COVID19 Remote Care Program Structures and Protocols COVID19

COVID-19 Remote Care Program Structures and Protocols

COVID-19 Remote Care Program Introduction Remote Care Program Benefits is a rapid way to standardize the remote care of COVID-19 patients across a healthcare system Increases the number of COVID-19 patients a doctor can care for remotely by leveraging other staff and other geographies in their care For most COVID-19 patients it is safer to recover at home. The Remote Care Program monitors patients after they have been discharged for up to 14 days. Patients receive a daily telephone call from a clinically trained Telehealth Guide who monitors patients using a structured protocol. An Escalation Doctor is available for patients who deteriorate. Patient safety and early detection if a patient deteriorates at home Avoids unnecessary ED visits Supports patients’ social and psychological needs in home Better patient satisfaction

COVID-19 Remote Care Program Personnel Remote Care Coordinator The Remote Care Coordinator is the first point of connection between the referring doctor and the Remote Care Program. RCCs allocate patients to Telehealth Guides. Importantly, RCCs do not have to be local to the hospital. Telehealth Guides are clinically trained to monitor patients remotely using a structured protocol. Medical students, nursing students, care managers, nurse practitioners, and redeployed physicians are qualified to be Telehealth Guides do not have to be local to the hospital. Guides are critical for flagging patients to Escalation Doctors are MDs, NPs or other clinicians who can respond quickly to a patient flagged by a Telehealth Guide for urgent evaluation by phone or video. Escalation Doctors do not have to be local to the hospital.

COVID-19 Remote Care Program System Overview Escalation Doctor Manages up to 10 Telehealth Guides 300 to 400 patients per Escalation Doctor Hospital ED CCF/ Virtual Clinic Tent Remote Care Coordinator No clinical expertise required Telehealth Guide Onboarding 3 patients a day 30 to 40 patients per Telehealth Guide Clinical expertise required Patients at home Average duration in the program of 10 days.

COVID-19 Remote Care Program System Overview Patient Selection Guidance You can flexibly create eligibility criteria to manage the flow of patients into the program depending on the capacity of your Remote Care team. Home Devices The Remote Care Program does not require the use of home measurement devices. Some programs have obtained a supply of Pulse Oximeters and Thermometers to be given to patients who are at most risk of a downward trajectory. Some patients already have their own devices. Reimbursement Rules on billing are changing as the COVID 19 crisis progresses. Some services by the Escalation Doctors and Telehealth Guides may be billable. Data management system REDCap or any EHR based system can be used to set up patient tracking and documentation. Scaling Early deployments of this system have had one Telehealth Guide onboarding 3 patients a day for a panel size of up to 30 or 40 patients and an average duration in the program of 10 days. One Escalation Doctor can manage up to 10 Telehealth Guides and their patients.

COVID-19 Remote Care Program How it Works Referring Doctor or Nurse ① ② ③ ④ Identifies patient ready for discharge E-mails or sends electronic referral with name of patient and MRN to Remote Care Coordinator Confirms the accuracy of patient contact information Provides any other clinical information you would want the Telehealth Guide to know Telehealth Guide Communication with Discharge Team ① E-mails you to confirm that patient has been contacted by our Telehealth Guide after discharge ② Notifies you if unable to contact your patient ③ Notifies you if your patients is readmitted Telehealth Guide Daily Responsibilities ① ② ③ ④ ⑤ ⑥ Calls patients each day for up to 14 days Administers a symptom survey to assess patient’s condition May ask to check patient’s temperature, pulse, and oxygen level, if they have devices available for this. May schedule a two-way video visits with their doctor if necessary May escalate Patients with complications to an Escalation Doctor if flagged Instructs the patient that If their condition suddenly deteriorates, they should contact their NYP doctor or call 911

COVID-19 Remote Care Program Escalation Protocol COVID Symptoms Date of symptom onset “Since your last survey…” Have you experienced a new or worsening cough? Y/N Have you experienced any new or worsening feelings of shortness of breath at rest or when performing normal everyday activities? Y/N If thermometer: What was your highest temperature? If thermometer: What is your most recent temperature? If no thermometer: Have you felt like you have new or increased fever? Have you taken Tylenol (acetaminophen) or any other medication to reduce fever in the last 6 hours? If pulse Oximeter: What is your most recent oxygen level? If on home O 2: Have you increased the amount of oxygen you are receiving? IF YES, how much have you increased the oxygen? What is your most recent pulse (also called heart rate)? Do you have any other concerns you would like your doctor to know about? IF YES, Flag IF >=100. 4 F, Flag IF YES, Flag IF <95% Flag; IF <90% Consider ED IF YES, Flag IF>110 bpm, Flag Telehealth Guides will notify Escalation Doctor about Flagged patients via Secure Chat Escalation Doctor will document actions taken for flagged patients in Epic We are continuing to gather data and will update the escalation protocol as we learn more. Mental Health Screen & Patient Satisfaction Measure

COVID-19 Remote Care Program For additional information or questions contact Dr. Ian Kronish ik 2293@cumc. columbia. edu