Piloting Telehealth in a Pandemic

Posted: June 8, 2020
By Shelley Wong

As patients and providers navigated the pandemic and shelter-in-place order, faculty and students had to adapt together quickly, from a distance. In a time of adversity, their interprofessional creativity and success show us how opportunities can lead to innovation.

Responding to the COVID-19 pandemic and shelter-in-place (SIP) order, the Schools of Medicine and Pharmacy faculty quickly designed a two-week interprofessional telemedicine pilot rotation to meet three needs: the need of SOM for students do a telemedicine rotation, the need of SOP for students to conduct more clinical work, and the clinical need to conduct outreach to patients who might be affected by the pandemic.

Chris Bautista, MD, Iris Huang, MD, and Maria Wamsley, MD along with Marilyn Stebbins, PharmD led the rotation. Stephanie Hsia, PharmD and Sharon Youmans, PharmD, MPH served as the Pharmacy preceptors and Mackenzie Clark, PharmD provided input on the elective design. Faculty chose patients who might be disproportionately affected by the virus or who might delay care due to SIP, including patients with multiple chronic diseases and the elderly. SOM student Dallas Mindo-Panusis and SOP students Kristine Jermakian and Jordan Brooks were recruited to the rotation due to their prior experience working in discharge medication clinics.

After Bautista provided an overview on navigating APeX and Epic for charting and conducted a practice Zoom call, students honed their individual skills within their own professions on group Zoom calls with patients. Since this was a pilot, there was a lot of faculty-student team learning and student troubleshooting to solve problems and overcome technical barriers.

The students spent the two weeks trying different approaches to figure out what worked best with three people on a call with a patient and how to allocate responsibilities effectively. For Zoom calls, they used the private chat function quite heavily; if one was engaging with the patient, another could be looking up the chart or any patient inquiries, saving valuable time, which was unique to the telehealth experience.

But one of the biggest barriers was simply getting patients to answer a phone call. Since many might be averse to answering phone calls from unknown numbers, they tried using Doximity to call from a UCSF Mount Zion clinic number, which might be familiar to a patient’s phone, as well as 415 area code numbers. To prime patients to expect a call, they began leaving messages that they would call the patient back from a certain phone number within 15 minutes or the next day. Learning telehealth while making the technology work was further pressurized by the many unknowns of the pandemic and knowing the right questions to ask.

“I’m sure many patients felt uncertain of what their health would look like and how the hospital might be able to help them, considering that it might be a source of fear to go there,” says Jermakian. “In terms of the hands-on outreach, so much of it was learning how to work together as professionals to help a patient in a telehealth capacity, to ensure that their health is covered, that they have an appointment coming up, and to be on top of their own health as the pandemic is occurring in the background.”

The students found that their interviews were fruitful, and while nothing could replace an in-person interaction, they could pick up on how patients were feeling by their demeanor and tone of voice. They also learned a lot from each other, as the interprofessional aspect of the rotation allowed the students to see the thought process of their peers while talking to a patient in real time, and stay engaged with each other using the Zoom chat.

“Despite the technological challenges, telemedicine is what made the interprofessional aspect work because we were able to collaborate across physical distance. But I also think it was an opportunity to collaborate across the silos of professional distancing. The telehealth aspect was an advantage,” says Bautista. Hsia agrees that being able to work together remotely made collaboration easier by eliminating travel time and coordinating schedules to meet at the same physical location.

Faculty repeated the rotation with another group of students as SIP continued, focusing on outreach, and they would like to continue the rotation and integrate it into the curriculum, as SIP evolves.

Bautista and Hsia agree that the elective was not only a rewarding experience for students, but a joy for interprofessional faculty to collaborate on an educational project in addition to clinical work. Hsia says, “It was a great learning experience for faculty and rewarding to model what would hopefully be a collaborative practice model for telehealth for future. I hope that with this increased comfort with technology and telehealth and having the intention and motivation to do interprofessional work, more opportunities like this can be created.”

The students are equally enthusiastic. Mindo-Panusis says, “This telehealth outreach rotation would be a very good addition to interprofessional experiences at UCSF since it gives students a chance to work with interprofessional colleagues and talk to real patients while in their early part of their careers with the backing of their preceptors.”

Jermakian agrees, speaking to the valuable lessons learned within a brief two week-period, “The rotation was a good reminder and push to learn how to better contact a patient, speak to a patient, and learn how to communicate in ways that are purely verbal and not based on physical behaviors or appearance. Looking at how we can use telehealth to adapt to these times and connect with patients in unique ways was really important to me. A patient may not be coming into their provider, but we as health professionals need to learn how to engage them in a multitude of ways.”

The pilot is a testament to the power of teamwork. Hsia says, “The biggest takeaway for me would be how much we could accomplish with dedicated passionate people wanting to create robust interprofessional experience. It’s amazing to me that we accomplished so much, made significant patient interaction, and really impacted students with a valuable learning experience in six three-hour sessions. It’s a testament to what you can accomplish and do with limited time and a dedicated group of people.”