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 Welcome to this week in Health IT News, where we look at the news which will impact health it. My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. Uh, this week, as you know, I'm doing a series of interviews with health system executives, uh, who will share their plan plans around, uh, covid preparedness.

And just wanna let people know if you're a system with best practices to share, shoot me a note. Built this week in health it.com and we'll do a, uh, 10 to 12 minute, uh, zoom video conference, uh, which will hopefully benefit the industry. And I want to, again, thanks Sirius Healthcare, uh, who reached out to me last week and asked if they could sponsor this series of conversations to help the industry prepare and, uh, and also to celebrate the great work that health it is doing around the country right now.

And I appreciate, uh, their commitment. To, uh, the show and to the industry that they serve. Today's conversation is with, uh, David McSwain, the CMIO for, uh, medical University of South Carolina and USC. Uh, good afternoon, David. Welcome to the show. Thanks, bill. I'm really excited to be here. You know, I. You have, uh, been one of my, uh, health IT mentors from well before you even knew me.

I know we had that conversation in the past, and I think you, uh, are probably that for a lot of people that listened to your show. Well, I, I appreciate you saying that and, uh, it, it that this is how we met. I mean, we essentially met, uh, through, uh, David SMA and through the show we sort of connected that way.

And we have been planning this for a while, that we were . Actually gonna have you on the show. We're just, and we will again later. Uh, but this, this is a great opportunity to talk to you because you actually have three roles, uh, that you are currently playing. And there there's an opportunity to really talk in depth about telehealth.

Started with a pediatric critical care program to reach out to community emergency departments and really have been heavily involved in the development of telehealth, both at MUSC and nationally. Since then, and then, uh, for the past two years, I've been the Chief Medical Information Officer at MUSC, focusing on the integration of technology across the board into our clinical practice.

Yeah. And MUOC is just like every other, uh, organization. You guys are expanding your medical group, your geography, and uh, and increasing the services that you offer. Um, uh, talk a little bit about the, the NIH grant and the stuff you're doing in that area. That'll set the context for this conversation. I think.

Sure. Yeah. Like I said, I did a lot of work, uh, on the national level first through the American Academy of Pediatrics, who's really been great, uh, in supporting quality safe, uh, quality safe telehealth practices. And, um, through my work at MUSC and with the AAP, we developed this organization called Sprout, which supports, uh, the development of multicenter.

Uh, telehealth research projects to prove the value of what, uh, telehealth provides. And we got an NIH grant, uh, last year. Uh, it was a $3.6 million grant through the National Center for the Advancement of Translational Science to actually develop these tools and resources around the country, uh, to support, uh, these studies.

And our work specific to, uh, is we're. Um, uh, COVID 19 guidance on, uh, metrics to use in evaluating your coronavirus related telehealth programs and trying to provide some standard metrics and measurement frameworks that we're gonna disseminate around the country. Yeah, it's interesting. So, um, the, I I've talked to a bunch of health systems.

Everyone's standing up telehealth very rapidly or scaling it very rapidly. I've heard of, uh, people standing up training rooms. They now have, they're just training people left and right. They're standing these things up and, and it's appropriate and that's what happens in the time of a crisis and, and should happen.

Um, but there, there is this sort of sense in which. Uh, how, how are we gonna know if it was effective? How are we gonna know if this was the right approach? Uh, what aspects of this are we going to, um, memorialize or cement into our ongoing, um, care practices once this is over? And I mean, there, there's so many questions to go, but before I go there, I wanna give you the chance to highlight what, what are some of the things that MUSC is doing, uh, from a, a Covid 19 preparedness in your community?

Sure. I mean, MUS C's been doing telehealth and virtual care for well over a decade, and so we have a lot of infrastructure and a lot of talent in place that can respond to this really effectively. Uh, we have a number of different initiatives, many of which are already rolled out. Uh, we have a virtual urgent care platform that we're using for screening, uh, of patients with concern for Coronavirus and directing them through a drive-through testing facility in a parking lot outside of one of our buildings.

Um, that's something that we've, uh, seen in a number of facilities, uh, around the country, but we were one of the first ones to stand that up. Um. Are using the tools available within Epic to allow providers to substitute their in-office visits for virtual visits, either using video or using telephone, and still be able to bill for those services, still be able to document within the medical record.

And that allows us to protect patients and protect providers, um, who may be concerned about having, uh, those in-person visits. We're developing a remote home monitoring program for patients who do test positive for, uh, C Ovid 19. And that's gonna utilize patient entered data, uh, as well as as peripheral devices like SAT monitors with Bluetooth connectivity, going through a mobile application with a fire connection into the electronic medical record.

Using, uh, creating a registry and being able to disseminate that data. Um, we're setting up AEMS telehealth program so that our first responders can utilize telehealth, um, and hopefully prevent some of those patients from coming into the er. Um, and then we're using what we call virtual PPE, uh, personal protective equipment because one of the really key.

Um, one of the things that a lot of people are really scared of, including those frontline providers, is the critical shortage of, of personal protective equipment for our healthcare providers and for visitors to the hospital. So, um, we're using our telehealth capabilities, particularly, uh, in the new Sean Jenkins Children's Hospital that just opened a few weeks ago and has telehealth in every inpatient room, um, that operates through Epic.

Um. It's very fortunate that we have that in place because now we're able to allow our providers to, uh, be virtually present in the room to allow family members to be virtually present in the room, uh, for patients who would otherwise be under extreme isolation. So there, uh, so we are going to, we're gonna dive, there's so many things I could have talked to you about right now, but we're gonna dive deep into, uh, telehealth.

It sounds like you, um, didn't stand up a whole heck of a lot of new things. You leveraged a lot of things that were either, uh, already in place and well established or, or things that have started and you just scaled them up somewhat. Absolutely. And that's really the key. And that's where we're fortunate because we've put in so much work over the years to try to create an infrastructure that would allow for a response like this.

Um, you know, the, the Sean Jenkins Children's Hospital implementation was years in the making. And the key issue there is to get it to work from within our electronic health record so that providers are going into that record to initiate the visits. It provides more security and. Um, and allows them a better workflow.

But the presence of tho of those tools, um, allowed us to leverage that quickly. And having the personnel with the expertise, uh, to be able to respond quickly has been incredibly beneficial. So David, I mean, you have a ton of experience with this and back when I was at St. Joe's, we were just really starting to stand this up and scale it out for patient access.

We had, we had telehealth all we had. Telepsychiatry, we'd tele, um, uh, you know, I, we had whole bunch of tele solutions internally, but the external solutions, we were just starting to stand up. And as we were doing that, we found that embedding it in the workflow was key. Um, you talk, we were talking earlier and you said, you know, telehealth can be a bridge to nowhere very easily.

And, um, and, and we've, we found training to be important and, you know, because people don't. This, this, this whole screen experience is, is a good example. I have a lot of guests who come on who don't know how to make eye contact, who don't know how to, uh, you know, they have light behind them and whatnot, and their microphone's not set up there, there actually is training around just doing this basic conversation.

So what, what would you say to people who maybe aren't as far, far along and they are now ramping up very rapidly to, to really create the integration that's necessary for this to be effective? I would say first in a situation like this, you really have to integrate with the other resources across your institution.

You can't do this by yourself. You can't do this with just a small group of people. A lot. There are a lot of people, particularly in your IT organization that probably know some tools that could be used and that certainly understand the technology. And one of the huge, you know, the silver linings to this situation is that it has, in many ways forced, uh, places the country and also at MUSC to, uh, gain, uh, improved alignment of what we're doing as an organization and to have visibility into everything that's going on.

All of our leaders and our staff really aligned with these efforts. And if you're a new organization, um, I think the, you know, first thing, make sure that you are reaching out to others in your organization to build that alignment. And second thing is to look for, uh, resources that are available across the country.

Uh, to support the development of telehealth programs. That includes the, uh, telehealth resource centers. There's regional telehealth resource centers that are supported by hrsa. Uh, there's National Telehealth, centers of Excellence supported by hrsa. MUSC is one of those. The other one is at Mississippi.

Um, there's Center for Connected Health Policy out in California. Um, there's a number of different resources that you can reach out to. To help you get these programs started up? I think the first thing you know, and of course we have Sprout, although we're more focused on the research and uh, evaluation of programs, I would say the first thing is to, um, reach out to your telehealth, your regional telehealth resource center, um, to uh, get some assistance.

Alright, I'm gonna put you in, um, . In a critical situation. I'm gonna, we're gonna role play here a little bit, and I apologize I didn't give you any heads up on this, but let's assume you, you and I are in a health system. We haven't done anything. Well, there's nothing stood up and we're now in the middle of this crisis and somebody says, let's just use FaceTime.

I talked to my mom on FaceTime last night. Let's just get these doctors using FaceTime with their, uh, you know, with people if these are the only tools we have available and we can't go to American well tomorrow and can't go to Teladoc tomorrow, and we're gonna struggle to do the integration that we need to do right now.

What are some of the key things we're gonna have to stand up if I put you in that situation. I'm glad you're not in that situ situation, by the way. Yeah, no, it's an excellent question and it's one that a lot of people are facing and I, I think, um, and also very timely that you mentioned Facebook, uh, and those types of solutions because there's guidance from, uh, from uh, uh, the federal government that came out.

Two days ago, I believe that said that in the coronavirus, uh, during the coronavirus response, non HIPAA compliant solutions, um, can actually be used for, uh, c delivery of clinical care in, uh, coronavirus response. So we could, so we, we could stand up zoom just like we're doing right now, and this could be a mechanism.

Yeah, and I think Zoom is actually HIPAA compliant, but I, but using, finding those, finding those video conferencing tools that you can use, uh, you can stand up quickly and cheaply. I don't want to get into, uh, seeming to endorse products, but I'll say, you know, there's one called Doxy Me, um, that is free, that provides, uh, easy access to providers around the country.

Uh, you can use, um, you know, relatively inexpensive services like Zoom. Um, and in this situation you can use, uh, things like FaceTime, Google Hangouts, Skype. But the key thing there is, you know, there's more to a telehealth consult than just that video connection. Yep. You really have to make sure that you know how to document, you know how to bill, you know how to get the records, uh, to get records into your electronic health system.

Because if you're doing the visits, sorry,

if you're doing the visits and I didn't mute my, I, my people are actually trying to get, get in touch with you with the three jobs that you. Yeah, I know they tend, I, I'm, I'm a little popular these days. Um, oh my goodness. Okay, let's see here. How can I, uh, well, we may just have to deal with that. Um, so if you, if you just do the video consultation and you don't, um, have the right systems in place to be able to, to get that information into your, into your electronic health record, then you're shooting yourself in the foot.

You're not getting the revenue, you're not getting. The documentation. And so that's again, where you have to work across your institution with your informatics people, with your, uh, with your IT people, with your data, people, with your health information management people, and make sure that you know how to make that work.

Yeah. And if you and I were like in this. Triage mode of, we don't have anything, we have to stand this up. We'd probably select something simple, FaceTime, zoom, whatever, or, or the solution that you talked about. Alright, we, we've established that video connection. Then we'd have to do a significant amount of training, maybe create some templates in the EHR.

'cause essentially what's gonna happen is you're gonna have, you're gonna have the tell us solution over here on your screen. You're gonna have the EHR on this side of your screen and you're gonna be documenting as you're having a conversation. But it would be helpful if template in. I mean, I already have that stuff that way now it's, it's kind of manual, it's kind of clunky, but it, that, that could work, uh, for, for documenting those kind of visits.

Right. . Yeah. And the other thing is, you know, since this is so front and center in the Coronavirus response, most of your EHR vendors, most of a lot of your technology vendors are providing guidance on what to do if you're standing this up quickly. So you can get guidance on what to, uh, do for that. But I think, you know, working with your teams, uh, in, um, how to get the basics of how to be com of how to be compliant.

How to document how to bill, and then the technology really takes care of itself now because they've, uh, opened things up so much. Yeah. And that's, um, you know, the, the thing is, I wouldn't introduce a lot of variables at a time of crisis, so, uh. Uh, just personally, I, I would focus in on the technologies that work in your market.

If all of a sudden, you know, zoom is overwhelmed, but face FaceTime or Facebook or, or Google Hangouts, whatever one's working, at that point, I'd be, I'd have a plan A, plan B, plan C, plan D, uh, and whatever people are comfortable with, just use that as your, your, uh, video connection because quite frankly, a lot of things can work for that.

Um, and some people are saying, well, do you run out and get American well right now? Well, if you don't have American, well now, I'm not sure. Running out today and standing it up is, is the smartest thing to do. You're introducing a lot of variables in a very short period of time. Right. And I think you, you know, at this, this will pass.

And ultimately, um, you know, you may not have the ability to utilize a non HIPAA compliant video conferencing tool. And so as you're doing this, you need to be thinking towards the future of how can we make this sustainable? 'cause the goal really should be. This, this should, uh, initiate a, a transformation of the way we deliver care.

But in order to do that, we have to do it the right way and make it integrated. And you have to have forethought and think about how are you going to transition once this emergency, this crisis situation is passed. So, yeah, that's a good part. And, and we've already gone over, but if you'll allow me one more question, I would really appreciate it.

And that is, what of these things do you hope stays around? So we've, we've relaxed, uh, crossed state lines. Uh, we've relaxed some of the HIPAA high tech stuff. I assume that stuff will come back, uh, back as soon as this has passed. Um, we have reimbursement for telehealth that we. Didn't necessarily have before.

What are some of the things that you hope, and we have new habits that are forming, you know, people haven't, one of the things is we found that people who use telehealth love it, but we just couldn't get enough people to use it. Uh, was one of the things. So we're now in the process of changing behavior across the board.

So one of these things do you think will take hold and what of these things do you hope, you know, doesn't really snap back to the way it was? You know, I go to integration with the medical home integration with established care providers and care coordination. What we're seeing right now, particularly is providers from around our institution saying, how do I see my patients?

How do I reach out to my patients? How do I work with my, my colleagues remotely to be able to ? Coordinate care and, and really when you think about telehealth, to me, the greatest potential value of telehealth is reaching out into the homes to provide care for the most complex, the most expensive, the most complicated patients that really need that care coordination, that need that remote home monitoring, that need the, that multidisciplinary collaboration to occur.

Whatever, you know, I think there's gonna be some of these, uh, these relaxed regulations that are gonna get pulled back. But if we really want this to transform the way we deliver care, we need to look at how do we maintain that ability of. Uh, telehealth to provide that connection across multidisciplinary teams and into the home for the patients that really need it most.

This is gonna be great. This, I, the, I really appreciate this conversation. I'm glad we were able to memorialize this conversation 'cause, uh, I think, uh, a lot of people post this. We'll look back and say what happened during this timeframe. And what things should we, should we hold, hold onto. And I think this, this does change behaviors and, and telehealth will be one of those things that we will look back on this and say, that was a, a catalytic event.

And a, and a, a real, uh. You know, moment that changed how we, uh, think about delivering care. And we, you know, quite frankly, as you know, 'cause you've been studying this, uh, if we can increase the number of touchpoint between care providers and uh, and the people who need the care, we're actually gonna get better outcomes in the long run.

So, hey, thank you very much for your time. I really appreciate it. David. Um, is there, are you active on social media? Do you post, or where, where would you put post? Um, I am, uh, somewhat active on, so social media. I do have a LinkedIn profile. That's where I do most of my social media, social media, uh, business related work.

Um, I do have a Twitter handle. I don't use it a ton. Uh, I think it's DMM Lane md. Um, but certainly happy for, uh, folks to reach out. And, um, you know, these days my, uh, my inbox is a little chaotic, so, um, hopefully things will calm down just a bit. That's, that's what I'm hearing. Um, I'm hearing that everybody's email inboxes have doubled and, uh, and it wasn't good before.

So, uh, yeah, three jobs. So it's, uh, raised to like the sixth power. Yeah, I understand. Well, thanks again, David. Appreciate it. Uh, that's all for this week. Special thanks to our sponsors, VMware Starbird advisors, Galen Healthcare Health lyrics and pro talent advisors for choosing to invest in developing the next generation of health leaders.

This shows the production of this week in Health It. For more great content, check out the website this week, health.com, or the YouTube channel. If you wanna support the show, best way to do it, share it with peer, however you do that. Send 'em an email, send 'em a note. Or, uh, you know, dmm, 'em, whatever you do, just, um, that's what you should do.

We'll be back again with more interviews. We're gonna keep this going through next week. I already have a couple more interviews lined up and we will, uh, continue to release those and hopefully, uh, benefit the, uh, the industry as a whole as we, uh, continue to progress through this. Thanks for listening.

That's all for now.