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North Bay health care providers tap telemedicine to screen for coronavirus, serve spike in patients

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With a deadly virus rampant in the community, Sonoma County health clinics, hospitals and physicians are turning to telephone and video communication to treat patients while guarding the safety of their facilities, staff and other patients.

Telemedicine, also known as telehealth, dates back to the 1960s as a way to connect patients to connect with caregivers. It is getting a boost during the coronavirus outbreak that has infected nine people in the county and brought much of life in the Bay Area to a standstill.

Sutter Health and Kaiser Permanente, as well as community health centers based in Santa Rosa, Petaluma and the west county, are ramping up telephone and video connections linking thousands of patients to their health care providers.

The St. Joseph Health Medical Group, affiliated with Santa Rosa Memorial Hospital, is relying on the internet to enable patients to get help without risk of exposure at a time when residents have been ordered to stay home, with schools and many businesses shuttered.

Extended care

The federal government has, for the first time, extended telemedicine to all Medicare beneficiaries regardless of their circumstances.

“We are in a unique time in which inexpensive, off-the-shelf video technology allows us to provide meaningful and clinically relevant care to even our most vulnerable populations,” said Dr. Jason Cunningham, CEO of West County Health Centers, which serves 15,000 patients.

“Most importantly, it allows us to provide ongoing care that is safe for our patients and staff in this critical time for our community,” he said.

Sutter Health’s Walk-In Care clinics in Santa Rosa and 25 other communities around the Bay Area and Central Valley will all, by week’s end, have activated systems allowing Sutter patients to make a “video visit” from home as a first step toward treatment.

“This means you avoid being exposed to the cold and flu, and, if you are sick, you won’t expose others,” said Carolin Delker, Sutter’s Walk-In Care clinical director.

If the clinician, via an online visit, determines the patient’s symptoms are “mild to moderate,” testing for coronavirus is usually unnecessary and the patient is given instructions for self-care at home.

Patients who need a “higher level of care” will be directed, as needed, to testing at a Sutter hospital or another facility within the system, Delker said.

Patients who show up at a Sutter clinic will see signs on the door advising them to make a video visit though a Sutter app called My Health Online.

In addition to safety, the video system “will help relieve some of the pressure on our front-line clinicians if there is a surge in patients,” Delker said.

Santa Rosa Community Health, responding to the reports of community transmission of COVID-19, the disease caused by the coronavirus, is screening all patients over the phone or outside the clinic for symptoms or COVID-19 risk factors. Those who may be infected are directed to testing within the network of clinics.

The organization, which served 42,000 patients last year at eight sites around Santa Rosa, has also established a team of medical staffers to make telephone visits to patients who have appointments for noncritical care.

The idea is to “keep people at home” whenever it is appropriate and identify those with respiratory symptoms that could be evidence of the viral infection that has afflicted more than 1,000 people in California, said Annemarie Brown, the organization’s communications and grants development director.

West County Health Centers, with seven facilities in Sebastopol, Forestville, Occidental and Guerneville, is calling patients with appointments to give them the option of a telephone or video visit with a clinician, while personal office visits are available by appointment on a limited basis, said Cunningham, the CEO.

“A portion of what we do in primary care can be handled remotely in this situation,” he said, noting that diabetic patients, who are at high risk for coronavirus infection, are better off staying at home.

“We want to align our care delivery with what’s necessary to fight this disease,” Cunningham said.

Patients who arrive for an appointment are checked for evidence of a fever, cough or shortness of breath and people with those symptoms are asked to wear a mask and evaluated outside or in their car, said Dr. Rain Moore, chief medical officer.

Health care providers wear N95 respirators for high-risk encounters, but Moore said they are not recommended for the public “and frankly are discouraged as there is a need for these (masks) among the medical community,” she said.

More work over phone

Petaluma Health Center clinicians are handling about 80% of their contacts with patients over the phone, with more than 400 calls one day this week, said Pedro Toledo, chief administrative officer.

Everyone arriving at the Petaluma and Rohnert Park clinics is screened for symptoms of COVID-19 and those who have them are brought in through a back door to an isolation room.

The Rohnert Park facility, where a worker became the county’s first case of the coronavirus-related disease due to community transmission, was closed for two days for “deep sanitation,” Toledo said, attributing the move to “an abundance of caution.”

Dental care at both clinics is now limited to emergencies and all routine teeth cleaning and filling of cavities has been postponed because drilling has the potential to “spread patient material,” he said.

The current drawback to telemedicine is the state has not issued guidance on how to bill for those services and it’s not known when that might come, Toledo said.

“We’re all doing the work and hoping we might get paid some day,” he said.

Santa Rosa Memorial and Petaluma Valley hospitals, both part of the St. Joseph Health system, canceled all elective inpatient procedures Wednesday, citing the prospect that Northern California health care resources may be strained in the coming days and weeks.

Hospital leadership teams and surgeons are expected to “thoughtfully review” all scheduled outpatient elective surgical and invasive procedures, such as endoscopy and cardiac catheterization, said Dr. Chad Krilich, chief medical officer for the system.

Emergency room visits should be reserved for people with profound difficulty breathing, unremitting fever, lethargy or weakness, he said, as well as those with diabetes, chronic lung disease or other serious conditions who feel quite ill.

Memorial Hospital is the region’s designated trauma center.

People walking into the emergency room should call ahead, if possible, and ask the staff for a face mask upon arrival, Krilich said.

The St. Joseph Health Medical Group, with about 180 members, maintains an optional online portal for members to conduct a “virtual visit” with a clinician, said Dr. Rajesh Ranadive, a Petaluma internist.

One goal of the portal now is to limit trips to a medical office by people over 65 who would be exposing themselves to the virus, especially if they are using public transportation, he said.

“Self-isolation is the best protection at this point,” said Ranadive, who is president of the Sonoma County Medical Association.

Social distancing

Kaiser Permanente is offering telephone and video appointments for members in the interest of supporting social distancing, said David Ebright, a Kaiser spokesman.

Staffers will be stationed at building entrances to provide masks and screening, if needed. Kaiser members are asked to call for an assessment before coming to medical offices and encouraged to use the system’s mail-order pharmacy, he said.

Elective surgeries and procedures were postponed this week and perhaps beyond, both to maintain capacity and resources to treat patients who may have or do have COVID-19 and reduce potential exposure to members, Ebright said.

Rep. Mike Thompson, D-St. Helena, applauded the Trump administration’s announcement Tuesday that allowed Medicare beneficiaries expanded use of telemedicine to contact their physicians instead of traveling to a health care facility.

Prior to the announcement, telehealth services were only available to rural Medicare enrollees if they received the services at a clinic, hospital or other facility and not from home.

Thompson said the new guidance was authorized in his measure included in the $8.3 billion emergency funding bill approved by the House and Senate and signed by President Trump earlier this month.

“If people can consult with their doctor from the comfort of their home, fewer people will spread the virus and more people can get treated,” Thompson said in a statement.

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