MUSC Health - David McSwain This Week in Health IT
March 23, 2020

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March 23, 2020: Our guest today for this episode on coronavirus preparedness is David McSwain from MUSC. David gives us some insight into his position at the institution and the different roles he fills before jumping into the main segment of the conversation, looking at telehealth and how necessary it is right now. He shares his thoughts on health systems that are moving fast to get on track with the infrastructure and resources to provide better telehealth as well as MUSC’s current status in relation to the crisis. David explains how he and his team have been building out telehealth over the last ten years and what it takes for each system to get to the level it needs to be. He emphasizes the integration of resources as things move so quickly, citing this as the way to scale sustainably. We also look at some of the important areas that need attention in the realm and why good documentation and payment systems can save a lot of time and effort in the long run. We finish off our chat thinking about the long term effect of this crisis and the elements that will remain in place when the COVID-19 period subsides.

Key Points From This Episode:

  • David’s three roles at the university where he works.
  • The fast-tracked trends towards telehealth and MUSC’s own expansion. 
  • COVID-19 preparedness at MUSC and the importance of personal protective equipment.
  • Scaling the systems that have already been put in place. 
  • The integration of resources as telehealth is ramped up during the crisis.
  • Key areas to address for systems late to the telehealth game.
  • Proper documentation and billing when launching a new telehealth platform.
  • The guidance that is provided by vendors at the present time. 
  • David’s hopes for the future and the practices that will stick around after the crisis. 

Health IT Coronavirus Prep with Medical University of South Carolina

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Health IT Coronavirus Prep with Medical University of South Carolina

Episode 206: Transcript – March 23, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[0:00:04.5] DM: 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 podcasts, videos and collaboration events dedicated to developing the next generation of health leaders.

This week as you know, I’m doing a series of interviews with health system executives who will share their plans around COVID-19 preparedness and just want to let people know if you’re a system with best practices to share, shoot me a note, [email protected] and we’ll do a 10 to 12 minute Zoom video conference which we’ll hopefully benefit the industry. 

And I want to again thank Sirius Healthcare who reached out to me last week and asked if they could sponsor this series of conversations to help the industry prepare. Also, to celebrate the great work that health IT is doing around the country right now. I appreciate their commitment to the show and to the industry that they serve. 

Today’s conversation is with David McSwain, the CMIO for Medical University of South Carolina and USC. 

[0:01:02.9] BR: Good afternoon David, welcome to the show.


[0:01:05.8] DM: Thanks Bill, I’m really excited to be here. You know, you have been one of my health IT mentors from well before you even knew me, you know, we had that conversation in the past. I think you are probably that for a lot of people that listen to your show.


[0:01:22.6] BR: I appreciate you saying that and this is how we met, we essentially met through David Benjamin and through the show, we sort of connected that way and we have been planning this for a while that we were actually going to have you on the show, we’re just – and we will again later.  But this is a great opportunity to talk to you because you actually have three roles that you are currently playing and there’s an opportunity to really talk in depth about telehealth. Why don’t you introduce the three roles you’re playing and we’ll get one to the conversation?


[0:01:54.8] DM: Yeah, first off, I’m a pediatric intensivist, I came out of my fellowship at Duke in 2009, came straight to MUSC, I’ve been practicing pediatric critical care since then. I’ve been working in telehealth for over a decade, started with the 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 for the past two years, I’ve been the Chief Medical Information Officer and MUSC focusing on the integration of technology across the board into our clinical practice.


[0:02:35.7] BR: Yeah, MUSC is just like every other organization, you guys are expanding your medical group, your geography and increasing the services that you offer. Talk a little bit about the NIH grant and the stuff you’re doing in that area, that will set the context for this conversation, I think.


[0:02:54.8] DM: Sure, yeah. Like I said, I did a lot of work on the national level, first through the American Academy of Pediatrics and it’s really been great in supporting quality safe telehealth practices. Through my work at MUSC and with the AAP, we developed this organization called Sprout which supports the development of multicenter telehealth research projects to prove the value of what telehealth provides.


We got an NIH grant last year, 3.6 million dollar grant through the national center for the advancement of translational science to actually develop these tools and resources around the country to support these studies and our work specific to COVID-19 is we’re developing a COVID-19 guidance on metrics to use in evaluating your coronavirus related telehealth programs and trying to provide some standard metrics and measurement frameworks that we’re going to disseminate around the country.


[0:04:00.9] BR: Yeah, it’s interesting. I’ve talked to a bunch of health systems, everyone standing up telehealth, very rapidly or scaling it very rapid effort of people standing up training rooms, they now have – they’re just training people left and right, they’re standing these things up and it’s appropriate and that’s what happens in the time of a crisis and should happen. But there is this sort of sense in which how are we going to know if it was effective, how are we going to know if this was the right approach, what aspects of this are we going to memorialize or cement into our ongoing care practices once this is over.


There’s so many questions to go but before I go there, I want to give you the chance to highlight, what are some of the things that MUSC is doing from a COVID-19 preparedness in your community?


[0:04:55.3] DM: Sure. MUSC has 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. We have a number of different initiatives, many of which are already rolled out, we have a virtual urgent care platform that we’re using for screening 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. 


That’s something that we’ve seen at a number of facilities around the country but we’re one of the first ones to stand that up. We also are using the tools available within Epic to allow providers to substitute their in office visits for virtual visits for virtual visits. Either using video or using telephone and still be able to bill for those series, still be able to document within the medical record and that allows us to protect patients and protect providers who may be concerned about having those in person visits.


We’re developing a remote home monitoring program for patients who do test positive for COVID-19 and that’s going to utilize patient enter data as well as peripheral devices like sat monitors with Bluetooth connectivity going through a mobile application with a fire connection into the electronic medical record using – creating a registry and being able to discriminate that data, we’re setting up a EMS telehealth programs so that our first responders can utilize telehealth and hopefully prevent some of those patients from coming in to the ER.


Then we’re using what we call virtual PPE, personal protective equipment because one of the really key – one of the things that a lot of people are really scared of, including those frontline providers is the critical shortage of personal protective equipment for our healthcare providers and for visitors to the hospitals. We’re using our telehealth capabilities, particularly in the new Shawn Jenkins Children’s Hospital that just opened a few weeks ago and has telehealth in every inpatient room that operates through Epic.


It’s very fortunate that we have that in place because now we’re able to allow our providers to be virtually present in the room to allow family members to be virtually present in the room for patients who would otherwise be under extreme isolation.


[0:07:27.5] BR: We’re going to dive – there’s so many things I could have talked to you about right now. But we’re going to dive deep into telehealth. It sounds like you didn’t stand up a whole hack of a lot of new things, you leverage a lot of things that were either already in place and well established or things that have started and you just scale them up somewhat?


[0:07:48.5] DM: Absolutely. That’s really the key and that’s where we’re fortunate because we put in so much work over the years to try to create an infrastructure that would allow for a response like this. You know, the Shawn Jenkins Children’s Hospital implementation was years in the making and they key issue there is to get it to work from within our electronic health records so that providers are going into that record to initiate the visit that provides more security and more privacy and allows them a better work flow but the presence of those tools allowed us to leverage that quickly. Having the personnel with the expertise to be able to respond quickly has been incredibly beneficial.


[0:08:33.7] BR: David you have a ton of experience with this and back when I was at saint Joseph, we were just really starting to stand this up and scale it out for patient access, we had telehealth all – we had tele psychiatry, we have tele – we had a 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 work flow was key.


You taught, we were talking earlier and you said, you know, telehealth can be a bridge to nowhere very easily. And we found training to be important and you know, because people don’t – this whole screen experiences 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 – they have light behind them and what not and their microphone’s not setup. There actually is training around just doing this basic conversation. What would you say to people who maybe aren’t as far along and they are now ramping up very rapidly to really create the integration that’s necessary for this to be effective.


[0:09:44.2] DM: 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. There are a lot of people p particularly in your IT organization that probably know some tools that could be used and it’s certainly understand the technology. 


One of the huge, you know, the silver linings to this situation is that it has in many ways, forced the country and also at MUSC to gain improved alignment of what we’re doing as an organization and to have visibility into everything that’s going on, have all of our leaders and our staff really aligned with these efforts and if you’re a new organization, I think the first thing, make sure that you are reaching out to others in your organization to build that alignment.

Second thing is to look for resources that are available across the country to support the development of telehealth programs that includes the telehealth resource centers, there’s regional telehealth resource centers that are supported by HRSA. There is national Telehealth centers of excellence supported by HRSA and USC is one of those. The other one is Mississippi, their center for connected health policy out in California. 


There is a number of different resources that you can reach out to, to help you get these programs started up. I think the first thing and of course we have Sprout. Although we are more focused on the research and the evaluation of programs I would say the first thing is to reach out to your regional Telehealth resource center to get some assistance.


[0:11:33.7] BR: All right I want to put you in a critical situation. We are going to roll play here a little bit and I apologize I didn’t give you any heads up on this but let us assume you and I are at the health system. We haven’t done anything. There is nothing stood up and we are now in the middle of this crisis and somebody says, “Let’s just use FaceTime. I talk to my mom on FaceTime last night, let us just get these doctors using FaceTime with people.” 


If this are the only tools we have available and we can’t go to American Well tomorrow and we can’t go to Teladoc tomorrow and we are going to struggle to do the integration that we need to do right now, what are some of the key things we are going to have to stand up if I put you in that situation. I am glad you are not in that separate situation by the way. 


[0:12:15.1] DM: Yeah. No that is an excellent question and it is one that a lot of people are facing and I think also very time related. As you mentioned Facebook and those types of solutions because there is guidance from the federal government that came out two days ago I believe that said that in the coronavirus here in the coronavirus response non-HIPAA compliant solutions can actually be used for delivery of clinical care in coronavirus response. So what if we – 


[0:12:49.1] BR: We could stand up Zoom just like what we are doing right now and this could be a mechanism. 


[0:12:54.4] DM: Yeah and I think Zoom is actually HIPAA compliant. But using — finding those video conference and tools that you can use, you can stand up quickly and cheaply. I don’t want to get into seeming to endorse products but I will say there is one called that is free that provides easy access to providers around the country. You can use relatively inexpensive services like Zoom and in this situation, you can use things like FaceTime, Google Hangouts, Skype. 


But the key thing there is you know there is more to a telehealth consult than just that video connection. You really have to make sure that you know how to document, you know how to bill, you know how to get the records to get records into your electronic health system because if you are doing visits – sorry. If you are doing the visits and I didn’t mute my phone. 


[0:13:59.8] BR: Yeah, you mean people are trying to get in touch with you with the three jobs that you have? 


[0:14:03.9] DM: Yeah I know. I am a little popular these days. Oh my goodness, okay let’s see here, how can I – well, we may just have to deal with that. So if you just do the video consultation and you don’t have the right systems in place to be able to get that information into your electronic health record then you are shooting yourself in the foot. You are not getting the revenue, you are not getting the documentation and so that is again where you have to work across your institution. 


With your informatics people, 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. 


[0:14:47.5] BR: Yeah and if you and I were 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 the solution that you talked about. All right we have established that video connection and then we’d have to do a significant amount of training, maybe create some templates in the EHR because essentially what is going to happen is you are going to have the tell a solution over here on your screen. 


You are going to have the EHR on this side of your screen and you are going to be documenting as you are having a conversation but it will be helpful if the templates were already in place that you just – yeah I mean I already have that stuff that way it is kind of clunky but that could work for documenting those kinds of visits, right? 


[0:15:29.6] DM: Yeah and the other thing is since this is so front and center in the coronavirus response, most of your EHR vendors, a lot of your technology vendors are providing guidance on what to do if you are standing this up quickly. So you can get guidance on what to do for that but I think working with your teams on how to get the basics of how to be compliant, how to document, how to bill and then the technology really takes care of itself now because they have opened things up so much. 


[0:16:03.9] BR: Yeah, you know the thing is I wouldn’t introduce a lot of variables at a time of crisis. So just personally I would focus in on the technologies that work in your market. If all of a sudden Zoom is overwhelmed but FaceTime or Facebook or Google hangouts, whatever one is working at that point I’d have a plan A, plan B, plan C, plan D and whatever people are comfortable with just use that as your video connection. 


Because quite frankly a lot of things can work for that and some people are saying well do run out and get American Well right now. Well if you don’t have American Well now I am not sure running out today and standing it up is the smartest thing to do. You are introducing a lot of variables in a very short period of time. 


[0:16:54.9] DM: Right and I think this too will pass and ultimately, you may not have the ability to utilize a none HIPAA compliant video conferencing tool and so as you are doing this, you need to be thinking towards the future of how can we make this sustainable. Because the goal really should be this should initiate 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 fore thought. And think about how are you going to transition once this emergency, this crisis situation has passed. So yeah that is a critical part. 


[0:17:34.2] BR: And we have already gone over but if you allow me one more question I would really appreciate it and that is what of these things do you hope stays around? So we have relaxed across state lines, we have relaxed some of the HIPAA high tech stuff. I assume that stuff will come back, snap back as soon as this is passed. 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 that we found is people use telehealth love it but we just couldn’t get enough people to use it, which is one of the things. So we are not in the process of changing behavior across the board. So what of these things you think will take hold and what are these things that you hope doesn’t really snap back to the way it was. 


[0:18:24.6] DM: You know I go to integration with the medical home integration with established care providers and care coordination. What we are seeing right now particularly is providers from around our institutions saying, “How do I see my patients, how do I reach out to my patients? How do I work with my colleagues remotely to be able to coordinate care?” 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 that multi-disciplinary collaboration to occur and whatever I think there is going to be some of these relaxed regulations that are going to 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 Telehealth to provide that connection across multi-disciplinary teams and into the home for the patients that really need it most. 


[0:19:39.7] BR: This is going to be great. I really appreciate this conversation. I am glad we are able to memorialize this conversation because I think a lot of people post this will look back and say what happened during this timeframe and what things should we hold onto and I think this does change behaviors and telehealth it will be one of those things that we will look back on this and say that was a catalytic event and a real moment that changed how we think about delivering care. 


And quite frankly as you know, as you have been studying this, if we can increase a number of touch points between care providers and the people who need the care were actually going to get better outcomes in the long run. So hey, thank you very much for your time. I really appreciate it David. Are you active on social media? Do you post or where would you post? 


[0:20:38.1] DM: I am somewhat active on social media. I do have a LinkedIn profile that is where I do most of my social media business related work. I do have a Twitter handle. I don’t use it a ton. I think it @DMcSwainMD but certainly happy for folks to reach out and you know these days, my inbox is a little chaotic. So hopefully things will calm down just a bit. 


[0:21:05.9] BR: That’s what I am hearing. I am hearing that everybody’s email inbox has doubled and it wasn’t good before so. 


[0:21:14.0] DM: Yeah, three jobs so it is a raised to the sixth power. 


[0:21:19.1] BR: Yeah, I understand. Well thanks again David. I appreciate it. 




[0:21:22.3] BR: That is all for this week. Special thanks to our sponsors, VMware, StarBridge Advisors, Galen Healthcare, Health Lyrics and Pro Talent Advisors for choosing to invest in developing the next generation of health leaders. This show is a production of This Week in Health IT. For more great content, you can check out the website at or the YouTube channel. If you want to support the show, the best way to do it is to share with a peer, however you do that, send them an email, send them a note or DM or whatever you do, that is what you should do. 


We’ll be back again with more interviews. We are going to keep this going through next week. I already have a couple more interviews lined up and we will continue to release those and hopefully benefit the industry as a whole as we continue to progress through this. Thanks for listening. That is all for now.




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