With SCTR's support, MUSC Health rapidly scaled up telehealth to meet the needs of patients during the pandemic.

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Sarah Pack, Medical University of South Carolina

Hailed for its ability to erase distance between health care providers in cities and patients in rural areas, telehealth has ironically enabled medical care to continue in a time when we all must keep our distance. 

Across the country, telehealth use has spiked as providers offer virtual patient visits to ensure medical needs are met while minimizing COVID-19 exposure. Regulatory agencies have loosened some restrictions on telehealth during this crisis, and more and more payers have begun to reimburse for it as they would for any other medical service.

The Medical University of South Carolina, one of only two Telehealth Centers of Excellence nationwide, quickly mounted a four-pronged response to the COVID-19 pandemic that ensured both continuity of care for patients with suspected or confirmed COVID-19 and continued ambulatory, also referred to as outpatient, care for all other patients. The team of telehealth and bioinformatics experts who led the effort documented their approach and its success in a recent article in the Journal of the American Medical Informatics Association.

Early on, MUSC Health and telehealth leaders saw the need for a coordinated response to the pandemic.

“The same realization was coming to the forefront of the minds of the leadership in telehealth, myself included, that this was going to be a big problem,” said Dee Ford, M.D., director of the MUSC Telehealth Center of Excellence and lead author on the article. “We needed in our own way to create some kind of response to what we believed to be a pretty significant public health problem. Planning started before we even had a case in the state.”

Very quickly, MUSC Health was able to stand up virtual screening of patients with suspected COVID-19 and mobile testing sites across the state, a remote home-monitoring program for patients with less severe COVID-19 and a telesitter program for hospitalized patients that enabled providers to monitor and communicate with patients via an audiovisual monitor, minimizing health care worker exposure and preserving personal protective equipment. 

It was able to do so in part because it had long been building its telehealth and bioinformatics capacity. With generous funding from the state, the MUSC Health Center for Telehealth, in coordination with the South Carolina Telehealth Alliance, has been expanding its telehealth services throughout even the remotest regions of the state. 

“The state of South Carolina made an investment in MUSC years ago to develop telehealth programs, which then led to a high state of expertise and readiness to pivot when COVID-19 arrived,” said Patrick J. Cawley, M.D., CEO of MUSC Health. “The MUSC Health Center for Telehealth is to be congratulated for this ability to lead during this crisis.” 

Since  2012, when MUSC Health adopted EPIC, an electronic health record, the MUSC enterprise has continued to recruit bioinformatics researchers, mainly housed in the Biomedical Informatics Center (BMIC)  and Information Solutions, to customize EPIC to the health system’s needs and to learn how to improve care by analyzing EHR data. 

Existing telehealth tools would prove invaluable to the initiative, but they had to be radically reimagined and integrated for the purpose of responding to COVID-19. Realizing that the scale of the effort would require easy-to-use options, telehealth leaders also onboarded some new tools, such as the user-friendly telemedicine platform doxy.me, created by BMIC researcher Brandon Welch, Ph.D.

“We had a battlefield-type mentality that we had to all get together to form a new structure,” said James McElligott, M.D., executive medical director of the MUSC Health Center for Telehealth.

As they worked to build a unified response and fashion existing tools so as to be COVID-19 relevant, telehealth leaders had the full support of hospital leadership, their colleagues in bioinformatics and the South Carolina Clinical & Translational Research Institute, which provided technical and logistical support. 

“No one ever said no, even if that meant working for five months straight and into the late hours of the night and calling up Bioinformatics and saying, ‘Make this work like this or change it like this,’” said article co-author Kathryn King, M.D., co-director of the MUSC Telehealth Center of Excellence. “No one ever said no because I think we just knew that it had to happen.”

MUSC Health chief research information officer and BMIC director Leslie Lenert, M.D., who is senior author of the article, is proud of his bioinformatics team, which put research aside for a time to help meet this urgent clinical need.

“We took the research capacity we had for EPIC support and improvement, and we told them to stop, and we put them on this full time. That's why we were able to respond so fast,” said Lenert. “So we took our best people, and we put them on this problem immediately. We protected their time, and we told them to get something done. We started early, we committed absolutely and we worked with our clinicians to solve practical problems that they had.”

With BMIC’s help and SCTR’s support, existing tools were quickly revamped to ensure continuity of care for patients with suspected or confirmed COVID-19 and continued ambulatory care for all other patients.

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Goal 5: Advance the Use of Cutting-Edge Informatics