Shawn Valenta, Dr. Kathryn Cristaldi, and Ryan Kruis at Converge2Xcelerate Conference (Boston, MA)
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INTERVIEW TRANSCRIPTS: Shawn Valenta, Administrator of Telehealth at Medical University of South Carolina, Dr. Kathryn Cristaldi, Assistant Professor at Medical University of South Carolina, and Ryan Kruis, Manager at SC Telehealth Alliance & MUSC Telehealth
Shawn Valenta – Administrator of Telehealth, Medical University of South Carolina: 00:00
This is the deploying HERSA Telehealth center of excellence case nationwide. So, I want to get into this a little background. So over the last decade, injury hospitals, rural hospitals have closed throughout the country. Another 400 are considered high risk categories, high risk for closing due to various financial strains. These closures will continue to widen the healthcare disparity gap in our country. And while there’s no one single magic pill that can cure this epidemic there is a movement in South Carolina of competing organizations coming together under a shared vision and shared goals of how to transform the way healthcare is delivered in South Carolina. And so before I go into that, and I just want to give a little bit of context in regards to before we can engage our panelists. So MUFC has been providing tele-health for over a decade ago.
Shawn Valenta – Administrator of Telehealth, Medical University of South Carolina: 01:08
Really started with clinical champions doing, you know, grassroots type of initiatives to address some of the healthcare disparities around maternal fetal health and stroke care. But in 2013, the state made a significant investment through MUSC, the Medical University of South Carolina to one create telehealth services that meet the needs of our of our communities, sustainable telehealth services. To do that and to create a statewide collaborative, they would bring you know, multiple stakeholders together under a shared vision and shared goals. So through that the MUSC center for telehealth was created bringing these services together under that mission statement of tele-health, efficient, effective care. And then also in 2014, within a year later, we established the South Carolina telehealth Alliance as the statewide collaborative. So background on that at MUSC through robust enterprise adoption of telehealth service development, MUSC created what is now known as the telehealth service implementation model, also known as TSM.
Shawn Valenta – Administrator of Telehealth, Medical University of South Carolina: 02:19
This is a structured framework in regards to how to take a telehealth idea through development and through a common architecture to develop sustainable telehealth services. This contributed to over 80 unique telehealth services being developed at MUSC. And in 2017, MUSC was recognized and entered into a cooperative agreement with HERSA and was designated a national tele-health center of excellence. What that means is tele-health is happening every day, all the time in South Carolina. And earlier this spring, this SCTA was recognized by the American telemedicine association with their president’s award for you know, our efforts, collaborative efforts in transforming the way healthcare is delivered in South Carolina. So with that, we’ll start to get into our panelists. I’m joined here by Dr. Kathryn Cristaldi and Ryan Kruis to represent both MUSC and the SCTA. So Kathryn maybe we’ll start with you. Can you give me like a little bit more background about the division of telehealth in South Carolina and how that’s evolved with the SCTA?
Dr. Kathryn Cristaldi – Assistant Professor, Medical University of South Carolina: 03:31
Sure. Thank you, Shawn. So the thought really in South Carolina was that the mission of widespread tele-health and adoption and implementation would help combat healthcare disparities in our particularly rural state. And so that’s really been the driving force that was really what inspired physicians to, to start the grassroots efforts in their individual service lines. Was really a need to reach patients who otherwise did not have access to care. Now, what that’s meant is in order to be good stewards of the state’s funding to support these efforts is that we’ve all had to work together. That means traditionally competing hospital systems in the state had to come together around a common table and say, how do we want to get this work done together? And how, in what way could we do it? That’d be the most efficient and the best for our patients and the citizens of South Carolina.
Dr. Kathryn Cristaldi – Assistant Professor, Medical University of South Carolina: 04:40
It became very clear, very early on that that would revolve around care provided as locally as possible, but always backed up by the larger healthcare systems as needed. And that kind of a network of care necessitated what we came to call an open access network. So the way that, you know, traditionally healthcare industry has driven technology is in a closed silo with technology that was not necessarily interoperable. And it became very clear that if we were going to all work together in this state to serve patients that we would have to be committed to technology that was open access or, or interoperable. And so we spent a lot of time over the last really decade thinking about the stages of maturity of that open access network and how we moved from just establishing standards from our technology to really collaborative models of care that use that technological framework. So those have been, you know, the major themes. How can we get together, how can we collaborate and you just really open access technology to best serve our patients.
Shawn Valenta – Administrator of Telehealth, Medical University of South Carolina: 05:58
And so, Ryan, you think about that level of coordination and communication because it’s unique for all of these stakeholders from across the state competing systems. Do you feel like were some of the key steps to be able to operationalize that vision?
Ryan Kruis – Manager, SC Telehealth Alliance & MUSC Telehealth: 06:21
So I think that you know, like Katie said, the bringing together diverse stakeholders, competing health systems, it, you know, to create a common vision. In order to do that, we really needed an organizational structure that kind of allowed folks to come to the table on a regular basis. And that allowed us to, you know, when bringing together these diverse stakeholders come to a common vision that both allowed us to move in the same direction, but also allowed for these individual health systems and partners to kind of also follow some of their own priorities as well.
Ryan Kruis – Manager, SC Telehealth Alliance & MUSC Telehealth: 06:54
While at the same time putting guardrails like Katie said we had to be stewards of the funds, so we wanted to make sure that the funds let us in that common direction. So one of the ways that we really have been able to do this and keep coming together is through our annual collaborative strategic planning process. So it’s actually happening right now every fall. We pulled together different leaders from all of the different health systems participating in the South Carolina telehealth Alliance, our department of mental health and some of our partners that work in broadband. We bring all of our different leaders in this state together. Sometimes it’s up to like 70 or 80 different individuals representing over 40 organizations have different work groups, different strategy sessions. And we map out what we plan to do together in the year ahead.
Ryan Kruis – Manager, SC Telehealth Alliance & MUSC Telehealth: 07:45
And the way that we’ve structured it in recent years, we’ve got eight different strategies and so obviously there’s a lot of energy that’s going into developing those clinical services that are going to reach kind of our rural communities and address healthcare disparities. So our big health systems are working on that, but we also acknowledge that in order to really increase adoption in this state, we needed to have some strategies that kind of changed the culture and changed the infrastructure in South Carolina to make it amenable to tele-health adoption. So we have a whole strategy focused on expanding broadband into rural communities. We can’t get the clinical services out there if we don’t have broadband in those communities. We have a group working on tele-health education, making sure that our providers and our healthcare trainees understand tele-health, understand what it means to, you know, be telehealth practitioners.
Ryan Kruis – Manager, SC Telehealth Alliance & MUSC Telehealth: 08:38
We’ve got a group working on promotion to make sure our general public feels and our patients feel comfortable using this. Know that tele-health means just as good of care as seeing their provider in office and have groups working on sustainability and reimbursement. So there’s lots of different arms. And going to this open access discussion early on, we brought together kind of IT leadership to kind of really map out what does this mean in South Carolina and giving definitions to what our open access standards were, which then allowed us when it came to our funding to be able to write into our contracts. You know, if you’re going to use a state dollar to go towards equipment, it’s got to be open access. We got to be a part of this common vision. And also, you know, when we give out funding to different partners, you’ve got to participate in this annual strategic planning process.
Ryan Kruis – Manager, SC Telehealth Alliance & MUSC Telehealth: 09:31
And then the last thing I know is that that accountability is, has been really key and critical to this as well. So like I said, every year we map out key deliverables for the year ahead. But then on a quarterly basis we have all of our community partners report what progress they’re making on those deliverables. And then we in turn hand that over to the state and create quarterly reports to the state on how we’re doing on our strategic plan. Again, all of this helping us move in the same direction and work towards that common vision.
Shawn Valenta – Administrator of Telehealth, Medical University of South Carolina: 10:13
So it’s obviously a lot of planning or getting coordination. As a clinician, from your perspective, what do you feel all that planning, like how that impacts your patients?
Dr. Kathryn Cristaldi – Assistant Professor, Medical University of South Carolina: 10:18
Yeah, that’s a great question. So, I think for a lot of people, an annual strategic planning process sounds like a lot. And it’s a lot, but really for us, you know, what it meant was sort of at least two-fold. One is that planning process has kept us out of the trap of setting kind of short term goals. So I want to be able to see my patient who’s two hours away. And so let’s set up you know, the infrastructure to do that and think about workflows. Okay, I did that and now I don’t know what to do next. Or how to scale that or what my long-term vision really is. Or I think, you know, the other side of that spectrum is sometimes organizations say we want a statewide telehealth network.
Dr. Kathryn Cristaldi – Assistant Professor, Medical University of South Carolina: 11:18
That’s our five-year vision and then don’t really have a plan to get there. So I think that it’s easy to get stuck in both of those places and I think that’s where coming together annually and saying, okay, what are short, medium and long-term goals? And while we established a 5-year vision and a 10-year vision coming together annually forces us to have the step wise process of achieving that vision. I think it also has kept us up to date in those very rapidly changing environment that is tele-health. I think the things that we thought were possible for our patients five years ago are different from the things that are possible today and are going to be different from the things that are possible in five years or even less. And as a clinician, what I want is the most effective care for my patients.
Dr. Kathryn Cristaldi – Assistant Professor, Medical University of South Carolina: 12:16
It’s made me stop, take a step back and say, you know, instead of delivering my care in three-month intervals for 15 minutes at a time. And that’s how I organize how I care for my patient. And how I deliver interventions in a certain disease process instead of what if I said, I just want one bit of information every day. If I have one bit of information every day, how would I more effectively take care of my patient? And this technology has enabled us to have one bit of information every single day if we want. And really rapidly change how we manage patients. I think that the process has also enabled us to really have a bi-directional relationship with a lot of technology vendors. And that was for me as a clinician, an unexpected kind of perk of really thinking about what the next stage in development should be. And thinking ahead is that’s what the industry does. It pushes us forward. It’s always thinking about the next thing.
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