Telehealth visits surge at University of Florida Health

— As the COVID-19 virus began making an indelible mark on everyday life, a group of University of Florida Health leaders wrestled with an urgent issue: how to provide medical and dental visits while protecting patients and providers. The solution was as swift as the task was herculean — meeting an unprecedented demand for online appointments.

In just several weeks, UF Health’s telemedicine met the challenge by growing exponentially. On March 12, UF Health providers conducted 20 telehealth visits. By April 16, the daily count was 1,497 visits — a 7,385% increase. Today, almost every UF Health practice has a telehealth component. A telehealth program for the College of Veterinary Medicine is being developed.

As COVID-19 became more pervasive, a telehealth task force of 17 people was marshaled by Marvin A. Dewar, M.D., J.D., CEO and chief medical officer of UF Health Physicians and a senior associate dean of the UF College of Medicine.

“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 several weeks ago and 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 both 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. As of April 8, UF Health-Jacksonville was conducting more than 1,000 daily telehealth visits.

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. Criticalcare 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, vice president of ambulatory services. 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.

“To reduce the risk of infection during this pandemic, we thought they would be better off with telehealth,” Co-Vu said.

It also has other benefits: Young heart patients and their families sometimes come long distances to UF Health for specialized care and follow-up appointments. A single telehealth visit can eliminate the time and expense of traveling to Gainesville from the Panhandle or Jacksonville. Some of Co-Vu’s patients make a six-hour round trip twice a month. A telehealth appointment can accomplish what is needed in about 30 minutes.

“This is one upside to the current situation. Parents and patients can get a visit without driving all the way to a clinic,” she said.

Telehealth is an ideal platform for psychiatry because providers typically don’t need physical contact with patients, said Kishan Nallapula, M.D., director of telemedicine for the department of psychiatry. Outpatient telehealth visits went from 39 in February to 1,096 in March. The number of telehealth patients surged from 33 to 911 in that time. Child psychiatry already had a substantial telehealth presence before COVID-19 and the virus outbreak produced a significant growth in adult telehealth, according to Nallapula.

Families especially like child psychiatry telehealth because complex travel planning isn’t required, Nallapula said. Long-term, published studies have shown that the standard of care during telehealth psychiatry is equal to a traditional visit, he added.

UF Health has also established a telehealth “virtual clinic” for health care workers on Saturday and Sunday mornings. Free behavioral telehealth services are being offered for UF Health employees.

Beyond the current pandemic, Dewar and his UF Health colleagues see telehealth remaining as a mainstream medical option. Clarry, the telehealth administrator, points to its usefulness in accommodating more patients without immediately needing to add brick-and-mortar facilities. It also preserves precious space in the practices for patients who need it the most, he noted.

In pediatrics, Co-Vu said she sees technological advances improving pediatric telehealth. Computer tablets that can give physicians a remote, “virtual” stethoscope or perform electrocardiograms are in development. Those technologies, she said, will eventually be adapted for pediatric patients.

For telemedicine at UF Health, the future is now, Dewar said.

“With a pretty high degree of confidence, I can say we’re not going to come out of this pandemic and practice medicine completely the same way we did before,” he said.

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