• We have identified many members who are not receiving emails. I would ask our practice administrators to please send current email lists for all of your providers to Genesis Aquino. Given the circumstances it is imperative that we have active direct email addresses for all of our clinicians.
• Although the official recommendation is pending I would strongly urge you to no longer use travel history as a risk factor in determining Covid risk, assume community exposure, and apply appropriate triage and precautions to patients based on symptoms and exposure.
• Beginning tomorrow we are expecting many practices to transition to telemedicine/telephonic visit options and many patients are requesting this. Many practices have been able to set up accounts with doxy.me this weekend, and some saw patients this weekend. I would like to compile a list of practices who currently have the capability, particularly specialists. Contact Sue Loiacano with this information. This will be helpful to PCP's who need telemedicine consults for their patients. For those who use YNHH Epic their telemedicine system has been activated. Click here for more details. We will have more detailed guidance on telemedicine documentation, coding, and payer reimbursement tomorrow.
• There are multiple testing sites scheduled to open up this week, as soon as Tuesday. They are awaiting DPH approval. Protocol for who should be tested and procedure for ordering are still not definitively determined. We will coordinate ordering procedures for each test site.
• In order to help provide support for our practices during the Covid crisis, the Yale-New Haven Childrens hospitalist team is willing to temporarily assume coverage of newborns. Please see the attached letter from Dr Loyal for further details. This is a temporary and voluntary measure with resumption of normal routines in better times..
• We are releasing a protocol for triage, eval and management for pediatric patients.which you can find here. These were developed with clinical representation from the CMG and YNHCH. These should be considered preliminary as they are awaiting final approval, but I feel it is important to disseminate tonight. We also have some general operational recommendations for ambulatory settings and homecare for those with suspected covid. The last two will have applications for adults as well.
• I am also again attaching our adult guidelines here. Note the travel screen remains in these guidelines as they were written last week and have not been updated yet. See my above comments on deemphasizing travel history and assuming community exposure.
• I have been keeping a running list of helpful clinical operations suggestions. I have collated them here and will update periodically.
• I would like to close what has been a long week, in anticipation of a longer one with an important topic. It almost seems certain that some of our practices will face significant operational difficulties and possibly cessation of clinical activities due to illness or quarantine. We have many small practices with limited reserve capacity. I would like to put out a call for those who are willing to help when this happens. This could involve help with coverage, phone triage, extending your telemedicine services to another practices patients, or seeing their patients in their office. In the worst case we might have to assume all those roles for one of our colleagues. Specialists could take on a more primary role for issues within their expertise that PCP's may have done otherwise. We will also need specialists to support each other. If we cannot support our needs within CMG, then we will find outside resources. When this is over we will get everything back to where it was before. If you are interested in providing this kind of help please reach out to me directly and I will keep a list. Also if you need help please reach out as early as you can. Hopefully this won't be necessary, but let's be prepared in case it does.