Telehealth Use Surges

Stony Brook goes into high gear with its telehealth efforts for patients, faculty, staff and students
 

When the Greek philosopher Plato first uttered the words, “Necessity is the mother of invention,” he likely never envisioned a pandemic on the scale of the coronavirus. Nevertheless, when the need to do something becomes imperative, you’re forced to find ways to make things happen quickly.

Telehealth in the months leading up to the coronavirus In our densely populated tri-state region, where doctor’s offices are plentiful, Long Islanders in pre-coronavirus times hadn’t been as quick to embrace telehealth as people in rural upstate New York, for example, or the Midwest, where the need for remote access has been more pressing. Even so, before the COVID-19 pandemic hit, Stony Brook Medicine’s interdisciplinary Telehealth Workgroup – consisting of executive leaders; clinical, academic and technical experts; researchers; educators and marketers, already had several telehealth initiatives up and running successfully. They had piloted software programs and purchased hardware, established workflow, managed compliance and legal considerations, designed educational programs and developed marketing tools, all with an eye on sustainability and immediate expansion. Early-adopter champions led the way with pilot programs in Telepsychiatry; Long Island’s first and only Mobile Stroke Unit program; Teleneurology consultations; Suffolk County’s first Pediatric Telemedicine Transport program; and a Remote Patient Monitoring research study.

The Telehealth Workgroup’s efforts, led by Kristie Golden, PhD, LMHC, CRC, Associate Director of Operations for Stony Brook Medicine; Gerald Kelly, DO, Interim Chief Information Officer, Stony Brook Medicine; and Kimberly Noel, MD, MPH, Deputy Chief Medical Information Officer, Stony Brook Medicine, laid the foundation to build Telehealth at Stony Brook Medicine and respond nimbly in the current state of emergency.

Nothing’s impossible: From 14 telehealth visits a week to over 1,300 a day

In mid-March, seemingly overnight (in just 10 days to be exact), as Long Island rapidly found itself in the epicenter of the COVID-19 pandemic in the U.S., the immediate need for telehealth rose to the forefront. Stony Brook was prepared and moved its telehealth efforts into high gear.

“Joan Crawford, our Stony Brook Telehealth Project Manager, was the go-to person on the team since she has been managing the Information Technology aspects of the pilot projects,” said Dr. Kelly.

Being the all hands on deck, lead by example kind of person he is, Dr. Kelly rolled up his sleeves and worked side by side with Crawford and others around the clock to get the job done.

“With the potential to expand our use of Microsoft Teams®, we built out the needed programming for the entire health system and also enlisted help from some of our resident physicians,” said Dr. Kelly.

As the urgency continued to grow, Stony Brook’s ambulatory (outpatient) practice partners, led by Telehealth Workgroup member, Anne Walsh-Feeks, Chief Operations Officer, Ambulatory Operations; along with Information Technology colleagues began virtually training, developing additional workflows and expanding education to reach a multitude of new providers and patients. 

In the span of 10 days, just about every specialty, from primary care to dermatology to substance use disorder treatment, and approximately 20 other critical areas of specialty, was prepared to meet the outpatient healthcare needs of their patients. Patients who could no longer safely visit their doctor’s office due to social distancing and stay-at-home mandates to help stop the spread of COVID-19 now had a great alternative way of maintaining their healthcare needs. Stony Brook’s record-time ramp up also helped ease the unprecedented physical burdens placed on its physicians.

To put the magnitude of this feat in perspective, consider this: During the month of February, Stony Brook was averaging about 14 telehealth visits a week through the various pilot projects. By late April, that number skyrocketed to over 1,300 visits a day. Now that people are experiencing telehealth more widely, the number of Stony Brook Telehealth visits will continue to soar as more people get past their fears and concerns about using telehealth and experience the value it brings to both patients and providers.

 

Virtual care for patients who are hospitalized with COVID-19

Organized by a small group of innovative, resident physicians led by Samita M. Heslin, MD, MPH, MBA, MA, Stony Brook University Hospital (SBUH) also piloted the use of Microsoft Teams on smart phones in the Emergency Department to see patients with COVID-19 as well as those under investigation. The immediate success of that initiative was leveraged for use on inpatient units.

A coordinated team led by Edward Sun, MD, Assistant Chief Medical Officer; and Telehealth Workgroup members Susan Wilner, LCSW, Assistant Director, Behavioral Health Operations; and Joan Crawford, MS, PMP, Information Technology Project Manager, established a process to ensure that specialty consulting physicians serving SBUH patients could conduct virtual assessments using Microsoft Teams.

With the use of specially configured smart phones and iPads® to ensure privacy, Stony Brook is now facilitating virtual communications between doctors and patients, and nurses and patients, while helping to limit exposure to each other for everyone’s safety. A team of medical assistants have made this successful by ensuring the units have the devices for immediate use with patients.

“The iPads help minimize the risk of exposure to COVID-19 by healthcare workers needing to enter the room, which in turn, minimizes the number of personal protective equipment (PPE) changes at a time when PPE supplies are limited everywhere,” said Dr. Sun.

Through community donations of nearly 200 additional iPads, an effort spearheaded by Chief Patient Experience Officer Nicole Rossol, the team also found a work around for the current “no visitor” policy in place during the pandemic. The iPads that are unable to be used for virtual care purposes are given to patients who don’t have their own device, so that they can connect with family and friends via video chat to receive words of encouragement and to provide some assurance to family members and friends that they’re doing okay.

How a telehealth visit works

For a telehealth office visit, an individual first calls their physician’s office to see if their needs can be met virtually. If the answer is yes, then the doctor’s office will send the patient an email invitation with a link to have the video appointment and will walk the person through the process of connecting. The actual telehealth visit is similar to an in-person visit – the physician asks about the symptoms and challenges that the person is experiencing and takes data from them if appropriate. Sometimes practices will even supply equipment ahead of time to gather information. Stony Brook’s MyHealtheLife patient portal can also be used to exchange information ahead of a telehealth visit to save time.

For a visit that takes place while a patient is in the hospital during COVID-19, the use of technology is similar, but the “appointment” is facilitated by the inpatient team of Stony Brook nurses and doctors. A virtual care option is now available for a patient to be seen by their treating doctor, and to receive a specialty consultation by a doctor. The patient is contacted by the doctor through the use of the patient’s personal device, such as a smart phone, or through the use of an iPad that has been provided to the patient, and a virtual visit then takes place. Sometimes different technology or a separate device is also used to monitor a patient’s condition remotely (from outside the room), such as for diabetes, EEG (electroencephalogram), telemetry or dialysis.

The Information Technology (IT) team at Stony Brook plays an important role in assuring patient privacy to provide assurance that virtual visits are safe, secure and confidential.

Disaster Mental Health Team provides virtual services for faculty and staff

It’s always been important for Stony Brook to support its faculty and staff who experience on-the-job stresses that can take an emotional toll. Prior to COVID-19, Stony Brook had an established Faculty & Staff Care Team led by clinical psychologist, Cynthia Cervoni, PhD, to provide 1:1 support after a crisis or traumatic event in the hospital.

Stony Brook had also just completed a pilot project and was about to formally launch Team Lavender, led by obstetrician/gynecologist Megan Lochner, MD. Like the calming herb for which it is named, the purpose of Team Lavender is to provide immediate emotional, spiritual and psychological support for faculty and staff after an adverse or unexpected event. This new group approach consists of volunteers including doctors, nurses, social workers, patient advocates, chaplains, a faculty and staff care team, employee assistance program (EAP) and employee wellness program (Healthier U). These efforts, previously performed in-person, are now available virtually for faculty and staff.

In the wake of COVID-19, Stony Brook’s Disaster Mental Health Team quickly mobilized to discuss various methods, including virtual options, to care for faculty and staff. One aspect of the team’s efforts, led by clinical psychologist, Adam Gonzalez, PhD, Director, Behavioral Health, Department of Psychiatry & Behavioral Health, was to work closely with Dr. Kelly and IT specialists to configure a Microsoft Teams platform for delivering wellness strategies and other resources for mental health.

On Microsoft Teams, Dr. Gonzalez organized the Wellness Champions channel, which posts available local and national mental health resources and strategies for managing stress; the Daily Mindfulness Meditation team, where faculty and staff can access virtual mindfulness meditation sessions at 8 am, 12 pm and 8 pm, Monday through Friday, and 12 pm on the weekends; and, the Community Messages of Support channel, which hosts the Not All Heroes Wear Capes initiative, where faculty and staff can view photos and video messages of support from students and community members. The team has received over 300 emails filled with messages of support.

Everyone from Stony Brook doctors, nurses and technicians to custodial staff and housekeeping are able to benefit from these wellness initiatives.

“While frontline healthcare workers are trained to manage these types of situations and often check their emotions at the door to do the best for patients and families they’re seeing,” said Dr. Gonzalez, “even the strongest among us can benefit from these much needed forms of support to cope and stay emotionally healthy, while managing a difficult, unprecedented situation.”

The Department of Psychiatry and Behavioral Health, which was one of the first departments to embrace telehealth, also created a helpline that Stony Brook faculty and staff (as well as community healthcare workers) can call to get connected to appropriate support and other resources. Callers are able to be scheduled for brief counseling (five sessions) via telehealth with professional behavioral health specialists. The helpline is staffed every day 9 am to 5 pm and can be reached by calling (631) 632-CHAT (2428).

Virtual programs for Stony Brook employees and students during COVID-19

Another key area where virtual care is playing a significant role is in employee health. Right before the pandemic hit, Cathrine Duffy, Director, Healthier U (Stony Brook’s employee health program) and her team were about to roll out their new in-person programming. Instead, they transitioned the program to online in a matter of days. One of Healthier U’s most popular offerings is a mindfulness and meditation live streaming session on Facebook Live (weekdays at 3 pm) that’s open to the community and hosted by Stony Brook University School of Social Welfare alumnus Joshua Henrickson, PhD, LCSW, CIHC, who is an integrated health expert.

At Stony Brook University, telecounseling is also offered to students through CAPS (Counseling and Psychological Services). This pilot program was nearing launch just prior to the pandemic.  In just a few short weeks, under the leadership of Marisa Bisiani, DNP, AVP, Student Health Wellness and Prevention Services, who is also a member of the Telehealth Workgroup, and Julian Pessier, PhD, Director of CAPS, over 600 students have transitioned over from live in-person CAPS counseling to CAPS telecounseling. While students always had a CAPS after-hours line available to them, now they have access 24/7. Students can call (631) 632-6720. Simultaneous to the rapid transition to a telecounseling platform, Bisiani also swiftly transitioned the services provided by Stony Brook University’s Student Health Services primary care clinic, lab and pharmacy to a telehealth platform to ensure that students sheltering in place on campus would still have access to acute and preventative care they need during the pandemic.