Branching Out: My Role as a Consulting Manager for a Pediatric Telehealth Collaborative

image of a stethescope and mobile phone

When they write the book on the history of RTs in telehealth, Brooke Yeager McSwain, MS, RRT, will be front and center. She’s been involved with the Center for Telehealth at the Medical University of South Carolina (MUSC) since 2014, serving first as program coordinator for the emergency and inpatient telemedicine programs and then as the government relations and clinical outreach coordinator. Now she has taken on a new role as consulting manager for the newly created South Carolina Children’s Telehealth Collaborative (CTC). She shares more about her new job and what she believes the future holds for RTs in telehealth with us here —

First, can you tell us a little about the South Carolina Children’s Telehealth Collaborative? When and why was it formed, and what is its primary mission?

The South Carolina Children’s Telehealth Collaborative was co-founded by Dr. David McSwain and myself, in collaboration with leaders from the other three children’s hospitals in the state. It was initially funded through a $1 Million Duke Endowment Grant in 2015. Our goal was to build upon the success of our MUSC Pediatric Critical Care Telehealth program by coordinating the creation of similar efforts by children’s hospitals across the state. Access to sub-specialty critical care physicians and highly trained critical care RTs is extremely limited in rural areas of our state — as is true in most states — and South Carolina is largely a rural state, so expanding the reach of these services to strategic locations was crucial.

What made you decide to take on the consulting manager position?

The position grew from the initial grant-funded program, so I was the logical choice to continue running the program. Our early successes led to the CTC becoming a state-funded program and, beginning in January of 2019, the CTC officially became a collaborative partner of the South Carolina Telehealth Alliance, the state’s government-funded network.

What requirements — education and experience — did you have to meet to get the job?

The job requires significant experience in health care programmatic development, some background in telehealth, and an understanding of state and federal telehealth policy and regulations. There is a minimum requirement of a bachelor’s degree, though a masters is strongly preferred given the complexities of statewide coordination.

What are your main responsibilities, and how does your background in RT help you fulfill them?

Although clinical experience and certifications are not required, it is widely recognized that a background in critical care and patient care coordination is one of the factors that makes a candidate successful in this kind of position. Respiratory therapists are uniquely suited to this because we have wide exposure to such a broad range of patients.

My tenure as an RT included critical care and pulmonary rehab, and those experiences not only built an extremely strong clinical competency but also helped to sharpen my communication skills and program development expertise. Respiratory therapists are also the masters of multi-tasking, so it’s probably no surprise that I’m working on multiple interwoven efforts.

I also work with the SPROUT Collaborative, a nationwide research network of pediatric institutions and providers, which was recently awarded a $3.6 million NIH grant to support the development of collaborative telehealth research efforts across the country. I am fortunate to be serving as the health policy lead on this effort, overseeing efforts to identify state and federal telehealth policy gaps and determine how to address them through research. Additionally, in June, I will begin a summer policy fellowship with the HIMSS Institute for e-Health Policy. So, things are busy!

Are there other RTs working in a telehealth role in South Carolina? If so, how are these RTs being utilized?

RTs are not currently covered providers of telehealth services at either the federal or state level, so it is still somewhat unusual to find them working in the field. However, states are increasingly recognizing the critical role we play in providing low-cost, high-quality care to patients with a vast array of conditions. Because of this, states like South Carolina are finding ways to incorporate RTs into service delivery for programs such as school-based telehealth asthma programs, COPD readmission-related efforts, and more recently, as part of interdisciplinary teams providing home care to medically complex patients. MUSC currently has several RTs working in these areas and in prominent telehealth administration and research roles.

What are the top challenges and top rewards of working in this role?

Telehealth is literally —yes literally — altering the way we deliver health care services, so work in the field requires strong problem-solving skills and an ability to foresee what new challenges may be created by program implementation. No two days are the same, but when you see the genuinely life-saving effects these programs can have when properly developed and executed, it is almost impossible to not be grateful for the opportunity. We’re on the cutting edge of a field with so much potential to address the overwhelming health care needs and disparities faced in our communities.

Do you think telehealth holds job potential for other RTs? Why or why not?

There is absolutely a bright future for respiratory therapists in telehealth. Our roles will expand as payment systems shift from fee-for-service to value-based care. Policymakers continue to see the value of clinicians with the ability to deliver superior care at lower costs to a range of patients associated with some of the highest health-care expenditures in the country — and globally.

Both federal and state agencies regulating practice and reimbursement for telehealth are realizing the need and responding by expanding allowed coverage codes and lifting geographic and originating site restrictions. Changing laws about who can provide coverage will occur largely on the state level, as practice laws are governed by state medical boards. This is one of the reasons why respiratory therapists should be involved in their state and national organizations! We need both local and federal advocacy to inform our legislatures of what we do and how valuable we are in efforts to care for these patients!

How can a telehealth team make a difference in a patient’s life? This video tells the story of one little girl who might not be here today if not for the services of the CTC team