NYS Hep C Telemedicine Workgroup Meeting Notes | 4-17-20

NYS Hep C Telemedicine Workgroup – Meeting Notes

Friday April 17 (10 – 11 AM) via Webinar

In attendance at this meeting: See below notes

Workgroup Chair: Andrew Talal, MD, University at Buffalo, ahtalal@buffalo.edu

Workgroup goals: Short term: Identify, assess, document and disseminate current strategies and opportunities to provide hepatitis C treatment in substance use treatment facilities, via telemedicine. Long-term: Develop a NYS Telehealth network to provide a forum for ongoing learning and sharing of best practices to promote hepatitis B and C care and treatment through telehealth.

Meeting Notes

Discussion: Coronavirus and statewide need to rapidly implement telehealth services

• National and statewide policy changes in response to the COVID pandemic have allowed expansion of telemedicine to virtually all settings and providers, and that presents a unique opportunity to expand viral hepatitis telemedicine services.
• Provider working with substance using population reported greatly expanding telehealth via telephone, but virtual visits remain a challenge due to patients lacking the technology, infrastructure, and knowledge.
• Provider in methadone clinic reported providing more take-home medications for patients with mixed results; it was difficult to predict who be able to self-manage and maintain stability.
• DEA waiver of requirement for in -person patient visit for buprenorphine: https://www.samhsa.gov/sites/default/files/dea-samhsa-buprenorphine-telemedicine.pdf

NYS Telehealth Resources for hepatitis providers – webpage on Hep Free NYC – Please review and provide feedback to improve!

New training and support resources:

• Weekly webinar series: Telehealth During the Public Health Emergency: Training for Practices. NYC Health Dept.
• HHS telehealth website telehealth.hhs.gov
  

Presentation: Medical and Psychosocial Aspects of Integrated HCV and SUD Treatment
Andrew Talal, MD, University at Buffalo – ahtalal@buffalo.edu & Kathleen Davis, NP, University of Rochester Medical Center – kathleen_davis@urmc.rochester.edu

• See presentation here
• Andrew Talal, MD shared that PWUD face specific barriers to HCV treatment: stigma, lack of good information, limitations on prescribing and reimbursement.  Older survey by NYS found that only ~20% of OTPs were treating HCV onsite (any model). In telemedicine pilot study presented, 93% of patients achieved SVR.
• Kathleen Davis, NP from Live Strong OTP in Rochester shared that telemedicine was crucial for her patients to start HCV treatment & many patients would not have been treated without it.  Major barriers were incarceration, living in acute substance use/inpatient treatment programs, long-term sobriety requirements as many clients have ongoing drug use. Telemedicine needs to be flexible (i.e., off-hours appointment times) and individualized for treatment to be successful.

Presentation: Rapid Implementation of Telemedicine

Su Wang, MD, MPH, FACP, Medical Director of the Center for Asian Health, Saint Barnabas Medical Center – Su.Wang@rwjbh.org

• See presentation here
• SBMC implemented telemedicine in less than a month at a community hospital in response to COVID19. Process included developing a timeline that included testing systems, training providers, and EHR changes. Using Doxy.me platform. Iterative process, with providers coming on board at different times.  Have several trainings for staff that address virtual visit etiquette: appearing professional, proper positioning of device so patient can see them, closing doors, having a private and quiet space to conduct visits, uncluttered background.  Billing was also set up in EHR to accommodate variations in billing codes for telemedicine versus in person visits.

In Attendance: