Tia’s Dr. Kathleen Jordan on COVID-19, A Prison System as Proving Ground for Telemedicine, and the Future of Virtually-integrated Care

Dr. Kathleen Jordan, Senior Vice President of Medical Affairs at Tia, has a unique perspective on COVID-19. At the start of the pandemic, she was serving as Chief Medical Officer at Saint Francis Memorial in San Francisco. Dr. Jordan leveraged her infectious disease and internal medicine background to care for patients and support her team in the face of enormous unknowns. We had the good fortune to sit down and discuss that experience — plus what the next stage might look like for COVID-19.

As Chief Medical Officer of St. Francis, you were the ‘top doc’ when the pandemic hit and the US shut down in March last year. What was that experience like for you?

In some ways, this was a bonding experience that connected our team with a common purpose. We had to figure out how to protect employees and the community, all while treating patients. St. Francis had the first hospitalized COVID-19-positive patient in the Bay Area and that definitely forced us to get practical quickly. We figured out what personal protective equipment (PPE) we had — and used our knowledge of infection control on similar viruses to make it as safe as possible.

We were told to prepare but had no idea if there would be two or 200 patients — or if the pandemic would last two months or two years, so preparation was not simple.

You mentioned PPE — that was a major problem early on. How did you address that?

We leveraged our current supplies but also worked with our local and system partners to make sure the PPE was where it was needed most.  The chief medical officers in the city had routine calls to communally address our needs. If one site ran out of masks, another hospital would ship a box over. We solved these problems together — the lack of PPE created new collaboration among Bay Area healthcare systems. In addition to PPE collaboration, if one site was overwhelmed with patients, then we did what we could to help with patient care, with occasional safe patient transfers or redirecting ambulances and admissions.

It was nice to collectively manage this pandemic as a healthcare community. I felt very supported by my peers, the hospital team, and our public health agencies. Many of us relied deeply on the guidance issues by local and federal health agencies and relied heavily on contacts there to discuss best approaches for aspects where details were still emerging. This information sharing was essential to establishing best practices.

Seems like communication must have been an essential part of managing the crisis. What were some of the ways you did that?

We adopted a policy of full transparency. We held town halls to make sure employees could talk about what they were going through, address their concerns, and share what we were doing on their behalf and to be honest about what we did or didn’t know. At the same time, the CDC and public health departments were holding seminars and standing up hotlines to help. We knew early on that information dissemination would be huge and were quick to set up avenues of communication. These were for us to receive and digest information but also to disseminate it — not just for the medical staff but for the larger community.

Knowledge is a powerful tool to address panic. As we know more, we can respond and feel more prepared. There is some comfort in understanding more about the situation even if the situation is a pandemic.

How did healthcare workers figure into that communications effort?

Healthcare workers are their own emissaries of information and sources of expertise to their home communities. So we engaged them to really understand and digest the issues so that in turn, they could reinforce public health communication within their families, friends and neighbors. Even now as vaccinations roll out and more information is available, I spend a considerable amount of time sharing information with our practitioners so that they are robustly equipped to address concerns from patients but also from friends and families.

The pandemic really opened our collective eyes to the need for telehealth. Talk about your observations.

Our first crisis was that we had patients dying from Covid and a no-visitors policy in place for these patients in efforts to contain the disease — and that was very hard on patients, families and staff. We quickly enabled televisits to enable families to be able to say goodbye. While not the same as hand holding, telehealth enabled some beautiful human interactions. Goodbyes were no long longer limited to two visitors in the ICU. Relatives from across the globe could participate in discussions, goodbyes, or prayer sessions.  

Now that both families and healthcare workers have seen the power of this practice and how deeply personal it can be, I think it will be employed more frequently. I expect these virtual goodbyes will become more common as we accept them as being loving, human, and valued interactions.

How else did you institute good telehealth practices?

In addition to this immediate employment of telehealth, we started to use it for other needs: we had patients that needed care but clinics were closed due to lack of PPE and uncertainty on best measures to keep people safe from infection.  

Waiting rooms with a mix of well and COVID-19 patients seemed too risky. So whole clinics became entirely virtual in a few days!  Patients accepted it as they had few options and communities helped each other adopt the practice. We had grandkids showing their loved ones how to use the technology (both for providers and patients!), hospitals and individuals both buying and lending equipment, and tech teams working around the clock to support it all. We had some minor glitches along the way, but people were both patient and persistent and the use of telehealth continued to grow.  We have become very accustomed to using telehealth in Covid times and have seen improved care and connection as a result.

Saint Francis had a leg up when it came to telehealth because of its work with an unique part of the community. Can you talk about how your care for San Quentin’s prison population shaped your telehealth readiness?

We had recently set up telehealth services to support the health needs of the San Quentin State Prison population. The prison system has a highly developed telehealth system, born out of necessity. This included the cost of transport and safety issues as well as often remote locations needing specialty care outside of their geographies.

Through our work with them, we had established systems to integrate with electronic medical records, use telehealth to provide treatment while also ensuring privacy, set up malpractice insurance and privileging to cover telehealth work, and our managers had been trained on how to manage patient flow and check-in. We were primed to go with telehealth because of the work we had done together.

That established relationship also helped us give care quickly when there was a huge COVID-19 outbreak inside the prison itself; we were able to support them effectively remotely.

We’re still very much in the thick of the pandemic but attention is rightly starting to expand to the late sequelae (aka, “long haulers”) patients. What’s your take on the problems people are continuing to experience?

The clinical world is still defining what constitutes a late sequelae patient. It’s generally anyone who doesn’t return to their baseline health status a few months after they’ve had an active COVID-19 infection. Most do recover fully but persistent symptoms include ongoing fatigue, shortness of breath, coughs, aches and pains, depression or chest pain. In my most recent and current role as SVP of Medical Affairs at Tia, we’ve established clinical treatment modalities to support patients with these issues. I encourage patients who need it to seek help and care on an ongoing basis.

So how will the medical community best take care of these patients?

Late sequelae patients are often dealing with a variety of acute injury recovery. We don’t know how fast people, or how completely, these patients can get better. Right now, clinics are cataloguing symptoms and learning and chronicling the recovery. They’re deploying the full range of the healthcare toolkit — acupuncture, mood elevators, physical and cognitive therapies, non-steroidals, etc. — to see which interventions have success over time.

I’m optimistic that individuals can recover significantly, if not completely, from the toll of a COVID-19 diagnosis.

But the reality is that we will need to support them through this. The tools are there but the system is fragmented. Patients will need help navigating this model. 

Alternatively, there will be options that make it easier to navigate. At Tia, we offer integrative medicine for women and we’re seeing increased demand for our services because of these complex needs. We offer core gynecological and primary care services along with mental health support, diet and nutrition, sleep and work with partners around more complex autoimmune, neurologic or cardiopulmonary issues. Awareness around the value of a multidisciplinary team approach to healthcare is growing — and we’re happy to be a leader of innovation in that space.

How should payers step up to help these late sequelae patients?

They should continue to support telemedicine for access issues — and in a sustained way for rehabilitative services from their own communities where they can engage with their support networks.  These patients will also need a commitment of financial support for ongoing therapy needs, both physical and mental health therapy needs.

Can you tell us more about your new role at Tia, what attracted you to the company, and how your team is responding to COVID-19 here? 

I joined Tia when I heard about their emphasis on wellness as a science and a mission, much the way Welkin Health does. I began looking at the overall business of healthcare as less about serving the ill and more about investing in and supporting wellness in order to prevent illness. My prior work in hospitals has been so rewarding and I couldn’t be more grateful to have been invited to be part of these very pivotal moments in a person’s life, sometimes getting to save someone and other times being a support structure for devastating outcomes. All of it is so rewarding personally and professionally.  

However, as I became more reflective in these moments, I began to wonder what could have been done differently to affect outcomes. I became drawn to the outpatient setting, the science of preventative medicine, and to a wellness approach in general. I’m hoping my experiences in both realms will contribute to a new generation of healthcare delivery that impacts outcomes and leads to a generation of people living long and healthy lives.

Once we make it out of the pandemic and back to “normal,” do you see telemedicine as the future of all care? 

Telemedicine is here to stay. It’s no longer the future: it’s arrived. Patients and providers have so appreciated the convenience and the access. It’s also broadened service areas to benefit from unique specialty centers. Tia patients have certainly enjoyed the convenience of many visits being virtual. It’s eliminated the need for transportation, babysitters, and/or the extra time off work or out of their day.  

To support continued telehealth services, payers and health care systems will need to evolve adjusting regulations and oversight, prevent fraud and abuse, and ensure meaningful payment for the delivery of telehealth care. Fortunately, the demand is there and would be impossible to quell at this point.   

There will, of course, continue to be the need for in-person care and assessments, so at Tia we have integrated virtual and in-person care to optimize a combination of services. We leverage telemedicine as a tool to provide mental health services, virtual intake on history, some assessments, and counseling on acute and chronic illness. We also see patients in the flesh for complete or complex exams such as PAP smears and gynecological exams or to evaluate other complex medical presentations.