State of Telehealth

State of Telehealth with David McSwain, MD

Episode 305: Transcript – September 18, 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.

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[00:00:55] Welcome to This Week in Health IT. My name is bill Russell, healthcare, CIO, coach, and creator of This Week in [00:01:00] Health IT a set of podcasts, videos and collaboration events, then it came to developing the next generation of health leaders this episode. And every episode, since we started the COVID-19 series has been sponsored by Sirius Healthcare. Now we’ve exited that series, but Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show’s efforts to develop the next generation of health leaders. Today we’re joined by David McSwain, MD CMIO Medical University of South Carolina.

[00:01:28] Welcome back to the show, David, how’s it going? 

[00:01:31] [00:01:30] David McSwain, M.D.: [00:01:31] I’m great. thanks Bill. I’m really happy to be here again. A lot’s happened since the last time we talked, the, in addition to being the CMIO at MUFC, I also am one of the main PIs for the sprout telehealth research network. And so telehealth being such a central part of everything that’s going on with the pandemic.

[00:01:48] There’s just been a lot of stuff going on there, and it’s amazing to watch around the country, that kind of progress that people have made. And. and the progress that they’re on, the verge of making. So it’s really [00:02:00] exciting. 

[00:02:00] Bill Russell: [00:02:00] Yeah. So you’ve been spending a lot of time in telehealth and we’re going to, in fact, I think I have 10 questions to frame. I always come up with a framework of questions. Is there, they’re all around telehealth. So we’re going to talk a lot to telehealth. w what is the sprout network real quick? 

[00:02:15]David McSwain, M.D.: [00:02:15] Sprout is a, it’s a national telehealth research network. And it’s based out of the American Academy of pediatrics.

[00:02:23]we started that about five years ago and last year we got NIH funding to develop a, [00:02:30] essentially a support framework, to promote telehealth research, by people all around the country. And in fact, we’ve, supported, researchers and telehealth innovators and, in Canada and Puerto Rico and Australia, and really around the world.

[00:02:43]We’ve got over 120 institutions that are engaged. and our focus is on, supporting, Everyone, not just folks that are engaged in Sprout specifically, but they’re really trying to provide tools to promote, the evidence based focus [00:03:00] in telehealth development. 

[00:03:01] Bill Russell: [00:03:01] Evidence-based alright, so you’re a pediatrician.

[00:03:04] I don’t, ah, let me think. I’m going to talk to another pediatrician here shortly, but. I don’t talk to pediatricians all that often. I like it. Pediatricians there they’re wonderful people 

[00:03:13] David McSwain, M.D.: [00:03:13] Everbody likes pediatricians.  

[00:03:17] Bill Russell: [00:03:17] I don’t want to offend any other doctors, but generally pediatricians have a really good demeanor. They have to work with kids. They’re easy to talk to. 

[00:03:24] David McSwain, M.D.: [00:03:24] I’m a critical care doctor specifically. So I’m not the nicest pediatrician. [00:03:30] There are there are some that are way nicer than me. 

[00:03:32] Bill Russell: [00:03:32] Got it. But one of the things, we had a little conversation prior to this, so I’m going to go on a tangent here and it’s around education and I’m going to tie it back into telehealth, but, and specifically around research around telehealth and those kinds of things.

[00:03:47] But, we’re facing a really interesting time with regard to education. We have all these kids potentially staying home, some going back to school, some staying home, parents, families are making very difficult decisions that they haven’t, [00:04:00] I’ve never really been faced with before of this. what kind of conversations are you having? with people I assume parents and kids around them going back to school at this point. 

[00:04:11] David McSwain, M.D.: [00:04:11] Oh, yeah. I’ve had people I’ve had, principals reach out to me. I’ve had a friends from friends. I grew up with reach out to me, asking what they should do with their child in terms of going back to school.

[00:04:24] And I tell them it’s a really difficult. A decision because it’s so it’s very [00:04:30] situational. It depends on the circumstances of the individual, and it’s not necessarily so much about the child as much as the circumstances of the family. Do they have the support? Are they working from home or not?

[00:04:42] Do they have childcare available? Is the child coming into contact with a elderly grandparent or an immunosuppressed person? and then looking on the flip side of it, when you talk about the child, do they have the, are they able to learn in a remote environment? I think, particularly [00:05:00] special needs children, may.

[00:05:02]not be able to, for various reasons, may not, be able to benefit from a remote leader, the environment, and really need more of that hands on type of, educational approach. And it’s just a really difficult question to answer. Certainly, broadly. 

[00:05:18] Bill Russell: [00:05:18] Yeah. So it’s interesting. Cause we, we come back to that same thing you’re talking about with the Sprout network, which is it’s having research to back things up, but we had this, this education model sort of [00:05:30] thrust upon us very quickly.

[00:05:32] And, teachers from grade school to high school had to figure out how to educate across the wire without really a lot of, research and scholarly work done around what it takes to educate that age group. Remotely now we’ve got, a little bit more to look at based on college, age and beyond, because we’ve adopted some of those remote models, but we have, we don’t have lot, a lot to really back it up and how to do it effectively with those age [00:06:00] groups, for the teachers.

[00:06:01] But on the flip side, we don’t have a lot of research on how effective it is. For the kids. And we’re reading a lot of these heartbreaking stories of these kids really struggling because for school for them is much more than just the education. In fact, it’s a lot more than the education it’s, it’s recess, it’s friendships.

[00:06:19]it’s all that. It’s not staying home with your parents all day, every day. it’s a lot of things. 

[00:06:24] David McSwain, M.D.: [00:06:24] Yeah. Yeah. The parallels are really striking actually [00:06:30] between what’s happening with schools and technology and what’s happening in health care and technology. And as it relates specifically to the pandemic, because people are finding themselves, thrust into situations that they’re not prepared for.

[00:06:43] And what you’re seeing is a huge amount of variability. In practice, a huge amount of uncertainty, what you need to do. Can you do it a major lack of the technological capability to support? both at the school, [00:07:00] but even more so in the home, a lack of connectivity, a lack of bandwidth or lack of devices, even just the environment, a lack of a private space from which to participate in remote schooling, same thing with things like telehealth.

[00:07:15] And think when you look at, What we’ve seen as telehealth is scale rapidly across the country is it’s uncovered some really important, shortcomings, similarly to the school situation in which schools, [00:07:30] the risks who, children with disabilities, is, and with, special learning requirements, is, makes it much more complicated than that.

[00:07:38] You can’t approach them the same way. And when you look at telehealth, what we’ve seen is, issue like non-English-speaking populate populations, then being able to access telehealth platforms, people who don’t have the access to technology, the expansion of telehealth has really shown a spotlight on some of the [00:08:00] shortcomings with regards to really.

[00:08:02]impacting the access to care that was originally, the biggest focus of telehealth when it was conceptualized, really got to reach out to rural areas and disadvantaged populations. And now we’re seeing that lack of access to technology and, and the, availability of interpreter service.

[00:08:22] Is now becoming a social determinant of health. And that I think is, we need to focus it’s on, addressing and [00:08:30] overcoming these really core central barriers that are preventing us from making progress in some of these areas. And we need to really focus on. Developing some standardization and understanding what is the best practice and to your point, that requires data.

[00:08:46] It requires research, it requires analysis, of what’s the real value, the real impact, and what are some of these unforeseen consequences that people may not have predicted. And we really need to focus our [00:09:00] energy on. that sort of integrated approach and getting that information 

[00:09:05] Bill Russell: [00:09:05] Interesting. You’ve given me a lot to go off of there so let’s start with this. There’s I’ve, the pandemic has shortened everything and it almost feels like telehealth has gone through the complete Gartner hype cycle in six months. So expectations to peak to disillusionment literally in about six months. So people are sitting there going, this is going to be the change.

[00:09:28] It’s the tipping point where [00:09:30] now at a new norm, it’s going to be amazing to, some of the things we’re reading now is, telehealth visits are way down and, people, I don’t think anyone thought we would sustain what we were doing at the peak. the numbers are just staggering and were amazing, but, but it hasn’t turned out. There’s some people feel like it hasn’t turned out to be that tipping point. And they’re disillusioned, was the pandemic, a tipping point for telehealth or was there just an illusion of a tipping point? 

[00:09:58] David McSwain, M.D.: [00:09:58] I think it depends. It [00:10:00] depends on how you define the tipping point, right?

[00:10:01] If. If the thought is that it’s a tipping point in that we’re not going to have these challenges with adoption, that the people that have been championing telehealth for years can finally take a breath and relax, and that, they’ve tried it and they love it. They’re going to love it. And it’s going to continue to accelerate the know it’s, that’s not how medicine and healthcare works.

[00:10:22] I think if you define the tipping point, as we have gotten. Engagement and [00:10:30] understanding, on the value and the potential value of telehealth, from stakeholders at both the healthcare institutional level at the, at the policy maker level payer level from patients and population health experts, and folks genuinely see both the value and the challenges of implementing telehealth and are now aligned towards. an approach to really have a really moving towards a digital transformation [00:11:00] that integrates telehealth into the provision of care in a meaningful way so that we can support patients with chronic and complex conditions, and improve the coordination of care and improve the coordination with the patient center, medical home then yeah, I think this. Could certainly be a tipping point. The key is, do we change our, do we focus in on those opportunities? I think there’s a huge, what the pandemic has done has provided. It’s [00:11:30] provided us with an amazing opportunity and an amazing amount of data that we can use. To drive this transformation.

[00:11:38]but it’s not just, people, I think people that talk about attempting tipping point often they were talking about other people’s tipping point, They were right. All along and these others or people that just weren’t getting on board with that, it’s a tipping point for them. That’s not, yeah, that’s not true.

[00:11:56] It should be a tipping point for all of us. We have to learn, [00:12:00] from this experience and. Look at, the low hanging fruit of telehealth is now not so much. The on demand, urgent care, minor, acute condition type of approach, as much as it is a really integrated approach to managing these chronic complex high cost conditions and moving towards a value based approach.

[00:12:27] That can not only improve [00:12:30] outcomes and improve quality, but lower costs and really achieve these goals that telehealth has always talked about achieving. 

[00:12:39] Bill Russell: [00:12:39] Yeah. You know, I, so I’m going to go in two different directions here. One is I want to talk about the barriers and the headwinds that we faced going into the pandemic and get a lay of the land of how these are impacting us today.

[00:12:51] But, the second direction I went ahead and I want to start here is, establishing the value of a telehealth program. at the peak of COVID, it was [00:13:00] assumed that, Hey, telehealth is here to stay, look at the value. It’s great. people, once the pandemic or at least the perceived risk of the pandemics, subsides people go back to their normal behaviors and those kinds of things.

[00:13:14] And it’s really incumbent on  CMIO CIO for just the team of people, CMOs even, how do you establish the value of your telehealth program within a system. 

[00:13:27]David McSwain, M.D.: [00:13:27] I think it’s really about the data and what we [00:13:30] do with the data. And I also think it’s about that integration component. And, if the institutions that have created sustainable models of telehealth. during the pandemic are the ones that had already devoted significant time and resources to integrating telehealth into their care model. the integration of virtual care workflows and technologies and remote patient monitoring, into, the [00:14:00] electronic health record is incredibly important integration with remote patient monitoring applications. taking into account, the potential for predictive analytics and how that could play into triggers of a virtual video visit. having that well-rounded integrated approach is the way that you move this forward towards value. And I think, from our standpoint, we’ve been, we really can’t understate the [00:14:30] value of research.

[00:14:31] I think. Healthcare provider, what are the key misunderstandings on the part of folks that maybe focus upon the technology aspect is that at the end of the day, healthcare providers are always driven by evidence. We’ve had that drilled into us from a very early stage in our careers that you don’t change practice based on anecdotal evidence.

[00:14:56] And I’ve heard people say, regarding telehealth, if they just try [00:15:00] it. Then that’ll be, it that’ll be the tipping point, but that is literally saying that you’re relying on anecdotal evidence to drive your adoption. The anecdote being, I tried it, I liked it. Therefore, I’m going to change my practice and that’s simply not the way that.

[00:15:20] Practice change in healthcare works. You have to have the research. and the key thing, and what sprout really focuses on is providing the [00:15:30] tools and the frameworks to have some. standardization some, standard data definitions, some frameworks. We actually just published in pediatrics, our STEM framework, which is the sprout, telehealth evaluation measurement framework.

[00:15:44]it’s the first of multiple tools that we’re developing, but, that’s really key. 

[00:15:50] Bill Russell: [00:15:50] Wow. It’s and there’s again, as you’re talking to it, I just did a podcast, actually. I don’t even think it’s aired yet, but I just did, by the time this airs it will have, [00:16:00] and we talked about scientific method because this, healthcare startup CEO was a scientist before she was a doctor.

[00:16:07] So she. she’s, she practiced science and then you became a medical doctor. and I asked her, which of those really lends itself to being an entrepreneur. And she said, the scientist, it should cause so much of what we do is the scientific method. it’s making a high it’s proving or disproving that hypothesis learning from it, adjusting and doing the next experiment.

[00:16:29] She goes, we’re [00:16:30] constantly experimenting and the same, thing’s true here with telehealth. Isn’t it? it’s we don’t just throw up our hands and say, this worked, this didn’t work. We say, okay, what did we learn? What can we do different? Because telehealth is here to stay. as a mechanism.

[00:16:45] David McSwain, M.D.: [00:16:45] No, I think, it’s important to take the big picture view and I, to be clear, I’m not what anyone who’s a hardcore researcher would consider a hardcore researcher. I’m a hardcore pragmatist. I, From my standpoint, you [00:17:00] don’t, I’m not be more in favor of doing research just for research sake than I am for doing telehealth just for telehealth sake, you do it with a, as a means to an end, as a way to approach this larger goal of establishing value in healthcare.

[00:17:15] And I’ve heard people say, many times over the past decade that I’ve been having these discussions, that research is too slow and yeah. research, isn’t the fastest thing in the world, but honestly it’s faster than what we’ve seen, in terms of [00:17:30] progress. And it is in fact, the fastest approach to get to where we need to go, because. I’ve been in 2012, I had the discussion about research being too slow and in 2015 and in 2008. and then again, now in 2020, I’m having the same discussions and we’re still trying to get the same things through. We’re still talking about the same challenges in many cases, which if we had focused on the research.

[00:18:00] [00:17:59] Five years ago, 10 years ago to actually answer these key questions, to have the data, that decision makers in the legislature, and then at state medical boards need it. We had done that, back when we initially had this opportunity to devote some resources versus to really getting data and developing evidence, we would be so much further along.

[00:18:23] And that I think is. Where we really need to look critically at what the approach has been, [00:18:30] because we’re always chasing that carrot of, we want to get this done in three months and research is too slow. we’ve been chasing that here for a decade. So let’s look at what’s the realistic, pragmatic approach to getting this stuff done.

[00:18:47] Bill Russell: [00:18:47] All right. Let’s talk about headwinds facing telehealth. So you have money behavior, both on the clinician side and on the patient side, do you have regulatory scale technology or some headwinds? some more than [00:19:00] others, but let’s start with money. I’ve heard people saying that the funding uncertainty is holding them back from really making the investments that they. Want to make as a health system across the board. what are your thoughts with regard to money its current funding? Is it sufficient? Should we be worried about where the funding is going to go from CMS and others? Or, how are you guys, how are you thinking about this? 

[00:19:25]David McSwain, M.D.: [00:19:25] I think about it in terms of, you should be paying for care and, and [00:19:30] more so than paying for a particular approach to care. And if you focus on how do you provide the best quality service regardless of whether that’s in person or remote or using remote patient monitoring, then that’s an overarching principle to take and getting more, getting a little bit more down in the weeds. I’ve heard a lot of people talking about, telehealth could be reimbursed, but at a lower, a discounted rate because you don’t have to pay for you, you don’t have to cover the [00:20:00] cost of a brick and mortar location. But that’s actually counter to a truly integrated model that leverages telehealth to improve overall value because ideally the same providers that are providing in-person services have the capability to provide virtual services as needed, depending on the circumstances.

[00:20:19] There actually does need to be in my view, in most cases to provide a truly coordinated model, there needs to be a brick and mortar location. And. [00:20:30] So that you can provide the sir whatever type of service in whatever location is best suited to that circumstance. And if you’re going to take that approach, then you have to think about the total costs of providing care in that integrated way, in that flexible way, rather than what’s the cost of providing telehealth versus what’s the cost of providing in-person care.

[00:20:53] And so my, I am a believer in. That we need parity, for [00:21:00] telehealth services, we need broad parity for telehealth services, but I think it needs to be true parity and not, yeah, we’ll pay for it, but we’re going to pay for it at 50% or 75%. And that will then drive the broader adoption, a more integrated model because you’re not forcing clinicians to decide not only between what’s most appropriate and. Or not. You’re also forcing them to decide, do I want to get paid full [00:21:30] price or 50% when they’re making that decision and they shouldn’t be having to make that decision. They should be deciding in person versus virtual care based on what’s best for the patient at that time. 

[00:21:41] Bill Russell: [00:21:41] Yeah. I actually that last phrase, I think really summarized it so well of it.

[00:21:47] It really should be what makes the most sense the financials should be, Baked in either at the system level or at the payer level that people have thought it through and they’re giving the person who’s sitting [00:22:00] across from that patient, the ability to do what’s best in the best interest of the patient.

[00:22:05]That makes. So much sense. Let’s talk about behavior though. A behavior is interesting to me, cause I remember the pushback we got from physicians when we were rolling out our telehealth program. Yeah. And to be honest with you, we saw some that on the patient side too. the patients, some of the patients were like, no I’m coming into the office.

[00:22:22] I, I look forward to that visit to the office. I w what have you seen? we have new stats, new numbers. We’ve [00:22:30] had ton more experience. What have you seen. 

[00:22:33] David McSwain, M.D.: [00:22:33] I’ve seen it really across the board. I’ve seen folks that were very anti telehealth, who are now true  devotees of telehealth and realized that it was, there was value there that they never, they never realized I’ve seen folks that.

[00:22:47]have experienced it and are just saying never again because, they didn’t think it provided that value. I think the true, the truth of the matter is people are really thinking about it [00:23:00] in terms of. what allows them to provide the best quality care and you think patients are looking at it in terms of what allows them to maintain that connection with their providers, with their care teams, to have some control over their health information and their care plan to feel like they’re really connected and engaged, with their care.

[00:23:21] And if you have a model, if you have workflows. That allow, that kind of facilitate the physician [00:23:30] or the respiratory therapist or the dietician or whomever members of those care teams. They, if you have workflows that allow them to feel like they are truly providing high quality care, and doing so in a way that fits within their workflows and they’re going to be.

[00:23:47]they’re going to be, champions of telehealth. If you have patients that feel like it allows them to have a better connection with their providers and their care team, on top of being more convenient than they’re gonna [00:24:00] want to see that continued. 

[00:24:01] Bill Russell: [00:24:01] So I, based on what you’re saying, if I went out and did like a class has, the EHR survey, which is a handful of questions, it gives people’s, happy or, Satisfaction with their EHR and those kinds of things.

[00:24:14] But if we had a similar survey for telehealth, or that was like the class survey for telehealth, what I would find is those systems that have truly thought through and baked in. the experience into the clinical workflow, done the proper [00:24:30] education and training, giving them a tool. That’s easy to use that doesn’t, it doesn’t require, a lot of, there’s not a lot of complexity to it.

[00:24:39] It doesn’t really change their workflow all that much. And on the patient side, it’s again, easy to schedule, easy to see the physician. It maintains that, contact in a good way. if we saw those kinds of things, Those are the kinds of systems that would probably rank high and the ones that would rank low, really probably didn’t have it well thought out [00:25:00] ahead of time and just piece things together to try to handle the COVID search. Do you think that would hold true? 

[00:25:06] David McSwain, M.D.: [00:25:06] Absolutely. I’m actually, I’m a really big fan of the class arch collaborative we’re in, at NUSC we’re in the midst of completing our arch collaborative survey. your conversation with Taylor Davis from, the arch collaborative back a year or two ago, I think, I actually had saved it and listened to it occasionally.

[00:25:24]That’s the kind of approach that we really need to take. it’s not so much about the [00:25:30] technology itself as about how you work it into your system and how well integrated it is with. your educational approaches, everything that you said, I think that’s entirely accurate. 

[00:25:42] Bill Russell: [00:25:42] Well here. I want to hit some, a little different points here is just some of the stuff I’m picking up from other interviews and from, social media and stuff.

[00:25:52]some health systems and health system leaders, they’re calling for changes to the state rules around practicing across state lines. This specifically [00:26:00] impacts telehealth. prior to the. what are we calling them? The whatever the relaxation of the rules or the instituted, physician would have to get certified in multiple States to practice telehealth across state lines.

[00:26:13] While some are saying, Hey, look, let’s just these allowances that have been made. Let’s just make them permanent. let’s, somebody certified in South Carolina, they should be able to practice in North Carolina. They should be able to practice in Florida and, we’ll be able to do telehealth across those state lines.

[00:26:28]You know what, [00:26:30] yeah, what’s your view of that? how do you, how do you view that suggestion? 

[00:26:35]David McSwain, M.D.: [00:26:35] I think there is absolutely value to, relaxing those restrictions. I think, looking at it again, I’m a pragmatist looking at it from a practical standpoint, the stakeholders that were opposed to relaxing those regulations prior to the pandemic.

[00:26:51] I, I’m not sure that they are going to completely change their tune now. but I think that there’s absolutely [00:27:00] value to trying to continue to push that forward. I think the thing we need to also keep in mind though, is there are, there is downside and there is risk that goes beyond just, state medical boards lose their power.

[00:27:13] A saying there is risk because. the people, the institutions that are really focused on relaxing state licensure requirements are, big box telehealth providers, large institutions that are looking [00:27:30] to expand their reach across multiple States and such those sorts of relaxed regulations advantages.

[00:27:37]those institutions. and it really can disadvantage the community provider, the primary care pediatrician to take it straight to the folks that I know, that don’t have the resources or even the, they don’t necessarily want to. Have a three state footprint. They want to provide care to their patients and [00:28:00] their communities.

[00:28:00] And I think there is certainly a way to do this, that could facilitate that and lower those barriers to allow. What I would love to see is, is a relaxation of regulations so that providers can follow their established patients across state lines. When they go to college, when they go on vacation, when they go somewhere for work, right?

[00:28:23] If you have a CF patient that you’ve been following for years and they go to college out of state, [00:28:30] you should continue to be able to see that patient. If you are following in complex a patient with a chronic disease, or you have a care team, a coordinated care team, that’s really helping to manage. A patient, that has a lot of medical issues and they should be able to go on vacation in a different state and still be connected with their care team.

[00:28:51] And I think if we look at it from that standpoint, then we can Institute some really smart policies and regulations that will protect that medical [00:29:00] home and protect that, relationship with your, providers and still facilitate the. Expansion of quality telehealth services. 

[00:29:08] Bill Russell: [00:29:08] I’m going to steal a whole bunch of that. I’ve been trying to say what you just said right there on the Newsday show over the last six months or so. And that this is a highly nuanced. Thing. It’s not just a, Oh, stage versus now the federal sort of coming in and whatever. there is a competition aspect. Yeah, it does. It [00:29:30] does favor the, funded institutions, the large academic medical centers, the, that national telehealth players, it favors them.

[00:29:37] I think some people aren’t taking that into account. I love the aspect of it, of 

[00:29:42] know a longterm care relationship being extended to. somebody who’s going to another location. Yeah. The medical record stays with you. The relationship stays with you. They don’t have, I have to find as they go to college, they don’t have to find another physician.

[00:29:58] Obviously that’s not [00:30:00] a good example of somebody literally moves away. but if something’s going to go to CA if it’s a temporary situation, And it makes way too much sense. 

[00:30:09] David McSwain, M.D.: [00:30:09] Yeah. There’s really no reason why we shouldn’t be able to figure out how to do that. I think that, the challenge is a lot of people wouldn’t be happy with just that and, but it’s something that would be great to see happen.

[00:30:21] And I think it would be relatively, if we could get everyone aligned towards that sort of approach, it would be a fantastic thing to see as an hour, even if that’s [00:30:30] one of the major outcomes of the. Regulatory environment around the pandemic, allowing people to care for their own patients, no matter where they are.

[00:30:38]Bill Russell: [00:30:38] I’m gonna have to skip some of these questions cause I, we, I love the conversation so far. Talk to me about quality. Do we have any numbers on quality has quality? how would we measure it? what are we seeing around the effectiveness of the care that’s being delivered through telehealth?

[00:30:55]David McSwain, M.D.: [00:30:55] I think it’s, it’s quite variable. And again, it gets back to, there’s not a lot [00:31:00] of established standards, of how you measure that. that’s a lot of the work that we’ve done in sprout has attempted to address that. And we’re not trying to do that on our own. we’re working, we’re collaborating with institutions around the country that have more of a focus on quality. and collaborating with academic institutions and community providers, to really look at how can we support that. And I think, there is, one of the biggest challenges is, the lack [00:31:30] of resources that are truly devoted to evaluating this. And that lack of standardization. We did a survey.

[00:31:39] One of the first studies that we did in sprout was back in 2016, 2017. And it was looking at the infrastructure for pediatric telehealth across the country. And, it’s published in pediatrics. You can look it up. The, we looked at what, at telehealth programs, most of these were in academic centers, [00:32:00] but.

[00:32:00] Where did they devote their resources in terms of developing telehealth, supporting telehealth and sustaining telehealth. And, everyone had technical resources. Everyone had administrative resources. people had billing and compliance resources, but the two things that were leading often supported amongst all the institutions that we surveyed work, quality improvement and research.

[00:32:25] And I think. there’s such a push to expand telehealth rapidly [00:32:30] that, the quality improvement and research aspect kind of takes a back seat while you’re trying to get this, these efforts, rolled out quickly and because of the. Huge variation in state regulations around the country. Telehealth programs have evolved in such a different way in different States.

[00:32:49] There’s such a huge amount of variability that defining what quality looks like, for a particular telephone program becomes very difficult. So [00:33:00] another one of the things that we’ve seen, I think, as a result of the pandemic is this relaxing of a lot of regulations has leveled the playing field. in a lot of States and interestingly it’s resulted in a lot more, a lot less variability in practice.

[00:33:16] People are doing a lot of the same types of things, because they’re all dealing with the same types of regulations, at least during this period. And so this provides us with an opportunity to look at, in [00:33:30] this environment, what does quality look like and how can we measure it? How can we, collaboratively, report on it and establish some best practices and standardizations and, and really, push, move the needle on that aspect.

[00:33:49] Bill Russell: [00:33:49] Hey, let’s let, so let’s close on this question. Cause that’s probably the notice for your next meeting that just popped up. so let’s talk telehealth leadership and this is a hard one too, right? So [00:34:00] I’ve seen CIO lead it. I’ve seen CMIOs lead it. I saw a social media post about chief telehealth officer.

[00:34:06] I’ve seen a lot of different things and it’s hard, right? Because if you’re talking. Rural health care. It’s probably the CIO. If you’re talking academic medical center could be a chief telehealth officer. If you’re talking know it really could be all over the board. Just talk about what is your structure?

[00:34:21] How do you guys manage telehealth today? 

[00:34:25]David McSwain, M.D.: [00:34:25] we have a at MUIC we have a great center for telehealth. and we’ve got some [00:34:30] really, some really, 

[00:34:31] Bill Russell: [00:34:31] so you have a center for telehealth. what is, what does that mean? 

[00:34:34] David McSwain, M.D.: [00:34:34] Yeah. we actually have a center for telehealth at MUFC. it’s designated as a national Delta center for excellence. and it is, we got state funding from the South Carolina legislature back in 2013, I believe to help develop telehealth, infrastructure, not only at MUFC, but for the state of South Carolina. And so there’s, we’ve been in a very fortunate situation. I think relative to a lot of [00:35:00] institutions and a lot of States to be a well funded and to have the ability to really focus in on the development of telehealth, services, at our institution.

[00:35:10] I think, that it does take a large amount of funding to be able to support that level of, dedication to tell help innovation. And if we look at, how do you do it when you don’t have a, millions of dollars of, of funding? it’s really about, getting the engagement [00:35:30] of, leaders at your institution, whether it’s the CIO or the CEO or the COO, and driving it forward, with a focus on what are the strategic priorities.

[00:35:42] Of the institution. What are the opportunities? How does telehealth and virtual care fit in with the other initiative she lives that are happening on campus, and the priorities of the institution, and really, move it forward in that way, [00:36:00] because the question of. telehealth for telehealth sake.

[00:36:04] I think it gets almost, I’ve heard similar sorts of questions about, should there be a telehealth fellowship, should there be a special telehealth certification? And I don’t really think it should be. I think what you want to see is telehealth integrated within your approach to health care, so that.

[00:36:21] Telehealth care is just healthcare. And it’s a way of providing it people understand people learn about telehealth the same way they learn about using a sentence scope. [00:36:30] that it’s an option that you can use in the practice of, caring for your patients. And, I really, think it’s important not to have a siloed approach, but to support telehealth as, an institutional effort.

[00:36:46] Bill Russell: [00:36:46] David as always. I love our conversations. I learned something every time I learned a ton today, but I’ve learned something every time. Talk, if people want to follow you or get more information on some of the work or the sprout network, how would they do [00:37:00] that? 

[00:37:01]David McSwain, M.D.: [00:37:01] I have, I’m pretty active on LinkedIn. you can search, David McSwain and I should pop up if you look closely. it’s actually a picture of me and the tuxedo from my wedding from a couple of years ago. So you can confirm that, I’m also on Twitter at, D McSwain MD. Love to get some connections. 

[00:37:20] Bill Russell: [00:37:20] So did you buy the tux? Do you own the tux? That’s just, I’m curious. 

[00:37:25]David McSwain, M.D.: [00:37:25] I used to own a tux back when I was in college and I sang in an acapella group. [00:37:30] I rapidly outgrew that tux once I left college. And now I’m aware I wear tux tuxedos infrequently enough that I cannot count on my, I cannot count on myself to be able to fit into any given tux in any given year.

[00:37:47] Bill Russell: [00:37:47] This is the podcast devoted, but I’m sorry. Are you still in an acapella group or was that just a college thing? 

[00:37:53]David McSwain, M.D.: [00:37:53] now, and I’m not in a acapella group, unfortunately it was a little hard tocome by once you hit, 40 plus, we [00:38:00] did, and this opens a whole new can of worms, but we did have a karaoke wedding reception. that was, unique. 

[00:38:07] Bill Russell: [00:38:07] Alright, next time I have you on the show, you’re going to have to be prepared to sing something. I don’t know what it is. we’ll figure out maybe, maybe we’ll sing together and we don’t want to do that. People would not be happy. Yeah. 

[00:38:17] David McSwain, M.D.: [00:38:17] Maybe we’ll have my wife on with me and waiting to, we can do a duet.

[00:38:21] Bill Russell: [00:38:21] That would be great. David. Thanks again for being on the show. I really always appreciate our time together. 

[00:38:27] David McSwain, M.D.: [00:38:27] I enjoyed it, Bill, thank you for this [00:38:30] week. Don’t forget to sign up for clip notes. Send an email to [email protected] special. Thanks to our sponsors. Our channel sponsors, VMware, Starbridge Advisors, Galen Healthcare, Health Lyrics, Sirius Healthcare, Pro Talent Advisors and HealthNXT for choosing to invest in developing the next generation of health leaders.

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