In an article published by Psychiatric Services, clinicians at an outpatient psychiatric clinic described the process of converting all practice to a virtual environment.1 These insights may be helpful for other practices undergoing challenges with telemedicine and may offer lessons for future pandemic responses.
In response to the surge of the 2019 novel coronavirus disease (COVID-19) cases in Northern California, the outpatient psychiatric clinic at the University of California, Davis converted all clinic visits to virtual appointments, beginning March 13, 2020. Staff made phone calls chronologically based on initial appointment date to approximately 850 patients who had appointments in the following 2 weeks.
Confirmed virtual visits were noted in the patient’s electronic medical record (EMR), such that clinicians could appropriately schedule their time. Telepsychiatry training videos and reading materials were made available to all staff. A point person was assigned to provide software, hardware, and IT support. The clinic was shut down to in-person visits for an initial trial period of 2 weeks, which was later extended. During the first week, clinicians, office staff, and patients were asked to provide feedback on their experiences with telepsychiatry.
Within 3 business days, the clinic converted all scheduled visits to virtual appointments. On the first full day following conversion, 73 virtual appointments were conducted. Most of these appointments were conducted via videoconference (n=67; 92%), although some were performed over the phone (n=6; 8%). Approximately 95% of treating clinicians were partially or fully working from home during this period. By the time California’s statewide shelter-in-place order was declared on March 19, the clinic had already been operating virtually for 3 business days.
Minimal care interruptions were experienced, and few patients canceled their appointments. Interviewed patients expressed appreciation for the telemedicine option; many also indicated that they planned to continue telepsychiatry after shelter-in-place orders were lifted. Clinicians also responded positively to the virtual schedule, with many expressing that the option of working from home assuaged childcare concerns.
The most significant challenge during clinic transition was contacting all patients. Individually contacting 800 patients required considerable time and effort from staff. In the context of a rapidly evolving pandemic, clinics may benefit from a quicker method of patient contact, such as mass e-mail or EMR message. Additionally, a minority of patients and clinicians reported technology barriers. For patients without access to a smartphone or webcam, phone calls were substituted for videoconferencing. Some clinicians encountered difficulties in using telepsychiatry software on personal computers, although IT staff were able to resolve any issues.
All telepsychiatry software programs were compliant with Health Insurance Portability and Accountability Act (HIPAA) regulations. For clinics with no prior experience with telepsychiatry, the study authors recommended the use of built-in computer webcams or applications offered through EMR programs. Zoom and Epic’s MyChart were used for all virtual visits.
This information may be useful to other clinics seeking to accommodate patient needs while complying with social distancing recommendations. Rapid conversion to telemedicine was difficult but feasible, the study authors wrote, and was executed without significantly disrupting patient care. The 2-week trial period was essential to assess clinic workflow and capability before proceeding with a longer time frame. As of June 2020, the UC Davis psychiatry clinic is still conducting most visits virtually.2
1. Yellowlees P, Nakagawa K, Pakyurek M, Hanson A, Elder J, Kales HC. Rapid Conversion of an Outpatient Psychiatric Clinic to a 100% Virtual Telepsychiatry Clinic in Response to COVID-19 [published online May 28, 2020]. Psychiatr Serv. doi:10.1176/appi.ps.202000230
2. UC Davis Health (2020). Psychiatry Outpatient Clinic. Retrieved June 5, 2020 from: https://health.ucdavis.edu/psychiatry/clinicappt.html