3/25/2020

1. Weitzman ECHO on COVID-19:
Develop and Define Your
Telehealth Strategy
March 25, 2020

2. CME Credit
• Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State
Medical Society to sponsor continuing medical education for physicians. The
Bridgeport Hospital Yale New Haven Health designates this live activity for a
maximum of one (1) AMA PRA Category 1 CreditsTM. Physicians should claim only
credits commensurate with the extent of their participation in the various
activities.
• This activity has been planned and implemented in accordance with the Essential
Areas and policies of the Accreditation Council for Continuing Medical Education
through the joint sponsorship of Bridgeport Hospital Yale New Haven Health and
the Weitzman Institute. Bridgeport Hospital Yale New Haven Health is accredited
by the Connecticut State Medical Society to provide continuing medical education
for physicians.
• The content of this activity is not related to products or services of an ACCME-
defined commercial interest; therefore, no one in control of content has a relevant
financial relationship to disclose and there is no potential for conflicts of interest.

3. Weitzman ECHO on COVID-19
A Primary Care Perspective cont’d
Stephen J Scholand, MD
Infectious Disease Consultant
25 March, 2020

4. Objectives
- Review latest updates on novel coronavirus (2019-
nCoV, SARS-CoV-2) epidemiology
- Quick overview of potential drugs
- Promise of Telemedicine
- Manage resources effectively
- Coordinate health care delivery in partnership with
local health department and health care leadership
- Remind people to follow the rules: This is war!

5. 46450 cases 3/24/20 – up from 6496 cases last week (3/18/20) -
https://coronavirus.jhu.edu/map.html

6. Avoiding the surge

7. Italy, il mio cuore

8. Other options?
• Hydroxychloroquin: early, positive evidence
• Kaletra failed (lopinavir/ritonavir)
• Remdesivir – no more compassionate use
• IL-6 inhibitor - Tocilizumab
• Other anti-virals…
• Antibodies
– Harvested serum, monoclonal antibodies
• Vaccines

9. Patient groups at highest risk
• Hypertension
– ACE-2 receptors (?) – ACE inhibitors, ARBs
– NSAIDs to be avoided
• Other Cardiovascular disease
• Chronic lung disease; moderate-severe asthma
• Diabetes
• Obesity (BMI > 40)
• Immunocompromised (Cancer patients)
• Renal failure; Liver disease
• Nursing home residents/LTACs
• Extremes of age (<1, over 65)

10. Use of Limited PPE Supplies
• If your mask becomes wet or soiled, remove it, as it may cause a
greater risk of infection if left on.
• If you plan to reuse your mask, follow these steps between uses:
– Wash your hands before removing your mask.
– Remove your mask and place it in a bag (paper is better to allow the
mask to dry out thoroughly).
– If the mask is visibly soiled or ripped and damaged, throw it away.
– When reusing, practice good hand hygiene as described above.
– If you have more than one mask, consider alternating use to give
maximum time between uses for drying.
• If you are using a cloth mask, remove, place in a bag for transport
and launder between uses.
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html

11. Any good news?
• Stopped transmission in China
– Draconian measures: 3 days without any cases
• Stopped transmission in S. Korea
– Tested 20,000/day, implemented targeted
quarantine
• Italy: first decline in cases noted 3-24-20
• Which model will the USA follow?

12. Summary
• Exploding epidemic
– Your area could be next
• Be a local health resource
– Advise, educate, advocate
• Telemedicine
• Review PPE inventory
• Continue with Communication
– Colleagues, other health care facilities
– State and local health departments
Dr. Li Wenliang

13. Staying up to date – Trusted sources
• https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2020/callinfo_030520.asp
• https://www.who.int/emergencies/diseases/novel-
coronavirus-2019

14. health
phone
work
Putting it all “Remotely” together
Veena Channamsetty, MD, FAAFP
Mary Blankson, DNP, APRN, FNP-C
Timothy Kearney, PhD

15. Telehealth: IT Infrastructure
• Internet bandwidth
• Increased home VPN/Remote connections to corporate
network
• Capacity to handle the increased incoming/outgoing
calls
• Assess current accounts capacity
• Assess staffing needs to support telework environment
• Trainings and train the trainer
• Help Desk and live support

16. Tele-Work
• Have a clear well thought out remote worker policy with
clear requirements and expectations.
• Ensure remote workers are comfortable with the
technology they’ll be using at home to connect with others
in the workplace – Zoom, Outlook calendar invites, Lync,
etc.
• Be sure that IT has developed a system with enough
bandwidth to support remote workers.
• Remote employees should be sure they are scheduling
meetings in a regular basis to connect with key
stakeholders.
• As an organization be sure you create a way to track all of
the employees who are working remote.

18. Telephone/Telehealth Visits
• Preparation
• Patient Consent
• Documentation
• Coding
• Etiquette
• Patient Considerations

19. Behavioral Health
• Realities in Tension:
– Patient/client need
– Infrastructure capacity
– Staff needs
– Financial
– Constant communication

20. Behavioral Health
Emerging program
• Patients moved to Telehealth services.
• Schedules reflect 20 minute telehealth visits
only.
• Workflow
• Changing regulatory and billing picture
• Documentation
• Staff training

21. Nursing
• First line clinical responders to patient(s) calling in with
a medical, dental or behavioral health complaint for
triage. It is vital for nurses to have the training and
guidance to correctly assess any patient presenting on
the phone to determine what course of action is
needed to best address the complaint they present
with.
• Telephone triage could range from recommending the
patient proceed to the nearest emergency department,
to accommodating the patient with a same-day
appointment, or offering recommended self-
management advice with appropriate follow-up
guidance.

22. 22
Free COVID-19 eConsults
• For all Safety-Net Primary Care Practices
– FQHC, FQHC-look alike, Migrant Clinicians, Healthcare for the
Homeless, Free Clinics
• For clinicians and clinical staff with questions specific to
Covid-19
• Consults addressed by ConferMED’s expert specialists
• Submit consults and questions via the ConferMED
website: www.ConferMED.com
• Receive a rapid response by email
* This initiative is supported by

23. 23 * This initiative is supported by

24. Thank You!
For questions or to join our
mailing list:
Contact us at
WeitzmanLearning@chc1.com
www.weitzmaninstitute.org/coronavirus