A Pioneering “Hospital Without Walls”

The Center for Telehealth at the Medical University of South Carolina (MUSC) is saving lives, improving health care access and closing equity gaps by digitally connecting patients, communities and health care providers.

The center helps extend vital services to patients like Kathy, who was rushed to her local hospital in rural Hartsville, S.C., following a stroke.

“I asked a couple of times… did I really have a stroke? And (the emergency room staff) said, ‘Yeah,‘” recalled Kathy, who requested we withhold her last name to protect her privacy.

She recalled them asking her to describe how this frightening experience began.

“I was home. I got up. I was dragging my leg down the hallway. I wasn’t talking, I was mumbling. I then felt my left arm was numb. My roommate brought me to the hospital immediately – it was about 10 minutes away,” Kathy recalled.

For stroke victims, the specialized care of a neurologist is vital. However, in Hartsville and many rural communities with smaller hospitals and staff, health care specialists such as neurologists are not often available in person. Through telehealth connections, neurologists and other specialists in a distant location can work in real time with local patients, doctors, nurses and other health care providers in these rural communities. For Kathy, the expert guidance of a Charleston-based neurologist who connected with her ICU care team in Hartsville via the MUSC stroke telehealth program, proved to be pivotal.

“I was taken to the ICU, all of the sudden there was a TV at my feet, and the neurologist on the screen (was) right there, right in front of everybody, saying this is what you need to do and you need to do it right now. We don’t wait,” said Kathy.

“It was lifesaving,” concluded Kathy.

Kathy’s story is one of many with positive patient outcomes that have been made possible for rural South Carolina residents through telehealth. What is telehealth? Simply put, it’s “the use of communications technologies to provide health care at a distance,” according to the National Institute of Biomedical Imaging and Bioengineering.

The Duke Endowment, seeing how well these services can increase access to care, is working to expand telehealth services in the Carolinas. These telehealth efforts are driven by partners including the MUSC Center for Telehealth, local and regional hospitals across the Palmetto State, health care providers, non-profit organizations, and government agencies collaborating within the South Carolina Telehealth Alliance.

Medical leaders made stroke care the first area of focus for telehealth access, in part because stroke is a leading cause of death in South Carolina. When strokes occur, “time is brain,” according to Dr. James McElligott, executive medical director of the MUSC Center for Telehealth. Research has proven that it is critical to reduce the time that elapses from the onset of a stroke to receiving care; quicker response means a better chance of avoiding death or debilitating long-term impacts.

Since the stroke telehealth program began at MUSC in 2008, it has expanded dramatically to include stroke care for patients across all 46 counties in South Carolina, a milestone achievement in a state where more than 27 percent of residents live in rural areas. “Currently, through our collaborations in the South Carolina Telehealth Alliance, 100 percent of all South Carolinians are within a 30-minute drive of an expert stroke doc. We have built a major, statewide stroke hospital without walls,” said Dr. Christine Holmstedt, the medical director of the MUSC Stroke and Telestroke programs.

Across the U.S., telehealth gained momentum during the global COVID-19 pandemic. In an effort to curtail the spread of the virus, face-to-face interactions between patients and their health care providers were limited. In February 2024, the National Center for Health Statistics at the Centers for Disease Control released data charting the rise in use of telehealth for office-based physicians from 15.4% in 2019 to 86.5% in 2021.

Telehealth services are now available to patients for preventative efforts, critical care, remote treatments, follow-ups, and on-going services and supports. Over 100 telehealth programs are now offered through South Carolina Alliance for Telehealth partners, including cardiology, mental health counseling, ob/gyn, palliative care, pediatric, urgent care, and women’s reproductive behavioral health (see connected story). Note: link to MUSC Women’s Health story on Centennial site.

In 2023, patients in South Carolina utilized telehealth services 1.3 million times from sites including their own homes, 45 hospitals, 100 schools and 100 community clinics. “South Carolina truly is a leader in hospital-based connectivity. Just about every hospital in the state has a telehealth partnership,” remarked McElligott.

For historically underserved minority and rural areas, telehealth access offers the promise of helping to close decades-long health care inequities. However, powerful societal and health care inequities persist.

In response, leaders of the MUSC Center for Telehealth and the South Carolina Telehealth Alliance are approaching the next stages of telehealth growth with clear intent to address barriers to digital access and use, including access to high-speed broadband service, up-to-date equipment, training and IT support services. Digital barriers can put effective telehealth care frustratingly out of reach for many underserved populations, and further, can exacerbate existing disparities across geographic, socio-economic, racial and ethnic divides.

“The point is to truly make a difference in health inequities and in health maintenance across the entire population,” said McElligott.

“We have such a unique partner to help. This is something that we did together, and it will have lasting and meaningful impact,” said MUSC President David Cole, pointing to the special relationship between MUSC and The Duke Endowment.

For patients like Kathy, the strategic impacts of telehealth in the Palmetto State remain deeply personal. “I am back working again. I just turned 73 last week. I know I’m gonna be OK. I’m still me,” she exclaimed.

Learn more about the MUSC Center for Telehealth.