his care with the other specialists and other doctors until it was figured out.  And to my knowledge, he’s never been to the ICU since then. Also, his mom got to the point that she didn’t even take breaks at work when I called her; she would sort of whisper at her desk and give me the information I needed and then go back to work. That really made me happy. I was really sort of doing house calls. I was going into their life and trying to figure it out. And to be honest, it took me less time than it normally takes. I did it in little spurts, problem by problem. And his mom stayed at work, the child stayed at school, and I had time to do what I needed to do. We got more done. So that was my epiphany.

 

You almost describe telehealth as a “back to the future” opportunity, the ability to build relationship over small, frequent visits with our patients, ultimately taking less time but providing more value. It’s something we desperately need moving forward in our healthcare crisis.

Absolutely. I would just emphasize that it takes a little bit of bravery on the traditionalist’s part to realize it’s less about his assessment in ten minutes and more about following a person over time. That’s a bit of a shift in our thinking.

 

Can you tell me about your current role with the Medical University of South Carolina and the state more broadly?

I’m now the medical director of telehealth. After all this grass roots effort, we formalized a center for telehealth here at MUSC, and I get to head that up with a group of great folks. But we also administer the South Carolina Telehealth Alliance, which is a collaboration of health care entities and other stakeholders across the state that work together under strategic planning to do more with these opportunities that telehealth technologies provide. That is funded by the state, so we receive state-appropriated funds for our operations, we utilize funds here at MUSC, and we disseminate funds to other entities to try to get more done with telehealth in our state. So I have my administrative and service development duties here at MUSC, and I also chair an advisory council of stakeholders across the state and oversee strategic planning each year for how we go about our efforts.

You told me a bit about how MUSC is supporting even some of your competitors in the state with the telehealth platform. Can you tell more about that and what drove you to do that?

I want to emphasize that it’s a work in progress. You can’t over-state the need for persistent communication with your partners, and not forcing things on them. But in general, we try to not specify any particular platform but more of an open-access way of communicating—it’s sort of like you don’t make someone buy a Verizon phone or an AT&T phone but you make sure than they can call each other. That’s our approach. But behind that, as we develop technologies on platforms, we do it with an eye towards the state, so that anything that’s developed here at MUSC could be utilized elsewhere. That way we can enhance things for everyone. In particular we have what I believe is a fairly novel approach to our community locally, here in Charleston, about how to handle strokes in our urban area and those elsewhere that get transferred in. We have a partnership with a would-be competitor with the other health system in the city, and we’ve actually formed a call-pool of doctors that work together to answer the strokes, triage them appropriately, and work together to maximize the type of stroke-care that we do. So these doctors—not just from two institutions but multiple others—all participate in the same call-pool to rapidly respond to strokes happening anywhere in our 26 connected hospitals. We work together to bring them in, we use a common platform, and we use a common group of doctors working together.

 

I was fascinated by this story because one of the things that really bothers me about healthcare in America is that every hospital system views another hospital system as a competitor. We find all these centers of excellence within a stone’s throw of each other, and the patient has a lot of difficulty understanding where to go if they have this or that problem. And because every hospital system offers every conceivable service, all of them offer a little less quality. When I was in Europe they had regional centers of excellence as opposed to whoever wanted to hang out a shingle and offer services being able to do that. So I think what you’re doing at MUSC is transformative, working collaboratively in the best interests of the folks in the state.

Do you have any advice for other physicians who are driving telemedicine efforts? What do doctors really want out of telemedicine?

Bringing it back down to the day-to-day operations, I think there’s been a shift in telehealth thinking. Telehealth used to be for getting care over distance—I had that child who was far away in a rural community that needed me—but it’s really about how efficiently we care for a patient or a population. And the important thing about that is that if your goal is to make sure that you get more care out there more efficiently, you’re owing up to the fact that you can’t call on your doctors—that there are only as many of your doctors as there are and they only have so many hours in a day. So, how can they take care of more with less? You can specifically design your tools or your use of video or any other type of virtual care over distance to make things more efficient. And that’s really important.

 

Telehealth itself is unselfish. It’s about getting closer to the patient. But to make a service scalable and usable by everyone, you have to look at it from the physician’s perspective and make sure it works for them. So you get to ask the docs, how can I make your life a little better? And you have to get them to think outside the box. But you get to this idea where they’re using time and small snippets of care to compensate for things, like they can’t pass everyone in the city through their office and still take care of folks. You see their eyes light up, like, really? We can do that? You still find that payment mechanisms get in the way of doing these smart things, but that’s starting to change as value-based care comes on, where you get paid to do the job well—not just sort of per click but by keeping people healthier. It’s really opened up a lot of avenues to be smarter and rethink the way we deliver care. So that’s what doctors want. They want to do more with less. They’re happy as long as you can demonstrate that it’s safe and high quality, and they can use different things such as messaging between the patients. It doesn’t all have to be a video or those kinds of things as long as we’re keeping a close eye on quality, which is of paramount importance as we go through this shift. 

It gets back to “less time, more value” for the physician to be able to care for that patient. There’s a heavy emphasis, partly due to legacy, on video—look at the word TELEhealth. Do you think video is the most important thing doctors want or is it text and voice? Or is it that they all need to be integrated into a single platform?

I believe they can be integrated for a number of reasons. But rather than talk about technology, it’s important to remind people about the purposes of what we’re doing. Folks use video for relationship building and for the quality of the interaction. If they need to see something, it’s better than not being able to see something. So focusing on the quality aspect and the relationship-building aspect and making sure those are okay, then you use video when it’s appropriate. But forcing everything to be like video is kind of like forcing everybody to pick up the phone to order pizza when nowadays they can just go online. You have to understand that certain types of communication are easier and will be used more by patients. So I think integrating them is important, to get the patient to go to a portal, say, and use it for their health maintenance and to communicate with the providers. If you force it to be video every time, then you won’t hook those patients into being proactive with their care. There needs to be easier ways to use it, and then use video when it’s appropriate, holograms when it’s appropriate, and whatever else we can come up with.

I also think the public doesn’t realize it would be far easier if your doctor could get back to you at the next available slot he has, rather than “I have to meet you right now”—this idea of synchronous right now video versus an asynchronous kind of work list to get through. I’m hoping telehealth moves in that direction.

Moving forward, what do you think are the big opportunities for collaborative telehealth? What are we missing in the industry that would really make it compelling—a real tool to improve health?

How do you get collaboration to occur in a wise way? Well, what you need is common goals. Take the health system across the street—we might have competitive interests, but there’s also something to work on together. In the case I mentioned it was stroke care for us, but there’s a number of other opportunities. By making sure your goals are real and measurable and that they unite purpose, you can get collaboration. And just being data driven—and taking that term “data driven” to a new level—making sure that we have robust data on outcomes and quality, and they’re being shared, and then the activities will come together underneath that. A big focus on good quality data will bring us together I think.

I spend a lot of time telling folks that they need to start talking about the problems for the healthcare system, for the hospital CEO, the CFO, rather than necessarily having a technology driven discussion. They should care about how they managed this patient through the continuum rather than how they gave them access at a particular time. But I agree with you wholeheartedly that it has to be measurable.

 

Do you have any final thoughts for folks who are thinking about telehealth or what they can draw upon? If there’s a healthcare system that’s trying to emulate what MUSC is doing, can they reach out to you at MUSC?

I’d love that. Absolutely. I think you’ve hit on all the things that are important to me. I’m glad we’re aligned in our thinking. Just do it for the patient, but be selfish when it comes to your design so that it’s scalable and more efficient for your providers because that’s what we need. It needs to be good for all parties.

Jimmy, I truly appreciate your time. Thank you so much.

Thank you Alan.