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NYS COVID-19 Telehealth Expansion Recommendations

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Recommendations by NY based physician group with expertise in public health, telehealth, and emergency medicine.

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NYS COVID-19 Telehealth Expansion Recommendations

  1. 1. NY STATE COVID-19 TELEHEALTH SCREENING RECOMMENDATIONS Daniel E. Choi, MD Carlos Zapata, MD Saya Nagori, MD Dhaval Bhanusali, MD Michelle Lin, MD, MPH
  2. 2. WHO AREWE? NY BASED PHYSICIAN EXPERTS ONTELEHEALTH + EMERGENCY MEDICINE ■ Daniel E. Choi, MD: MSSNYTelehealth Committee,Young Physicians Section Chair ■ Carlos Zapata, MD: MSSNYYoung PhysiciansCouncilor, Emergency Medicine Physician at Nassau University Medical Center ■ Saya Nagori, MD: founder and board member of telehealth company Simple Health ■ Dhaval Bhanusali, MD: founder of telehealth company Health Digital and Skin Medicinals ■ Michelle Lin, MD: Emergency Medicine attending physician at Mt. Sinai Hospital **No other relevant disclosures pertaining to this presentation MSSNY – Medical Society of the State of NY
  3. 3. PRIMARY GOAL: “FLATTENTHE CURVE” Prevent overwhelming OF OUR DELIVERY SYSTEM
  4. 4. Lessons from North Italy ■ 2 weeks ago – Italy had 322 confirmed cases. 1 week ago – 2,502 cases ■ Now – 12,462 cases ■ Doctors and nurses are unable to care for everyone who need it. Not enough ventilators ■ Care rationing being planned: “It may become necessary to establish an age limit for access to intensive care.” https://www.theatlantic.com/ideas/archive/2020/03/wh o-gets-hospital-bed/607807/
  5. 5. Current trajectory - USA EPIDEMICCURVEAPPEARSTO MATCHTHAT OF N. ITALY - FRANCE, SPAIN,GERMANYALSO CLOSELY FOLLOWING N. ITALY
  6. 6. U.S. CAPACITY ■ The U.S. has fewer doctors per person and fewer hospital beds per person than Italy, said Gounder, a clinical assistant professor of medicine and infectious diseases at NewYork University. ■ “We have less capacity to absorb a big surge in cases,” she said. “We need to be preparing for that.” https://www.cnbc.com/2020/03/11/nyu-doctor-us- hospitals-are-unprepared-for-coronavirus-will-be- flooded.html
  7. 7. Key Strategies to “Flatten Curve” in China and S. Korea ■ Widespread implementation of telehealth ■ Offsite testing capability (drive thru testing)
  8. 8. https://www.scmp.com/video/china/3074522/china-embraces-tele- medicine-amid-coronavirus-outbreak
  9. 9. The Case to Ramp Up Telehealth Now ■ “Forward triage” – sorting of patients before they arrive in ED is critically necessary ■ Patient centric and conducive to self-quarantine ■ Protects patients, clinicians, and community from exposure. ■ Allow physicians and patients to communicate 24/7 using smartphones or webcam enabled computers. ■ As healthcare workers get exposed and need to be quarantined, there is concern about workforce capacity. Quarantined physicians can cover telehealth services. Hollander JE, Carr, BG.Virtually Perfect?Telemedicine for Covid-19. N Engl J Med 2020.
  10. 10. COVID-19Telehealth Screenings currently being offered in NYS as of 3-13-2020 ■ Mt. Sinai Hospital ■ NYU Langone ■ Northwell Health – through telephone service Other national services: -Roman -CoolQuit https://www.mountsinai.org/appoint ment/telehealth-ms-now
  11. 11. Local leaders calling for expansion of telehealth services ■ “Brooklyn Borough President Eric Adams held a press conference with NewYork-based doctors and advocates to call for expanded use of telemedicine as a means of mitigating the overcrowding of emergency rooms while pre-screening patients to prevent the transmission of novel coronavirus, or COVID-19.” https://www.brooklyn-usa.org/as-city-encourages-remote- options-such-as-telecommuting-and-virtual-conferences-to- combat-spread-of-coronavirus-bp-adams-and-local-doctors-call- for-expansion-of-telemedicine-mobile-testing-centers/
  12. 12. NYS Emergency Departments are Being Overwhelmed Already ■ Internal email to medical staff of Long Island hospital from CEO on 3/12/2020: “Our emergency room (ER) is being overrun with patients sent in by offices for testing. We cannot perform testing on those not requiring admission (testing is still severely limited). ■ ED physician in Manhattan on 3/12/2020: “Despite telehealth and everything I’m trying to message, we are seeing daily doubling of ‘worried well’ in ED seeking testing. It is extremely time consuming and a poor use of resources for physicians who are trained to resuscitate to spend half their shift taking nasal swabs AND places uninfected patients at high risk while exposing health care workers.”
  13. 13. TELEMEDICINE SCREENING DEMAND high most importantly - keeping patients out of the ed ■ ED physician in Manhattan 3/12/2020: “We are getting upwards of 5-10 [telehealth screening visits] per hour, so we expanded single to double coverage and are rapidly adding shifts. ------------ has had similarly high volumes. We estimate at least 100 diversions AWAY from ED at - ---------- alone per day”
  14. 14. https://www.healthleadersmedia.com/clinical- care/telemedicine-playing-front-line-role-covid-19- outbreak Telemedicine screenings for COVID-19 being used successfully in Michigan already
  15. 15. IMMEDIATE Action Recommendations for NYS DOH and Governor Cuomo ■ Emphasize to public not to report to ED directly with mild symptoms: cough, sore throat, runny nose. ■ Promote to public how to use telehealth services currently being offered in NYS ■ Emphasize to public that patients cannot get testing by going to the ED
  16. 16. OTHER ACTION recommendations for NYS DOH and Governor cuomo ■ Centralized consumer facing website hosted by NYS that directs patients to telehealth screening resources currently available ■ Expansion of current telehealth infrastructure in all possible ways – Consider use of funding grants to private companies with infrastructure in place ■ Continued promotion of telehealth services available to NYS public by NY DOH and Governor Cuomo ■ Work with DFS to eliminate all out of pocket patient expenses for telehealth screening to encourage widespread use by public. ■ Reduce regulatory burdens and medicolegal liability for physicians willing to participate in telehealth screening.
  17. 17. OTHER ACTION recommendations for NYS DOH and Governor cuomo ■ Expansion of off site (away from ED) testing capabilities (outdoor tents, drive thru) throughout NYS ■ We applaud Gov. Cuomo’s initiative to open drive thru testing site in New Rochelle

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