A seizure sent Danielle Lovette to the hospital where a brain scan revealed an oligodendroglioma, a cancer of the central nervous system. With the help of her husband, Corey Nigrelli, Lovette endured exhausting treks to Moores Cancer Center at UC San Diego Health for lifesaving treatment. But then the novel coronavirus changed everything, including how Lovette attends speech therapy.
“Telehealth video visits have been very helpful,” said Lovette. “Given the current pandemic, they have been the only source of rehabilitation available to me.”
The Numbers
Prior to COVID-19, video visits were used sparingly. UC San Diego Health had completed just 870 telehealth appointments in the preceding three-year period. But days before the state of California issued a stay-at-home ordinance, UC San Diego Health put in motion a plan to provide all of its health care providers with the tools and training they needed to convert in-person appointments to video visits. In just four days, 1,000 face-to-face clinic appointments were successfully converted to telehealth visits.
Nine weeks into the stay-at-home ordinance, UC San Diego Health has safely increased in-person appointments with health care providers by 26 percent while seeing only a modest 3 percent decrease in video visits. Telehealth visits continue to make up 55 percent of medical appointments.
Lovette was among thousands of UC San Diego Health patients who, in the first six weeks of the state’s stay-at-home ordinance, participated in more than 34,000 telehealth visits, allowing patients access to essential medical services that range from a consultation with a primary care provider to a post-surgery follow-up appointment.
Once a week, Lovette logs into the MyUCSDHealth app on her mobile device for a live video visit with Liza Blumenfeld, CCC-SLP, BCS-S, speech-language pathologist at Moores Cancer Center, who might ask Lovette to verbally explain the process of making a sandwich while Lovette is in her kitchen physically preparing it.
“Danielle and I haven’t lost any ground shifting to video visits. In fact, I would say that, in her case, telehealth has enhanced functionality because she works at home using words from her day-to-day life,” said Blumenfeld. “We have not cut ties with our patients. We have not allowed COVID-19 to get in the way of providing life-changing care and remaining connected.”
High-Risk Patients
Currently, 75 percent of appointments at Moores Cancer Center are telehealth visits, said Joseph A. Califano III, MD, physician in chief and director of the Head and Neck Cancer Center at Moores Cancer Center.
“I had a consultation with a patient from Palm Desert who has a tongue cancer and needs surgery. He cannot travel easily so telehealth was a great option for him,” said Califano. “We are able to set up an anesthesia pre-evaluation, schedule surgery, setup pre-op nutrition, speech pathology and survivorship visits. All through telemedicine.”
Telehealth provides people with access to health care services that were previously challenging to access, said Califano. Support services, such as palliative care, psychological services, diet and nutrition are now almost all conducted via telehealth. Moores Cancer Center has also converted many of its support groups and its wellness and education classes to virtual.
“Being in the comfort of my own home and having the ability to sit and conduct face-to-face, personal therapy has been amazing,” said Lovette. “I have enjoyed it so much that I would prefer the telehealth method over the inconvenience of driving to the hospital and conducting the therapy there.”
Howie Tran, MD, UC San Diego Health heart failure and transplant cardiologist, said patients with cardiovascular disease, especially those he sees who have undergone heart transplantation and are taking medications to suppress their immune system, also like that they can visit with multiple providers — from cardiologists to pharmacists to nutritionists — all during the same video visit while reducing unnecessary public exposures.
“I think telehealth has revolutionized our practice. It is going to change things moving forward,” said Tran. “Even as we return to face-to-face clinics, we will also have telehealth clinics and mobile clinics to accelerate access to appointments. This experience has given us the comfort to resort to telemedicine when necessary, and patients appreciate the flexibility in this practice.”
In four days, UC San Diego Health rolled out the tools and training health care providers needed to convert in-person appointments to video visits, ensuring patients had continuous and safe access to critical medical appointments. Patients and health care providers see the value of video visits for convenient, quicker and safer access for appropriate cases, including follow up appointments, nutrition consultation, diabetes education, speech therapy and much more, says Joseph A. Califano III, MD, physician in chief and director of the Head and Neck Cancer Center at Moores Cancer Center.
Lifesaving Screening
When it comes to eye health, telehealth may make it challenging to diagnose patients. But in one case, Shira Robbins, MD, an ophthalmologist at Shiley Eye Institute at UC San Diego Health, had no choice. A patient called with new symptoms of double vision but refused an in-person visit because of fears about COVID-19.
“I had a video visit with her that day and diagnosed a new onset sixth nerve palsy, a disorder that causes your eye to cross inward towards your nose. There are many possible causes but because she also had vertigo it concerned me for a significant brain disease,” said Robbins. “I ordered an immediate MRI. The scan revealed a brain aneurysm. We then got the patient to neurosurgery all through telehealth. It can work with the right patient and right set up. I am so glad she called as we likely saved her life.”
Since the COVID-19 pandemic, UC San Diego Health has made telehealth available to all of its providers for clinic appointments, express care services and consultations with patients already hospitalized to help maintain social distancing guidelines. UC San Diego Health has also instituted telehealth services with El Centro Regional Medical Center to provide access to experts without requiring the physical transfer of patients.
Visit health.ucsd.edu/coronavirus for COVID-19 resources and to view an easy-to-follow video that explains the telehealth process to patients.
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