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Telehealth raising quality of care in rural areas

Dawn Brazell | MUSC News Center | December 8, 2014

Dawn Brazell


Paul Hletko, M.D., of Georgetown Pediatric Center, examines a patient in his teleconsult room. On the television monitor above him is pediatrician James T. McElligott, medical director of the MUSC Center for Telehealth. The two say the partnership is a "win-win" situation for improving care to rural areas.


Felicia Frasier knows her daughter’s weight could create issues that follow her through life. Duranda, 14, carries almost 180 pounds on her 5-foot-two-inch frame.

It caused her to be teased at school and may be why her daughter now prefers to do online homeschooling rather than face the drama of high school.

When Frasier heard from their pediatrician, Paul Hletko, M.D., of Georgetown Pediatric Center that they could do a teleconsult with pediatric nutritionists at the Medical University of South Carolina (MUSC), she jumped at the chance.

Georgetown-MUSC telehealth
Dawn Brazell
Dr. Hletko likes how some of the telehealth tools, such as his new digital otoscope, can help him show parents what their child is experiencing. 

Her daughter was placed on a new diet plan and counseled in ways she can get more activity and make behavioral changes. She also is getting testing done to see if there may be other issues, such as thyroid problems.

“It’s neat. It’s like they are in the room with you,” Frasier said of the pediatric nutritional consult that kept her from having to drive 90 minutes to Charleston. Frasier, who works two jobs, also has transportation issues at the moment that would have made the trip difficult, she said. “It was very instrumental in telling us options she may have, and she’s already lost a couple of pounds.”

Frasier isn’t the only one thrilled.

Her pediatrician Hletko loves being able to offer his patients more services, and he practices in a region where obesity rates run higher.

“Up to 25 to 30 percent of some practices deal with children who fall into the 97th percentile on the body mass index graph. This is a tragedy and is truly going to negatively impact our ability to have a healthy working population and a healthy student population for many years to come.”

Integrating telehealth consults with the MUSC Center of Telehealth is giving him access to university-based pediatric nutritionists, weight loss experts and endocrinologists, just to name a few of the subspecialties he now can tap into.

Hletko recalls he had to make a big adjustment coming from a university environment in Michigan to a small town in rural South Carolina in 1989.

“It was clear to me from my first day in practice that we need to unite a major children’s medical university with rural areas. There’s no excuse in the 21st century to have two standards of care – one big city university and another small town, very limited access to healthcare environment.”

Hletko said his practice used to have MUSC specialists visit once a week, but with the electronic telemedicine consultations they now offer, he can get a range of pediatric specialists any day of the week whenever he has a difficult problem. It also means his patients may not have to take the time and expense of traveling to Charleston to see a specialist.

“It’s made a great deal of difference in the quality of care we can get – and not just on one day of the week. We are very thankful that the Medical University has chosen to invest the capital it takes to launch a statewide telemedicine program,” he said. “It’s sort of like my Linus blanket. It’s so reassuring to not be alone in a rural community.”

For example, he said he likes that he can call someone such as Julie Kanter-Washko, M.D., a sickle cell expert at MUSC who is a trained pediatric hematologist-oncologist, and have her on a teleconsult in four minutes helping him quickly treat a child who is desperately ill.  “That’s not just with sickle cell disease but for a whole rainbow of problems we face in pediatrics in rural communities. This is a move forward that will sweep the nation, and it’s nice to see MUSC at the vanguard of this movement.”

James T. McElligott, M.D., a pediatrician and medical director for the MUSC Center for Telehealth, said Hletko’s practice is the largest user of outpatient telehealth and he has no doubt Hletko’s enthusiasm in adopting numerous telehealth programs is accelerating the service development of this technology.

As a longtime advocate in reducing disparities in health care that may be caused by poverty or living in rural areas with lack of access, McElligott said making strong partnerships with small town physicians and health centers will open opportunities for rural, underserved communities.

“Georgetown Pediatrics is the most advanced primary care practice integrator of telehealth in the state.  It’s one of the most progressive pediatric practices you could find anywhere, particularly in a rural region.  The value cannot be overestimated. I have the utmost respect for Dr. Hletko as a person, a leader, a researcher, a clinician and an innovator.”

The practice receives consultative services from MUSC in: sickle cell management, nutrition counseling, Parent-Child Interactive Therapy (PCIT) that deals with behavioral issues, Heart Health Program and telepsychiatry. The practice also plans to use telehealth services to join, via video, school individualized educational plan (IEP) conferences to help guide educational planning for their patients whose performance might be affected by their medical conditions.

Georgetown Pediatrics 
The Georgetown Pediatric Center was founded by Dr. Hletko in 1992. 

Since Georgetown Pediatric Center has been an early adopter of telehealth, it has given MUSC the opportunity to pilot many of its programs, said Shawn Valenta, program director of the MUSC Center for Telehealth. These programs are expanding into many rural areas and also being used in hospitals. Georgetown as a region is receiving telehealth services in developmental pediatrics, sickle cell disease, nutrition counseling, stroke evaluation, mental health evaluation and pediatric critical care consultation, he said.

“We look at telehealth as a way to enhance access to care and maximize the efficiency of the care system,” Valenta said. “Our vision is to facilitate the access of care at earlier points along the health care continuum and create coordinated, co-management care between medical homes and specialists.”

Hletko foresees many other rural practices integrating telehealth as a necessary part of growth as it can enhance the reputation of a practice to have the support of a wide range of subspecialties.

“It’s but the beginning of a huge expansion of services for children in South Carolina,” he said, citing a long list of more complicated medical conditions where children would benefit in having expert specialty teleconsults, including patients who suffer from cystic fibrosis, seizures, renal failure or who have had organ transplants.

“It’s a fabulous augmentation of our ability to help children. We have four pediatricians and two nurse practitioners, but we have more than that when you consider the assistance we get from the Medical University. So we actually have a whole department of pediatrics in Georgetown now, and it’s called telemedicine.”


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