Some of the sickest residents live and die early in rural South Carolina. There is no clear answer how to best improve medical access in these areas - particularly as rural hospitals serving these hard-to-reach communities struggle to stay open - but two Charleston health care systems are testing very different ideas.

How telemedicine works

Dr. David McSwain, medical director for inpatient and emergency teleconsultation at the Medical University of South Carolina, regularly needs to examine pediatric patients with respiratory problems far away from Charleston.

Historically, doctors could only communicate with other physicians about those patients' conditions over the phone. It was an imperfect system, but it was all they had.

"It's virtually impossible to understand by having something explain it to you," McSwain said.

"It impacts so many management decisions that need to be made very quickly. We have to decide whether the child needs to intubated, what therapies to give, what therapies they don't need. Obviously there can be side effects - you don't want to give therapies that aren't necessary."

Telemedicine eliminates any doubt. It is far superior to trying to gauge a patient's condition over the phone, he said.

A high-definition monitor and camera, set up on a mobile telemedicine cart, allow McSwain to interact with a patient, their doctor and their parents in another hospital - even a facility many miles away from MUSC.

"Really it's a gamechanger," he said. "The technology is so good the camera goes away and you're standing in the room with the patient, even though you're 100 miles away."

Lauren Sausser

While the Medical University of South Carolina, with the help of a multimillion-dollar state investment, is making strides in telemedicine to deliver services digitally and remotely, Roper St. Francis Healthcare recently started sending its top oncologist outside Charleston into rural Hampton County once a week to meet with cancer patients face-to-face.

"There are significant disparities in care depending on where you live," said Scott Broome, director of oncology services at Roper St. Francis Healthcare. Both cancer incidence and mortality are often higher in rural counties, he said, because patients are not screened for the disease as regularly as patients in urban counties and their cancer is usually more advanced once it's detected.

"Some things lend themselves well to telemedicine and virtual consults and some things don't," said Dr. Steven Akman, medical director of Roper St. Francis Cancer Care. "Oncology is one of those, especially, that doesn't lend itself to - you need to be hands-on because you're infusing chemotherapy."

Akman started seeing patients through a collaboration with Hampton Regional Medical Center this month. He travels an hour-and-a-half each way to the hospital in Varnville once a week from Charleston.

Telemedicine network

Meanwhile, MUSC is ramping up the South Carolina Telemedicine Network, which is designed to reach some of these same rural patients but doesn't require physicians to step one foot outside of the hospital.

Telemedicine or "telehealth" broadly includes three technologies: live video conferencing, store-and-forward photographs, which can be sent to a specialist and analyzed at a later time, and remote patient monitoring.

While these concepts aren't exactly new, they're gaining newfound traction in South Carolina. Lawmakers recently approved a $19 million investment into the state's new telemedicine network, up from a $12.5 million investment last year, with the expectation that it will improve health care access for those patients in rural parts of the state who forgo treatment because their local hospitals don't offer the services or they can't afford to travel to urban medical centers.

Programs for stroke care, intensive care, maternal fetal medicine and a number of other specialities are already connecting MUSC doctors with hospitals and patients around the state. The state investment will expand the network's reach.

"It's great news," said MUSC lobbyist Mark Sweatman. "In less than three to five years, it's going to transform the state in the delivery of health care."

Technically, doctors already practice telemedicine every time they're on call, said Dr. Mark Lyles, MUSC's chief strategic officer.

"The first telemedicine use ever was the first telephone exchange. It connected nine doctors with the local pharmacy - I think it was Hartford, Connecticut," he said. "It's just now we have the ability for video and to layer that on comes with a heightened sense of well, now it's part of the record."

Most of the state money is intended to cover capital costs. Each participating hospital's initial investment can be expensive - a telemedicine cart, equipped with high definition cameras and monitors, costs several thousand dollars - but the technology could eventually save the health care system money. Patients can be treated remotely through telemedicine, often eliminating the need for expensive transportation.

"That's the big thing that's a barrier to telemedicine - the up-front cost," said Shawn Valenta, MUSC's telehealth program director.


While Roper St. Francis and MUSC are tackling the rural access issue differently, both are still figuring out how to ensure their programs are sustainable.

For example, Akman isn't treating patients in Hampton County for free, and it's still unclear if that market can sustain an oncologist, even one practicing only once a week.

Broome estimates that Akman may treat between 100 and 150 cancer patients in the Hampton County area each year, based on the population.

Roper St. Francis bills for Akman's professional services and Hampton Regional Medical Center bills for the ancillary services, including lab work and infusions. Akman probably won't treat every patient diagnosed with cancer in the area, but both hospitals hope they can capture a large percentage of that market.

"In some sense, it's experimental," Akman said. "We view our obligation as extending beyond the local area and how do we provide the best services for our outlying partners? We're going to learn from this. I'm sure the relationship will look different a year from now than it looks now."

MUSC faces an even larger hurdle as it fights for a new law that would require health insurers to reimburse hospitals and providers similarly for telemedicine consultations and in-person appointments. Valenta said 21 states have already adopted "parity" laws. South Carolina has not. Until then, it will be difficult to convince doctors that telemedicine consultations are worth their time if providers aren't adequately reimbursed for the service, he said.

"The insurance community supports telemedicine. They think it's a smart way to use technology," said Jim Ritchie, executive director of the South Carolina Alliance of Health Plans, a group that represents health insurers in the state. "What they oppose is when doctors and hospitals seek government mandate to guarantee them profits. Most states have a much more mature market that we have. This is still an emerging market in South Carolina."

Reach Lauren Sausser at 937-5598.