“It was very much a team effort and the driving factor was visionary leadership and a bold, determined plan,” said Stuart Clarry, the UF Health telemedicine director.
Clarry and his colleagues jumped in, connecting about 1,300 UF Health providers to a secure Zoom videoconferencing platform and getting them trained to use it. They equipped every practice site for telehealth visits, set up a telehealth help desk and worked through patient scheduling issues. When social distancing took hold, Clarry’s team worked through the logistics of setting up providers to do telehealth visits from home.
“There were a lot of late-night meetings. When I look now at the number of clinics and people we set up to provide telehealth, it’s very gratifying,” Clarry said.
Dewar said he knew it was time to act while watching COVID-19 cases explode in Washington state before cases spread through the rest of the country. Now, UF Health has the capability to accommodate 2,000 to 3,000 telehealth visits a day.
“This has been a huge revolution in the way care is delivered and the speed with which it has been adopted,” Dewar said.
The shift has had its challenges, Dewar said, including getting patients comfortable with a new way of keeping appointments and assuring that providers’ home internet connections were up to the demands of telehealth. But it also has provided a sense of relief for some physicians and nurse practitioners, letting them practice medicine while allowing for social distancing, he said.
Across UF Health, providers have found new ways to leverage telehealth. Dental patients can get emergency assessments for conditions such as tooth or mouth pain due to an abscess or large cavity. Directing them to a provider who can help also reduces the chance that they’ll seek help for oral pain at an emergency room, said Micaela Gibbs, D.D.S., interm chair of the UF College of Dentistry’s department of community dentistry and behavioral science.
The teledentistry effort, fast-tracked as part of the college’s COVID-19 response and introduced on March 26, is now serving the community at large. While the actual delivery of dental procedures can’t be accomplished by telehealth, Gibbs said it is an extremely useful tool for diagnosing and triaging urgent issues as well as connecting patients to care while also teaching dental students.
“Teledentistry is a natural fit for our profession. I can’t imagine patients and providers won’t maintain this approach to patient care in the future,” Gibbs said.
In Community Health and Family Medicine, Nick Dorsey, M.D., started spending one to two hours every day on telehealth visits in the early days of the COVID-19 outbreak. Appointments tend to be fast and smooth for Dorsey and his patients. The visits include most everything except a stethoscope.
“If we are at all uncertain or need to listen to someone’s lungs, we get them to a clinic,” he said.
Family medicine telehealth had been a fixture at UF Health Jacksonville for more than six years — through the UF Health Virtual Visit program — when the COVID-19 pandemic arose, according to Nipa R. Shah, M.D., a professor and department chair. It only took a little fine-tuning to accommodate a spike in telehealth visits that more than quadrupled in recent weeks, she said.
At UF Health Central Florida, leaders moved quickly to use telehealth across the organization to expand access, improve patient care and protect patients and staff. Applications of telehealth include the development of an electronic intensive care unit (eICU), telehealth visits for physicians to see their COVID-19 inpatients, and a remote primary care clinic to identify, treat and screen potential COVID-19 patients.
The eICU was developed in collaboration with the department of anesthesiology at UF Health. Critical care specialists from UF Health monitor all COVID-19 patients remotely and provide direct input to the physicians and nurses caring for patients locally.
That collaboration has enhanced the organization’s ability to provide state-of-the-art care for the most critically ill patients with COVID-19. The organization also quickly adapted its urgent care center to a telehealth model, allowing residents to call and get COVID-19 questions answered and receive advice on treating symptoms.
Telehealth is both a reassuring presence and a way to keep patients from flooding emergency rooms and urgent care centers, said Bill Pfingsten, FACHE, vice president of ambulatory services at UF Health The Villages® Hospital. The telehealth service is staffed by a nurse practitioner who can address COVID-19 symptoms and other primary care issues. About 40 patient calls came in on the second day of operation.
“It was critically important for us to establish a primary care access point, both for COVID-19 and other primary care concerns. It provides people with a sense of comfort knowing they are not shut out of health care access by staying home,” Pfingsten said.
Among other practices, an already robust telehealth presence was scaled up to accommodate surging demand for online visits. For UF Health pediatrics, the pandemic has been an opportunity to further expand its telehealth presence, said Jennifer Co-Vu, M.D., a pediatric cardiologist and director of the Single Ventricle Program at the UF Health Congenital Heart Center. Her patients include children with a single ventricle, a defect that leaves one chamber of the heart undeveloped. Some heart transplant patients are also using telehealth.