Listen as Fabric COO Aiden Feng and Dr. Jimmy McElligott, Executive Medical Director for the Center of Telehealth at MUSC, discuss how MUSC became a National Telehealth Center of Excellence by expanding access and reimagining care delivery. Learn how MUSC is using asynchronous telemedicine—powered by Fabric—to drive clinical efficiency, reach more patients, and build healthier communities. This conversation highlights MUSC’s broader vision for innovation, workforce transformation, and seamless patient journeys—and how Fabric is helping bring that vision to life.
Transcript
Aiden Feng
Hello, I'm Aiden Feng, Chief Operating Officer at Fabric. I'm here today with Dr. Jimmy McElligott, Executive Medical Director for the Center of Telehealth at the Medical University of South Carolina and an associate professor in the Division of General Pediatrics at MUSC Children's Hospital. He's our friend and partner, and he oversees the MUSC Center for Telehealth which is recognized as a National Center of Excellence under his leadership. So congratulations on that achievement. Maybe we'll start there. You know, we'd love to hear more about, the key steps and what it took to MUSC being recognized as the National Telehealth Center of Excellence. What sets you guys apart here?
Jimmy McElligott
Well, thank you. Happy to be here. Well, you know, I think the first place to start is, you know, really kind of talk a bit about our structure and then to make a little more sense in context. So our telehealth operations really have like three parts. There is the Operational Center for Telehealth which provision services. We might be direct to consumer video, but in large part for us, the contracts with hospitals or rolling out remote patient monitoring or School-Based allow the diversity of services that roll out under the Center for Telehealth operation. Then we have an advocacy and state facing, state supported called that South Carolina Telehealth Alliance. So that Alliance uses state appropriations tax dollars to apply to a strategic plan. Some of those services from the operational side are used in it, but it also supports other health systems throughout the state and helping them apply telehealth towards goals that we set collaboratively in the state. So that's the second part. The third part would be what our designation as a Center of Excellence and what that means is it's a federal designation through HRSA, and applies federal funds to the study of telehealth. So to be, it's part of a network of supports, telehealth support entities across the country. And what that means is we are charged, with studying telehealth and disseminating best practices. And to get the designation, you have to have a couple criteria. One, you have to do a lot of telehealth. We had that. We had our state support and we had our Operational Center up and running pretty well at the time. And then two, you had to be in a rural, high need state. We, South Carolina unfortunately meets that. Not unfortunate because it's rural, but unfortunate because it's high need, there and then three you have to have the academic ability to study and disseminate best practices. So we had to have the academic infrastructure to do it. So we met the bill. There was other great entities out there doing great telehealth, but our charge, along with University of Mississippi, is to take what we're doing on the operational side and translate that into something that can be disseminated nationwide.
Aiden Feng
Yeah, that's amazing. And we're grateful to have been a part of this journey with you. And, you know, in terms of best practices, I think, one area that we wanted to discuss today, was how MUSC stood out with the use of asynchronous telemedicine or, you know, Async Care. And, you know, unlike traditional telehealth, which most people think of as a video interaction, in Async Care, providers and patients interact, asynchronously, for the lack of better word and, you know, a patient answers a series of questions without an appointment and then, afterwards, provider reviews and responds when it's most efficient for them. Why did you include this offering and the telehealth offering that you all have built out? And, how has that evolved over time?
Jimmy McElligott
Yeah. No, it's a great question. You know, early on, I talked with our CEO, who was really and when I first started down this journey, I was, just a starting out young, an academic professor, looking to work in health equity, you know, arenas. And so my CEO didn't trust me, and he shouldn't have. So I had to meet. I got the privilege of meeting regularly with them when we really started to lean in on telehealth. And I had to tell them early on after I kind of looked at value cases and, the why behind what we were doing. But I really believed in asynchronous I mean, not that anything knocking against how things have been done for 100 years, but it was hard to imagine solving problems without asynchronous, becoming a much bigger part of our workload. And so he was he had the leadership backing that, that helped a lot. Right. And then the second part is we really took our early on because we had, we were fortunate enough to have some state appropriations that we said, well, whatever we do, there's the business case, but there's also just a state case. We need to help our state. And we really had to look at our value cases from that arena. We had the luxury that most people do virtual urgent care because they're afraid, whether it's true or not, that they're going to fall out of competitiveness in a virtual urgent space marketplace. And that certainly getting more crowded. But at the time when we started, perception was that it was going to be crowded, but, you know, most healthcare is still local and it's still in a lot of ways. So, long story short, it that didn't really stand up. But what we really said, well, if we're going to make this, if the whole value case is to provide convenient care and for lack of a better term, to like rope people into getting involved in their own care and then care navigate them to something else, flu shots or whatever healthcare need, get them in the system. Not from a market perspective, but from, you know, just engaging the population in healthcare. Then we say, well, we need to make it super easy. Like the goal is to be get them in the goal isn't necessarily to solve all their problems. And so when we did that, we went looking for asynchronous products, chat products or other elements. And we ended up with your product. And really we've never looked back and we been we were early adopters of asynchronous. Now there's others doing it, but we're pretty mature at doing it. Having done it for a lot of years. And surviving the pandemic and really using it during the pandemic heavily for a variety of use cases. And that's where we got started. We really kind of looked at the why, and the answer was, you know, if you take billing out of it, why not make it super easy?
Aiden Feng
Right. Yes. For sure. And, you know, over time, now that you've been doing it for a while, how is it evolved over time, or have you seen the impact that you were intending to see in terms of, you know, for, quote, roping people in for follow up care and establishing that relationship, afterwards. Yeah, I think.
Jimmy McElligott
Yes. And there's a lot more work to be done. So I think, you know, one, we were making good ground pre 2020. We were doing a lot more than others. We were working on the workflows. But I guess the surprising thing is how busy it got. So we blew up. We were serving all across the state. We were busy. So really, we're keeping the lights on and trying to grow the staffing. And then the pandemic hit and we really had to pivot to supporting COVID testing first. And so that was our first use case of using it for a different element. And then we added on COVID treatment as pandemic. Went through its series of events that we all had to deal with. But you know, it's easy to gloss over and say that part. But it was a good 2 or 3 years of work where this platform and this team did amazing work, and it probably lost to the annals of history, but it shouldn't be. You know, we had we were so fast that cars were lined up and the tents weren't raised yet for COVID testing where they had their tickets the MRNs didn’t always match. It was chaos. But, you know, we had used the tool and flipped it and we were doing more testing than the Public Health Department. But it was fast. And we realized we could change things. One of our Medical Directors who know is our Chief Medical Information Officer, because of the hard work she did during this time period. I mean, at one point, she was when you had to actually sign for a COVID test, like a physician had to order it. Like, I think she was on tens of thousands of orders. And you see, her name was just put out there, everywhere because the workflow went that way. And so, long story short, and, that was a big enabler, distractor, whatever you want to call it. Now, in the past, I would say year really. We're really getting back to truly trying to integrate the people coming in the door where they need to be and where it's still pretty new. I think we're new at that. I think we got a lot to learn. I think the tools are there and we're super excited, but that's how it went down.
Aiden Feng
Yes, definitely. I think, you know, it's the combination of efficient and effective. Right. And that that is absolutely critical. And, you know, I think, we have really, dug into what that really means when it comes to, you know, artificial intelligence and, virtual care and how do we marry those two things together? And so we've one of the newest initiatives that we're undertaking at Fabric is, around hybrid AI, meaning that when it's an administrative question about, you know, clinic hours or parking or billing, we can apply the latest technology, you know, with the latest LLMs and create these personalized responses. But when it when we understand that it's a clinical intent, we then, create responses using decision trees. That's based on evidence and literature. Right. And that balance is not static, but it's going to shift over time. So, you know, we're excited to partner with you, on the, in that evolution, especially in the Async Care component. One other area that I wanted to click on with you is, you know, efficiency, effectiveness, but also patient experience. You know, I enjoy reading some of these reviews from MUSC patients. And one of them was, you know, this was the best experience I've ever had. I truly appreciate having this as an option. I think, you know, we'd love to hear, what the response has been from your clinicians and patients on this kind of an offering.
Jimmy McElligott
Yeah, that's an easy one. Thanks. The, well, first of all, you know, just to put it in context, you know, we're proud of all the work we do. We do hospital connections. We do lots of other things, and we try to perform well wherever we go. But usually I just hear the bad stuff, right? And so you can hear the concerns and complaints there. Brace for impact. And, you know, even though our metrics good I would say for the virtual urgent care program, which is the asynchronous first, not solely asynchronous, but it's going to first program. I mean, that it's you hardly ever hear anything bad that the Net Promoter Score is through the roof. Our leaders, our CFO recently did one, and he's a brand new CFO. And I definitely was bracing for impact, but he was like, that was amazing. I unfortunately, I think it speaks to people that don’t really want to interact with people that much. You know, they just want their problem solved. You know, there are times when you do and I think escalating and it fits in the continuum of care, a healthcare that a system should provide. But, I mean, if you do it well, you know, even when people get a response they don't like, they didn't get the antibiotic, they wanted. You know, it's delivered in a way that's like, hey, you know, you've only been sick for a few days. It's, you know, right here, try this instead. And I think in general, the speed, at first is, It's either really enjoyable or to a degree it can be sort of unsettling, like, wow, okay. It's only been three minutes then, but you know, it's just well done. And I think it speaks to that, but it's universal. I mean, the people are it's a wow factor, which is kind of neat, you know. And I think we'll get that more as AI comes on in other domains of healthcare. But it's nice to be achieved. And sometimes I have to tell people there's a real professional behind that answer. They reviewed everything. They looked at it, but they were teed up, you know, followed all the algorithms and everything was presented to them nicely. They can make a quick decision. And then also they have the ability to respond back in a very efficient manner. So it's all there and it is what it is. It's straight up accurate and fast.
Aiden Feng
That's right. I think it goes back to, you know, using this kind of hybrid AI platform to augment learning, clinicians. Right. You know, I think we all can agree that we still want that and need that human element to deliver effective, clinical care. But, this is you know.
Jimmy McElligott
Sorry to cut you off. I will say, just to make sure that the listeners, you know, understand, you know, a lot of our parents that come in like to use the chat feature, like there is a conversational nature in there, need it. But, you know, if you really like, the largest condition managed is URIs. A lot of people just want to know where they stand. Have they done everything they can? Runny nose and sinus stuff is miserable, right? And they just want to know they've done everything they're supposed to do and they get that answer quick.
Aiden Feng
Right? Right. But, yeah, in today's busy world, convenience is everything right? And just, solve the problem in the most efficient, kind of way. You know, maybe for the last topic, we zoom out a little bit, you know, there, you know, we know that there's this OneMUSC initiative with the three pillars, you know, Empowering Healthy Communities, Driving Innovation and Health Transformation and Reshaping the Future Workforce. You know, how does your virtual care strategy more broadly support this initiative? And how does it fit in?
Jimmy McElligott
Yeah. Well, you know, we've always been proud to work under the strategies from MUSC but that new one that you're talking about there, I'm very excited. But I mean, I think it speaks to our work. I like to think we help make MUSC ambitious enough that they tip those on. I think for the listeners, you know, a lot of the goals underneath those are bold. They are we want to move our state into a top tier health state. And in some of it's 30 years, right. It's you can't take a, as you know, a high need Southeast state and flip it into a very healthy state overnight. But they're really committed to that and have some core strategies behind it. So we are embedded in all of those pillars. I think, you know, the healthcare delivery ones are fairly obvious, but we have to put a lot of work on digital literacy and getting to all the populations that, you know, drive poor health outcomes because they haven't had the advantage of accessing care. I know historically, but also like the workforce development one, we are very literally creating new jobs, you know, so keep working in a virtual urgent space is one. These providers do this full time. This is a 24/7 service weekends, nights all the time. And there's whole shifts doing this. But also the nursing support roles for video visits, remote patient monitoring nursing roles. In fact, nursing in itself is going through a quiet revolution I think in virtual care, there's a lot of inpatient virtual nursing happening. We have whole centralized teams that support about 1000 visits a day on the video visit front, not to mention urgent care, not to mention the nurses that support inpatient visits, not to mention the nurses that do remote patient monitoring. So I think workforce development is a very real thing with us too. And I think if you can work remotely, you can live rural. So you don't have to move to a city for these jobs, and maybe we can keep some of that job. So we've had some workforce development grants to do, high school education, to look at tech colleges and show them the jobs they can have in virtual care. And hopefully they don't feel the need to always leave their communities, if they have the competencies to actually do these jobs at that level. So yes, thank you for mentioning that. I'm very proud of that strategy. Now, I want to make sure that everyone just kind of puts their money where their mouth is. And if its a 30 year plan, you know, first five years might be the most important. And that's what we're in right now.
Aiden Feng
Right. And you're definitely building for the future. You know, we're fortunate to have partnered with you for the past six years. I can't believe how long it's been. And, you know, looking forward, how do you think our partnership together will help achieve the goals that you just mentioned?
Jimmy McElligott
You know, when we look at partnerships, you know, we don't really look, very we don't look at it as a transactional nature. We look at as partnerships. Both sides got to put in the work, both sides have to agree on the vision. And that's been wonderful with you all. So I expect a lot more of that. I expect us to, you know, see what you're innovating and see what our needs are. Meet in the middle, not trying to change each other's roadmaps, just trying to find where those synergies are and where we can make, as much gain as possible. And that's you know, with all the, advances that you all are leaning on, the AI fronts around the care continuum front about using whatever efficient tools we have. They align very well, but some really core strategies that we have for us, they probably do build off virtual urgent care and expand from there. But we are going to be we said we do, what, 47 out of your 100 protocols and that's going to change. But to completely to increase to but to do that the next 50 protocols we probably need more continuum. We got to pass care plans off to other care virtual care teams and in-person care teams. And we're going to need help doing that. And we're going to need help making it the user experience, not diluting that from where we started, which is extremely high. So yeah, lots more to come. I think it'll grow out from there. I think keeping an eye on, efficiency like we've talked about and effectiveness, there's, it's wide open.
Aiden Feng
Yeah. No, we're very excited. And I think, you know, we're partnering together to not only expand access, but as we mentioned earlier, to create and curate these longitudinal journeys that, you know, bring the patients through the front door, which we're doing today, but also link them to the most appropriate, the right care at the right time via the right modality, with MUSC providers for the long term. Right. And I think, you know, we're very well aligned in terms of where that is a direction that we're headed in together. So, yeah. Thank you so much, Jimmy, for sharing your insights with us today. And we're very excited to continue our partnership. And driving innovation together.
Jimmy McElligott
Yeah. It's great work. Thanks for having me.
