During the COVID-19 pandemic, heroic clinician narratives have been a prominent feature of media coverage. Health care professionals who worked ceaselessly in intensive care units, sacrificed time with their families to travel to severely affected areas to care for patients with COVID-19, and put themselves in harm’s way have been acknowledged and rightly celebrated.
Over 250 expert judges selected winners from across 15 categories. Dr. Urmimala Sarkar, Associate Director of the UCSF Center for Vulnerable Populations, and Steve Barsh, Managing Partner at Dreamit Ventures, presented the winner in the Consumer Prevention category: Dexcom. Finalists in this category included Carrot, Surgical Theatre, and Podimetrics.
During the COVID-19 pandemic, heroic clinician narratives have been a prominent feature of media coverage. Health care professionals who worked ceaselessly in intensive care units, sacrificed time with their families to travel to severely affected areas to care for patients with COVID-19, and put themselves in harm’s way have been acknowledged and rightly celebrated.
But Clinicians Express Concern Over Diagnostic Accuracy of Phone Visits
Cross-posted via UCSF News
By: Laura Kurtzman
Date posted: May 10, 2021
As state and federal authorities decide whether to continue reimbursing for telehealth services that were suddenly adopted last spring in response to the COVID-19 pandemic, a new study out of UC San Francisco has found that clinicians in the San Francisco Health Network (SFHN) overwhelmingly support using these services for outpatient primary care and specialty care visits.
The results surprised the research team, which includes a number of clinicians at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG), since they witnessed firsthand the difficulties that many of their colleagues and patients experienced when they had to turn to telehealth overnight. ZSFG is part of the San Francisco Health Network, where the survey was conducted, which also includes clinics run by the San Francisco Department of Public Health.
“That transition was so painful for many people: to find a new way to provide medical care,” said Anjana Sharma, MD, MAS, assistant professor of family and community medicine at UCSF and first author of the paper, published in the Journal of Health Care for the Poor and Underserved. “We were surprised to see that nine out of 10 clinicians expressed comfort with providing care by phone and video.”
She said the team was also surprised at the concerns that providers expressed over whether they could accurately diagnose patients remotely. Almost 60 percent of those surveyed questioned the diagnostic safety of providing health care services over the telephone, and 35 percent had those concerns about diagnosing on video.
And there were other problems. Some 44 percent of clinicians reported that speech, hearing and cognitive barriers made telephone visits impractical. Significant portions also reported having patients who either did not have access to video (39 percent) or had no phone at all (38 percent), while 40 percent reported seeing patients who had trouble setting up video access because of language or educational barriers, and 35 percent reported patients without Internet.
Still, more than 90 percent of the clinicians surveyed said they planned to continue using phone and video to care for their patients after the COVID-19 pandemic ended.
For patients who can utilize the technology, particularly for follow-up care after a diagnosis has already been made, the benefits of telehealth are overwhelming. It saves time and money, especially for people who cannot easily get time off work to see the doctor or who may have childcare responsibilities. And, for those with access to video at home, the technology can make it easier to include other family members.
“People have been talking about telemedicine forever, but this transformation would have never happened if not for the pandemic,” Sharma said. “It’s the reimbursement flexibility that drove this to be possible.”
State and federal authorities are currently debating whether to lower or potentially eliminate payments for video and telephone visits that have been reimbursed at near similar levels to in-person visits throughout the public health emergency.
“We do believe that video visits are higher quality and are probably safer for patients,” Sharma said. “But we don’t want to leave anyone behind. We’re trying to say, ‘both/and.’ It makes sense to improve our video capacity for patients. But if telephone reimbursement goes away, that will be devastating for our patients.”
Other authors include Elaine Khoong, MD, MS; Courtney Lyles, PhD; Triveni Defries, MD, MPH; Urmimala Sarkar, MD, MPH; Delphine Tuot, MD; Malini Nijagal, MD, MPH; and George Su, MD, all of UCSF.
Summary: All too often advances in digital health tools don’t benefit disadvantaged populations. One reason is new ventures and their backers make assumptions about this market that aren’t true. By partnering with academic institutions that are focused on helping indigent patients, digital health companies can develop products that profitably serve all market segments and help make health care more equitable. This article offers six lessons gleaned from an incubator at the University of California, San Francisco.
UCSF’s Division of General Internal Medicine (DGIM) and Center for Vulnerable Populations (CVP) at Zuckerberg San Francisco General Hospital (ZSFG) is seeking a detail-oriented and excellent communicator to support the growing Health Information Technology and the Safety-Net program as a Research Data Analyst. The position is based primarily in DGIM’s offices at ZSFG but may involve occasional travel to other UCSF campuses. The position will be remote until UCSF discontinues its work-from-home guidance (currently through June 30, 2021).
Over 250 expert judges selected winners from across 15 categories. Dr. Urmimala Sarkar, Associate Director of the UCSF Center for Vulnerable Populations, and Steve Barsh, Managing Partner at Dreamit Ventures, presented the winner in the Consumer Prevention category: Dexcom. Finalists in this category included Carrot, Surgical Theatre, and Podimetrics.
Agency for Healthcare Research and Quality (AHRQ) Grantee Profile
Posted by AHRQ on September 21, 2020. View on AHRQ’s website here.
Urmimala Sarkar, MD, MPH
Division of General Internal Medicine
University of California, San Francisco (UCSF)
As a primary care physician working with low-income patients, Urmimala Sarkar, M.D., M.P.H., is committed to health equity—ensuring that everyone has the opportunity to attain their highest level of health regardless of income, geography, race, or ethnicity. With AHRQ funding, Dr. Sarkar, a professor in the Division of General Internal Medicine at UCSF, is achieving this goal by using innovative health information technology (IT) to improve patient safety and care delivery for diverse patients.
Dr. Sarkar’s aims align with AHRQ’s mission to remove barriers to care and make healthcare safer for all patients. “Digital and internet-based tools for patient-provider communication are becoming a standard of care, but not all patients benefit from these tools due to language barriers or technology literacy limitations,” according to Dr. Sarkar.
In 2008, Dr. Sarkar established a foundation for her health IT research through a career development award from AHRQ. Under this grant, Dr. Sarkar’s team analyzed how well diabetes patients who used an interactive, online patient portal to refill their medication adhered to their medication plans. The research provided an early example of how digital approaches can benefit vulnerable patient populations. “Through this study, we learned that when patients engage with self-management tools between visits, we can detect and act on safety concerns,” noted Dr. Sarkar.
While her first grant analyzed the use and benefits of health IT at the patient level, Dr. Sarkar’s next project, which began in 2012, targeted care in safety-net hospitals that serve a proportionately higher number of under- or uninsured populations. In the United States, nearly 884 million healthcare visits were conducted in ambulatory care settings, where lack of information and fragmentation of care may worsen safety problems among patients. These issues are exacerbated in underresourced settings , where low-income and racial and ethnic minority patients disproportionately receive their care.
““With support from AHRQ, I have leveraged innovative health information technology approaches to advance the study of health equity. This research is helping to improve healthcare delivery and health outcomes for low-income and underserved patients.””
With support from AHRQ, Dr. Sarkar evaluated patient safety issues such as adverse drug events, missed and delayed diagnoses, and failed treatment monitoring that are challenges for safety-net health systems. Building on this work, Dr. Sarkar was awarded a 5-year AHRQ-funded Patient Safety Learning Laboratory grant. Her learning laboratory projects explore the epidemiology of outpatient adverse events and use human factors engineering methods to iteratively develop and test patient safety solutions using technology and teams.
Dr. Sarkar’s recently completed AHRQ-funded project, Investigating Failures of Notification and Monitoring in Outpatient Care: Safety Promotion Action Research and Knowledge (SPARK) Network, represented the first collaborative effort to measure and report ambulatory safety metrics. The network consisted of five safety-net hospital systems in California.
Dr. Sarkar’s work has highlighted persistent safety gaps and significant data and reporting challenges in operationalizing ambulatory safety measurement. For example, she and her team published a 2018 study that found that followup for a colon cancer screening test was just 49 percent after 1 year; she hopes the findings will enable participating hospital systems to address the issues identified and will also contribute to researchers’ knowledge of safety gaps.
Dr. Sarkar is the Associate Director of the Center for Vulnerable Populations at UCSF. She also mentors young investigators as Director of UCSF's Primary Care Research Fellowship, curricular director for UCSF's Fellowship Advancement and Skills Training in Clinical Research, and co-director of the AHRQ-funded Learning Health Systems Early Career Acceleration Program for junior faculty involved in learning health systems research. She is a member of the American Medical Informatics Association, American Public Health Association, and Society for General Internal Medicine.
Principal Investigator: Urmimala Sarkar, M.D., M.P.H.
Institution: University of California, San Francisco
Grantee Since: 2008
Type of Grant: Various
