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

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. 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. PRIMARY GOAL: “FLATTENTHE CURVE”
Prevent overwhelming OF OUR DELIVERY
SYSTEM

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. Current trajectory
- USA EPIDEMICCURVEAPPEARSTO MATCHTHAT OF N. ITALY
- FRANCE, SPAIN,GERMANYALSO CLOSELY FOLLOWING N. ITALY

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. Key Strategies to “Flatten Curve”
in China and S. Korea
■ Widespread
implementation of
telehealth
■ Offsite testing capability
(drive thru testing)

8. https://www.scmp.com/video/china/3074522/china-embraces-tele-
medicine-amid-coronavirus-outbreak

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. 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. 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. 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. 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. 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. 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. 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. 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