Copyright Charleston Post and Courier
Palmetto Care Connections recently hosted its annual Telehealth Summit in downtown Charleston, and there was an optimistic mood about its future use among providers. Having a specialist available via telehealth could help attract more primary care doctors to needy rural areas in South Carolina, and the state’s attractive and growing environment will aid recruiting, hospital executives said. The interactive video and voice links could also help rural providers do more prenatal care and help improve outcomes for women, a state official said. Executives from two of the state’s largest health systems, Palmetto Care CEO Kathy Schwarting and Dr. Edward Simmer, interim director of the S.C. Department of Public Health, weighed in on telehealth’s potential in the state. One of the first lessons South Carolina learned years ago, when establishing a telehealth network to improve stroke care, was that it wouldn’t work if everyone had a different system and software and none of them could work with the other, said Dr. Patrick Cawley, CEO of MUSC Health. The legislature got involved and the state has since moved toward more “open yet secure systems” that allow health systems to collaborate as needed, he said. Early on in those rural areas of scarcity, telehealth didn’t always work as intended. Tweaks and new partners needed to be added, and that has since become a strength for the Palmetto State, Schwarting said. “The collaboration is what really set South Carolina apart from a lot of other states,” she said. “We have health systems that work together instead of seeing each other as competitors.” Coming to South Carolina from Pennsylvania a few years ago, the network already in place for telehealth was impressive, said Dr. Jonathan Gleason, executive vice president and chief clinical officer for Prisma Health. “The infrastructure in South Carolina is really outstanding,” he said. Working with the legislature to help fund and further those efforts created a situation “where we can win in a digital environment,” Gleason said. One area where virtual access is already making a difference is for families signing up for aid through the Women, Infants and Children nutrition program, Simmer said. Where before they would have to come in to an office and fill out a form, “now they can get it up on their computer screen” and fill it out quickly, he said. The greater telehealth network could also help the state tackle a shortage of specialists, Simmer said. South Carolina has 15 counties where there is no obstetrician-gynecologist, and that has consequences for pregnant women, he said. “We have a lot of counties where women can’t get good prenatal care,” Simmer said. South Carolina has the eighth-highest rate of maternal mortality, and lack of prenatal care is considered a risk factor for pregnancy-related deaths, according to a 2018 study. Rural areas had a 62 percent higher rate in South Carolina than urban areas, a state review found. While counties lack OB/GYNs, every county has a family practice doctor who is trained in obstetrics, Simmer said. Those doctors could get help providing early care to pregnant women with the support of OB/GYNs elsewhere in the state, he said. “I think a telehealth component can make a big difference, so that they would have that help if they run into a challenging case, but they can still provide the prenatal care,” Simmer said. “Maybe even deliver the children.” The legislative investment has helped set up those systems and helped the state innovate. With potential rural health investment money from the federal government, those networks can help doctors create better systems of care for patients, Cawley said. “We need to start thinking about, how do we set up systems to monitor people's diabetes better, so it doesn't put as much pressure on providers (or) monitor high blood pressure,” Cawley said. “… there is no woman who's pregnant in the state, who's got a high risk situation, who shouldn't be seeing high risk (obstetrician).” The COVID-19 pandemic actually made some of these small towns and rural areas more attractive to people who wanted to get away from cities, who wanted fresh air and more land, Schwarting said. Good internet access means they can work remotely and still get what they are seeking. “There's a quality of life that they don't necessarily get in New York City,” Schwarting said. “One of the ways that telehealth helps with that is the fear of the (lack of) access to care is not what it used to be.” The state’s climate, booming population and demand for health care also helps attract new providers to the state, Gleason said. In recruiting, “we've just been leveraging how awesome it is in South Carolina,” he said. The Palmetto State also stands in contrast to many other states where growth is essentially “stagnant,” Cawley said. “Those are great places to pick up doctors,” he said. With a South Carolina medical license, some specialists could actually be almost entirely virtual, as well. Or others, once signing up, “can start almost immediately” providing care via telehealth, Cawley said. Those specialists can also become part of the network that supports rural providers. And it is not just doctors. “Virtual nursing is something that is growing rapidly,” Cawley said. The technology is also helping to end what had been considered a potential trade-off with virtual care, what Dr. Meera Narasimhan, the moderator, called the “high tech vs. high touch” conundrum. “Are telehealth, AI and automation really enhancing the patient experience or are they slowly replacing the human connection that really contributes (to) and defines quality care?” is how she framed the issue. That was always the assumption — that telehealth couldn’t provide that care, Cawley said. But with better definition on monitors and screens than there were 20 years ago, patients can see that compassion in their providers and they can hear it over monitors or over the phone, he said. “They can hear whether you are empathetic,” Cawley said. “I’d like to put that debate to rest.”
