Center for Telehealth leading innovative responses to pandemic

Americans have been learning a lot of new vocabulary words in the past month or so: coronavirus. Hydroxychloroquine. Asymptomatic. Serology testing. Telehealth.

And while that last one might be new to many in the U.S., it’s well-established at MUSC Health, which began offering telehealth services in 2005. It launched the MUSC Center for Telehealth in 2013 and became headquarters for the newly established South Carolina Telehealth Alliance the following year; in 2017, it was designated a National Telehealth Center of Excellence, one of only two in the country.

And today, the Center for Telehealth is right in the middle of just about every initiative at MUSC Health in response to the COVID-19 pandemic, providing interventions to help patients throughout the continuum of this disease.

From COVID-19 screenings to primary care visits, both patients and doctors have adapted, and even thrived, with this new remote medicine option, said Kathryn King, M.D., associate medical director for the Center for Telehealth and Telehealth Center of Excellence associate program director. In fact, she thinks many people will want to continue using telehealth once life returns to normal.

“I don’t think anyone’s advocating that we don’t need in-person care anymore. I think we all agree we do need in-person contact with our patients,” she said. But telehealth could become a new option that enhances care by enabling more contact between doctors and patients, she said. For example, instead of scheduling an in-person follow-up visit in three months, a doctor could schedule a quick televisit in a week to check on a patient’s progress.

More immediately, King is excited about how telehealth can help lead the way back to normalcy and proud of the numerous initiatives that the Center for Telehealth has been involved in. She thinks telehealth will continue to play a pivotal role moving forward, prompting the question, “Can we use telehealth to continue this continuum of care and patient engagement at the population level so we can successfully and safely reopen our state?”

COVID-19 screening

The center staff realized early on that it needed to create a means to screen people who would qualify for coronavirus tests, which were in short supply. Using the existing MUSC Health virtual urgent care platform, the team led by Tasia Walsh, director of Strategy and Virtual Solutions, and Ed O’Bryan, M.D., executive director for MUSC Health Solutions, developed a screening mechanism for people with symptoms that indicated possible coronavirus infection. Because of the highly infectious nature of this virus, it was important to keep the potentially infected away from crowded emergency rooms and urgent care clinics where they could spread the disease to other patients and to health care workers.

“As we preach social responsibility – don’t shake people’s hands, wash your hands frequently – this is another way to try to prevent community transmission,” O’Bryan said.

Remote patient monitoring

For those patients who tested positive for coronavirus but didn’t need to be hospitalized, the Center for Telehealth, along with Epic Research Operations and Integrations within the Biomedical Informatics Center, created a way for patients to report on their symptoms from home each day, with nurses monitoring for worrisome changes.

As of April 15, with 111 patients enrolled in the voluntary program, nine had been referred to a video visit with a doctor, and one was referred to an emergency room and admitted.

“It’s going well overall. The patients seem to genuinely appreciate the support,” said Emily Warr, R.N., director of operations for the Center for Telehealth.

And Leslie Lenert, M.D., director of the Biomedical Informatics Center, said his group appreciated the opportunity to participate in the coronavirus response.

“It's been a good way for people to really make a difference when they might have been distracted,” he said. “We are trying to do our part, and we hope we can be helpful to the brave clinicians who are out there on the front lines.”

Reduce health care worker exposure

The Center for Telehealth has been making a difference even within the hospital walls. A major concern throughout the nation has been the supply of personal protective equipment for health care workers. The center staff knew they already had a system in place that could help reduce the number of times health care workers physically needed to enter a COVID-19 patient’s space, and therefore, reduce the amount of PPE used by providers.

The system was one of continuous virtual monitoring carts that were being used to keep eyes on patients who were deemed fall risks or at risk of self-harm. The carts have touch screens, cameras and speakers and are rolled to the rooms where they’re needed. Typically, a remote staff watches the room through the camera and talks to the patient through the speaker if necessary – for example, to ask a patient not to attempt to get out of bed.

In the case of COVID-19 patients, the carts were repurposed to allow doctors and nurses to check on the patients through the two-way audio-visual connection without entering the room each and every time. At first, two carts were put to use in mid-March. That quickly ramped up so that by April 6, 15 carts were in use and handling more than 1,200 calls from cart to room per week.

“That significantly cut down on health care worker exposure and PPE use. Our early results show a significant cost savings,” King said.

Patient-family connection

The support of family, friends and community is important for anyone in the hospital, and putting patients and families first is one of MUSC’s core values. Unfortunately, during a pandemic in which many contagious people are asymptomatic, that has meant severely restricting visitors to decrease the chances that a well-meaning family member or friend could spread the novel coronavirus to patients, health care workers or other visitors.

 

To help patients connect, the Center for Telehealth information technology team, led by Michael Haschker, reconfigured iPads in each unit that were used to assist with rounding or electronic consents to be used instead for patients to communicate with family. Patients can use FaceTime, if they have an Apple ID, or they can use an app that creates a unique “room” accessed by a link sent to family and friends.

By April 7, all nursing units in Charleston had access to the iPads. The following day, the center shipped some of the reconfigured iPads to the Lancaster and Florence divisions.

“Once this is over, it’ll be interesting to see what happens,” Warr said. “I would not be surprised if this virtual visitation option becomes the new norm because it’s really not a unique problem to COVID that some family members can't get in to see their loved ones while they’re in the hospital.”

Ambulatory care

Though it might have felt like it at times, life didn’t stop as the pandemic reached South Carolina. Doctors still needed to check on their patients with chronic conditions. People still needed to talk to a therapist. Children still got pink eye or into poison ivy and needed prescriptions.

“Probably the most important thing is the health care system needs to keep running. We need to be able to continue to see our patients,” King said. “Our patients need the same everyday care they always needed in the ambulatory setting.”

With clinics shutting down and patients canceling appointments, MUSC Health set a goal of having 80% of ambulatory visits conducted through telehealth. Results have varied by department, but King noted that some areas have actually pushed past 100% of their prepandemic activity, thanks to the leadership of James McElligott, M.D., executive medical director for the Center for Telehealth, and the hard work of the entire ambulatory care team.

“This has been a mammoth effort, and it’s amazing how quickly the entire system has adopted these platforms for the good of our patients. We're giving patients the care they need while keeping them safe, and they are very appreciative. The providers and staff have had to adapt quickly and have done a great job putting on webinars for their peers and banding together as an organization to make this happen,” King added.

Group effort

King said the center’s achievements have been possible only because of the remarkable work ethic displayed by everyone from every corner of the organization.

“So many people have stepped up and done incredible jobs, working crazy hours to make this happen,” she said.

She highlighted Dee Ford, M.D., project director of the Telehealth Center of Excellence, who is wearing multiple hats during this unprecedented time; Shawn Valenta, administrator for telehealth, who has facilitated communication amongst all the teams; and directors Walsh, Warr and Ellen Debenham, who have coordinated as almost everyone in the Center for Telehealth has taken on new responsibilities to address the crisis.

“From school-based health nurses who flipped to working call lines to help people without internet access to navigate the system to our South Carolina Telehealth Alliance team assisting physicians throughout the state to take on telehealth and keep their practices going, this is really a huge team effort. I have been continuously impressed by the work ethic and commitment to our patients that everyone has displayed during this difficult time,” King said.

She is also encouraged by how well the entire health care ecosystem adapted to telehealth, including payers who have agreed to cover telehealth visits. The center is already working with payers to determine what data they will want to review to decide whether to continue to cover such visits in the future.