FEMALE SPEAKER: Welcome to Mayo Clinic COVID-19 Expert Insights and Strategies. The following activity is supported in part by an independent medical education grant from Pfizer Inc. And is in accordance with ACCME guidelines.

ANGELA DONALDSON: Hello, and thank you for joining us for this panel, which is part of the COVID-19 Expert Lecture Series. I'm your host, Dr. Angela Donaldson. And I'm joined by my distinguished panelists, Dr. Ross Jones, Dr. Ivan Porter, Dr. Pauline Rolle, and Monica Albertie. Today, we're going to talk about COVID-19. Where do we go from here?

As we all know, the cases of COVID-19 have specifically and significantly been disproportionately associated with minority groups both in the percentage of cases, percentage of hospitalizations, and percentages of death. We're also aware that many of the comorbidities that are associated with hospitalizations have been found in those who've had asthma, hypertension, obesity, diabetes, and chronic kidney disease. And unfortunately, many of these conditions are often found in higher rates in those in minority groups and those with limited access to healthcare.

Today our goal is to give you some actionable steps that you can take to improve access to care, as well as community engagement. With our hope, at the end of this lecture series, you'll be able to take some of the tips that we have given to help us bridge the healthcare gap. So let's get started.

We have no financial disclosures. Today's objectives are to discuss the benefits and barriers of using telemedicine from both the historic and future perspective. We will discuss the benefits, barriers, and recommendations for contact tracing both in the urban and rural communities. And we'll talk about the role and benefits of community partnership as we address COVID-19.

Our first guest is Dr. Ross Jones. He's the Medical Director of community health at UF Health, Jacksonville. He's also the director of Urban Health Alliance of Jacksonville. And he's a clinical assistant professor of UF Health College of Medicine. Thank you, Dr. Jones for joining us.

ROSS JONES: Hi. I'm Dr. Ross Jones. I'm going to be talking about telemedicine past utilization. So this talk, I hope to give a brief definition of telemedicine, a historical perspective about telemedicine use prior to COVID, and how our organization at UF Health used telemedicine to increase access for the underserved.

Currently, there's no standard definitions for telemedicine or telehealth. Telehealth or telemedicine commonly refers to the use of telecommunications to provide healthcare to patients and providers who are separated geographically. Telemedicine is commonly used to refer to when the provision of clinical services, while telehealth refers to a wider range of services, in addition to clinical services.

There are three main types of telemedicine services. One, is real time video or synchronous conversation, which is like FaceTime where we talk with video and voice communications. There is also store and forward, or asynchronous communications. In this type of telemedicine, the patient would provide information, either video or written, to a provider. The provider would then look at that and then send a message back.

This will probably happen not most likely in real time, as in comparison to the first video. And then the last type is remote patient monitoring. This is where smart devices, such as blood pressure cuffs, send information back about the patient's vital signs or other health information back to the providers, so the provider can provide feedback to the patient.

When we look at the benefits of telemedicine that were proposed historically, there were three main buckets. The first one was increased access to care. The second was decreased costs, and the third was increased patient satisfaction with healthcare and increasing their quality of life.

When we look more closely at the data from increased access to care, we can see that telemedicine had been used to increase access to both primary and specialty care. While uptake of telemedicine was decreased, but compared to general population's, access to care has been shown to be increased in these populations. One study actually found access to stroke care among African-Americans in Texas had increased the access by 1.5 million due to the use of telemedicine across the state.

When we look at reduced costs, cost savings for the patients have been estimated between anywhere between $20 to $120 per visit. Most of those cost savings came from reduced hospital admissions, reduced reduction in lost productivity, and better control of chronic conditions such as diabetes or hypertension. There's also been many studies that have shown that reduced travel time and other travel related barriers by the use of telemedicine.

When we look at the barriers to telemedicine, they can come in four main flavors. The reimbursement, patient privacy regulations, licensing and infrastructure. Reimbursement was one of the biggest challenges, as there was a lack of consistency in payment.

Payers, both private and federal were free to decide which services were covered. So commercial payers were able to decide if they were going to cover the synchronous or asynchronous, or invoke patient monitoring. As you can tell, this led-- many organizations cannot properly plan for how would they create a telemedicine system.

The Affordable Care Act encouraged the development of telemedicine by providing grants to states to help develop the programs. But this only went so far. Initially, Medicare would only reimburse for synchronous communications, however, they had many regulations about its use.

It was really dependent on where the patient was presenting from, what type of [INAUDIBLE] was using it. Usually, most cases it was in rural communities. And then Medicaid reimbursement was really decided on a state by state basis, and there was no federal mandate for payment parity in the Medicaid system.

The next bucket will be protection of patient data. Data security was one of the primary concerns. As you can imagine, there has been a lot of concern about the data being secure or hackers taking advantage of data and locking the patients, or other third parties, who are not invested in patient care being able to gain access to these records.

The health organization must still comply with HIPAA as well, which is another barrier. How do you make sure that these platforms are compliant and protect patients data? Additionally, some states even have their own regulations and laws to protect patient data, which were more stringent than HIPAA.

When we look at licensing, there is another barrier. Providers must be licensed in the state that they're providing telemedicine services. For example, where we're located in Jacksonville, Florida, we're right on the border between north Florida and southern Georgia. So a provider to provide telemedicine services to a patient located in Georgia, they must also have a Florida license and a Georgia license. As you can imagine, this caused a lot of confusion for our providers if they weren't aware of this. And several states also require their own special telemedicine license.

Barriers to telemedicine also include infrastructure needs. There was a high startup cost for necessary technologies. As you can imagine, they had to have all the necessary cameras. Headsets had to be involved. Also, the infrastructure for the healthcare systems had to be beefed up in terms of servers.

And then you also have to make sure that the patients themselves had the necessary technology. It required the need for establishing new clinical workflows to involve these new platforms. And then training had to be provided for healthcare providers and staff.

So here at UF Health, Jacksonville, we really invest in telehealth in 2015. A little bit more about our hospital system. It is an academic medical center, and it's the largest safety net provider in our region.

Our first set of programs really revolved around us using telemedicine in the neurology space to provide stroke care to those in rural communities. After we had success in that area, our hospital system decided to invest more heavily in telemedicine, so that we can provide care and support our various missions throughout the organizations. Clinics in the Department of Community Health and Family Medicine were early adapters.

Our department currently has 30 clinics across northeast Florida and southern Georgia. We look at our road map to telemedicine success. It really can be broken down into six steps.

Understanding our why, building our right teams, and understanding our what's and how's. Priming the pump, the rollout, and refining our process. So the first step was understanding our why.

As a safety net provider, we had to provide access to those who were the most vulnerable in our situation. Many of them had various barriers to care, including transportation. They had jobs where they cannot get time off easily. And then they also had various visits that could require multiple trips on the bus or co-pays.

So we understood that by providing telemedicine, we really can provide better access and care to our patients. And from that, it went to, now that we know that we needed to do this, who needs to be on the team to make sure that we successfully do this? As you can see from the previous slide, telemedicine had tons of barriers from the reimbursement side, to creating the infrastructure, to the legal sides revolving around regulations.

All of those had to be on our team. So our first step was really making sure that we had all the pieces in place. So we had a clinical team leader, who was very passionate about telemedicine.

We've also involved our legal and compliance departments. And then we also had our reimbursement and finance departments really chime in on this to make sure, how can we build a successful program that provides care and is also sustainable.

And then we really went into understanding how do we roll out telemedicine and understand the what's and how's of how would we roll this out? So for that process we actually engaged our clinical staff, so that we can really examine our current workforce process without telemedicine. And seeing how could we implement it.

So this involved our frontline staff, the providers, and our back office all talking about how do we provide telemedicine. So how do we schedule visits? How do we create new visit types? How long will the visit types be?

It even went down to our access center. How do we even make sure that the access centers understands how do you schedule a telemedicine visit? And how does that impact their workflow?

So all those pieces were crucial for us to have success in this program. And then once we really nailed down how the process would go for our patients, we really wanted to make sure we primed the pump. And by that we mean, how do we make sure that our patients were really receptive to telemedicine and that they understood that this process would help improve their care?

This really involved us going out and using our goodwill that we have established in the community as one of the largest safety net providers in the region, to make sure that this process was not replacing their traditional care, but was supplementing what was already going on.

So we made sure that the patients understood what was telemedicine. What kind of equipment they would need to do telemedicine. How their visits would be the same. How they still would receive high quality care.

And then what we additionally did, was we actually had staff members in the clinic who could explain the telemedicine visit. So before they had their first telemedicine visit, they can meet with a staff member they already knew in clinic. That staff member can make sure they had the necessary technology, show them an example of what a visit would look like on their phone, on their own device. And then help them schedule an appointment before they left the office.

This really helped our uptake of telemedicine as the patients felt more comfortable and they understood the process. So there wasn't this black box when they went home with trying to figure it out on their own. And then finally once we did this, we rolled out the process.

So we really pushed this throughout our various mediums. So when the patient called to the access center, they were told about telemedicine visits. All of our televisions with patient information had more information about telemedicine on it. And then the providers themselves in the clinic would select patients who they thought would be a good fit for telemedicine and teach them more about the process as well.

This has really showed that we had a steady increase in this over the last few years. The last three years have really shown a dramatic increase in this, even prior to COVID. Our most successful clinic, which is about 90% Medicaid, actually was able to complete over 2,000 telemedicine visits over a six month period prior to COVID, using the strategy.

And then finally, we refined the process. So during the course of our rollout, even with priming the pump and making sure that everybody understood the what's and how's, we still found some small areas that could be improved. For example, the way that these schedules worked with telemedicine visits.

We found that it was better to actually block your telemedicine visits together, versus scattering them among your schedule with in-person visits. That's because if things are going over, it's a lot easier to tell that patient who's physically in the room that it'll be running late, versus somebody who is on the computer. But we actually worked that process out by letting patients know. Having a MA call and let the patients know prior to, if the provider is running late.

We also had some barriers with the platform, as some patients still didn't understand even with the extra help they had on hand. They didn't understand how to use the technology. So what we did is, we also explored other platforms that were a bit more user-friendly, so that they can engage in that. So they would make it simpler for them to complete their visit.

And then we also have regular meetings, where providers and patients can bring any problems they have with telemedicine and figure out how can we make it so that it's the most optimal experience possible for the patients, providers, and staff. In the future, we hope to create more patient education about the use of telemedicine. So we actually hope to provide videos that the patient can look at home, prior to a visit, so they can understand how do they connect with telemedicine.

We want to continue our Navigator program for telemedicine. We continue to refine our workflow processes. And then we really want to continue to expand the services offered by telemedicine.

We hope to offer some remote patient monitorings for our patients, especially who have uncontrolled chronic conditions, such as diabetes or hypertension. Thank you.

ANGELA DONALDSON: Thank you, Dr. Ross for that wonderful information. I'm now going to introduce our next panelist, Dr. Ivan Porter. He is an assistant professor in the College of Medicine here in Jacksonville campus of Mayo clinic. And he also is a consultant nephrologist. And he is going to talk to us about telemedicine future utilization. Thank you, Dr. Porter.

IVAN PORTER: Thank you very much for having me. I am very interested in the discussion on telemedicine. It hits close to home, literally. And I'll try to explain what I mean by that.

Dr. Jones has done an excellent job of going through some of the differences between what we call telemedicine and telehealth. And this kind of really cloudy, murky definition where the two things are truly talked about. And so they're the same thing.

We know both from past experiences and what companies are doing now to try to implore the use of telemedicine more globally. That there are plenty of opportunities for us to make improvements. And that's both on the provider side, but also on the patient side. We saw very fast what we had to do in order to be able to care for a population in a completely unknown space. And I'm referring to this global pandemic.

And what we were able to do at Mayo Clinic, for example, where almost 70% of all of our visits at the peak of the pandemic in Jacksonville, Florida-- so mid April-- we're being done virtually. And as the closures-- the government closures slowed down, people did return to the clinic, but at much lower rates as they were still worried about high levels of community spread.

And we still had weeks to months where our virtual visit volumes were still in the 20% range. So going from very, very low to that 20% is a large amount. And the infrastructure, like Dr. Jones spoke of earlier, to have to do that on the fly is very difficult without those processes to kind of reprime the pump, as was stated earlier. And then to re-envision what the true process should be.

But we saw this with e-consultations in the inpatient setting. Being able to care for patients that were under isolation. Families being able to visit with patients that were admitted without being allowed into the hospital. That is with stringent visitor policies.

Being able to be present in end of life discussions and other family meetings. All these were things that were done kind of acutely in the inpatient setting, but what we can do in the outpatient setting. What we can do to underserved populations. Really, that's where the focus of the future needs to go.

What other home and hospital based technologies can we use via video conference? How effectively are we using these store and forward asynchronous techniques that can replace urgent telephone calls and urgent visits to the clinic? How are we using the remote patient monitoring both in the acute setting and also for chronic disease management? Are we using the videos for pre-visit triage or pre-visit plannings before patients come onsite.

And seeing patients in other locations. So truly thinking about delivering care across those state lines and all of the licensure components that come with that, that have to worry about from an administrative standpoint as well. The technology is there. We need to leverage this technology and the number of people that we can affect is huge.

Let me use Florida as an example as I talk about what we can do to this underserved population. This here is the Agency for Healthcare Administration's Medicaid map for Florida. And me, personally, I'm from Okaloosa county. Fort Walton Beach, Florida.

So that's up there in the top in region 1, the third county over. And what Medicare data can tell us is how saturated is a market. What specialties are available in a market?

So in this 2015 data, we could see that, for example, my specialty, nephrologists. In Okaloosa county, there aren't that many. Endocrinologists, same way. These patients that require frequent visits with chronic monitoring in order to stay healthy and to prevent progression of disease processes. They don't have access to care.

And we have just a few other areas in Florida, that maybe have what you could consider, a saturated market. If we could leverage the technology that's available to allow those providers to provide care for some of these others that don't have access, we hit a lot of locations that otherwise would not be receiving any care at all. These are the things that as healthcare officials, we should concentrate our efforts.

And then also focus on our legislature, to make sure that they are producing laws and producing policies that actually incentivize this process. Because it takes care of more people. It makes more people healthier. And in the long run, it is a cost effective approach.

Video appointments is usually what we think about. We think about that as the simplest way, whether FaceTime or whether you're using some other approved tool-- some HIPAA compliant tool. But there are considerations, like, I need to see this patient. Or I can't I can't do this without a physical exam.

But we know that there are certainly times where we can utilize this technology, where that may not be necessary. A direct examination may not be necessary. There are other times where the examination may have been performed asynchronously. So was that done a week ago?

And this can easily be just a treatment follow-up question. Or we changed the medication. Let me see what the affect is? What was the response to the treatment that I prescribed?

Think about a second opinion just in general. This is the management that I've had at this time, and I just wanted to know if you agree. That's another use we could use.

The post hospital follow-up. If someone doesn't necessarily need to be evaluated with a physical exam at the time, then there may be ways for us to utilize this technology. Also think about just educational visits. OK.

So reiterating advice that you've already given. If practices have worked to digitize information and be able to send that electronically, then there is certainly no reason that we can't have such a meeting just as you and I are now, where we can reiterate information that is already available to the patients in order to reiterate those practices that we need them to do to stay healthy. Phone visits are another type that are available, but a little bit more difficult to keep with the nuances of the billing.

That is, a face to face visit may need to accompany, or may not be able to have accompanied that phone visit within a certain amount of time, or you may be committing fraud by billing. So again, those considerations may make one less likely to do a telephone visit. Whereas, this may be easy for the patient.

Also, you think about the lower reimbursement that you'll get from the time that's spent on a telephone call, versus the changes that happened with this public health emergency. Basically made it to where these video visits were treated the same as a face to face visit. So that means for reimbursement purposes, at least during the public health emergency, would be equal to the time that you would have spent if they were in your office.

Now that's great, but the question is, will that continue? And that's where we have to rely on our legislature to do the right thing. And there are proposed changes to what the physician fee schedule will be in calendar year 2021.

And basically, kind of simplifying a lot of those level two, three and four. But the questions remain of how virtual visits will be impacted and what the new revenue at this point will be. These are important to any practice that is trying to plan ahead, but also important from the patient's perspective. Because again, any unnecessary cost or unplanned for cost is certainly going to be problematic for many of the patients that we're trying to target with this.

So while it's easy for a practice to gain market share, it's easy to improve access to care, to improve quality of care, to improve the efficiency of what we're providing. And honestly, we're able to define populations as well. We're able to define those disease groups that can definitely be enrolled in such a program, and continue to be managed with chronic disease.

Or think about an accountable care organization or an employer-based group. These are all people that we can put in a group and manage effectively if we are empowered by those that make the decisions on how we're reimbursed. And on those that decide if we can affect those patient barriers, some that Dr. Jones alluded to.

We think about internet access, but we also have to think about the hardware that a patient would use. We have to think about the health literacy at baseline. So if someone always has somebody that comes with him to the clinic in order to kind of elaborate on their care or kind of to understand and then re-explain, that may be a difficult thing to do in a setting of a video visit. Or that person may not be available at the time of an asynchronous visit.

And that's something that we also has to have to keep in mind. The reliability of the internet access is also going to be a problem. And on the provider side, you think about bandwidth issues. So I want to make sure that I'm able to provide that care without any hangups on my end or changes in the video quality, or things like that.

And again, that licensure piece is big, especially if you're talking about caring for people that are crossing a state line if you're near a state line. Some practices are going to have to decide if licensure in multiple states is important for them, and if it makes sense financially for them to do so. But again, if the goal is to improve access of care, I think that it is clear that one way to do that is by leveraging the options that we have with telehealth and telemedicine.

And I hope that this is a direction that all of us in the US healthcare system will be able to employ in the very near future. Thank you very much.

ANGELA DONALDSON: Thank you, Dr. Porter. That was an amazing discussion. I now have the pleasure of introducing our next panelist, Dr. Pauline Rolle.

She is an M.D. PhD and a CPH. And she is also the Interim Health Officer and Medical Executive Director for the Florida Department of Health. And she is going to talk to us today about the public health role in COVID-19, as well as contact tracing. Thank you, Dr. Rolle.

PAULINE ROLLE: Thank you, Dr. Donaldson. It's my pleasure to be here this evening to present. So the Department of Health. So one of our roles during this COVID response is to act as lead agency. And tonight I'm going to cover some of our primary responsibilities, and one of the main ones, contact tracing.

So March 1st 2020, the governor designated the Department of Health as the lead agency. And so what that meant was, we were responsible for coordinating the COVID-19 emergency response in the state of Florida from the state level down to the local level. That included public health advisories operating statewide call centers.

We also operated a local call center. We were responsible also for receiving all lab results from across the state, whether it be positive or negative. In addition, a primary function of the health department is to perform contact tracing. In fact, it is mandated in statute.

Amongst our other roles, include infection control and testing. We provided infection control prevention measures to our long-term care facilities in our jails. Helping them to ensure that they had excellent infection control processes in place. The other thing that we did was monitor persons under investigation as a part of our contact tracing.

Quarantine and isolate people. That is what most people are familiar with during this COVID-19 response. Again, quarantining and isolating is in the purview of the Florida Department of Health. And it is outlined in statute as one of our responsibilities.

We also manage department of health testing sites, assess and test at long-term care facilities. We oversee school health programs and we monitor hospital bed capacity, to ensure that we were ready in the event that we had a surge in cases. And in addition to that, we operate special needs shelters.

And so far, we have not had to open any shelters in response to hurricane, but it is our duty to operate special needs shelters, and ensure that there is a specific shelter for COVID positive patients. In our role as the Department of Health, we provided testing directly, including antibody testing and PCR testing. And so we did that in conjunction with the city at Regency Square Mall and at Lot J when it was open.

But we also had independent testing sites at the Florida Department of Health on Sixth Street, as well as through mobile units that were throughout the community. Mobile units were strategically placed based on the data that we received. We tried to assess the needs in the community in terms of where testing was lacking, and send our mobile units into those areas.

We also provided a walk-up testing at our central plaza on 6th Street. And walk-up testing was available daily to people in the community. One of the things that we did to provide education to the community was to open up a call center.

Since March 13th, our call center has answered over 50,000 calls. We've provided education to the community, answered any questions they had, as well as assisted them in getting their test results. Infection control was a big part of what we do.

We partnered with the state to have infection control prevention nurses onsite in the city, to provide education to our long-term care facilities and other agencies that require such services. Our infection control teams visited schools, restaurants, bars. Many people will remember the outbreak initially at the bars on the beach.

Our infection control team went out, provided personalized service to those bars to ensure that they had good infection control practices in place to prevent another outbreak. In addition, our infection control team assisted in contact investigations and employee exclusions. Long-term care facilities was a big part of what we did.

We had to contact every facility and group home that had a positive resident. And we did investigations in those facilities. We walked side by side with those folks. In some instances, we actually provided staffing to those facilities who became overwhelmed by the number of cases they were dealing with.

We assisted in testing every employee every two weeks, and we tracked positives. We isolate and separated positives and exposed residents, and helped long-term care facilities set up systems that were sustainable, to be able to ensure that the disease did not spread within their facilities. One of the other things we did, was we recognized the issue of food insecurity in our community as it related to COVID.

And a lot of folks didn't think about that during this time. They were busy trying to get tested, trying to stay safe and prevent COVID from entering their homes. However, there were a number of people in our community who experienced food insecurity during this time. And so with that, we partnered with Safe Future Foundation to provide weekly food distribution onsite.

And some weeks, they would come two days a week. And other weeks, they would come one day a week. And provided food to the community as well as pampers and personal care products for women. To ensure that folks had what they needed to be able to survive this pandemic.

One of the things we're most proud of besides all of the other wonderful work we've done, including contact tracing, is mass distribution. The state of Florida distributed mass throughout the state. Here in Duval, we passed out over 400,000 cloth masks in the community. And we continue to provide those cloth masks to non-profits and even to the hospitals in our area.

These cloth masks are available to anyone for free. We partner with a lot of different community groups to get these masks out into the community. And so that's been a very successful venture.

The jail was one of our largest projects. We worked very closely with the jail staff to ensure that they mitigated the spread of disease in the jail. As you know, being in close contact is very easy for infectious diseases to spread. So in working with the jail, we provided support and guidance to ensure that they did not continue to have disease spread within their system.

And so they were great partners and we continue to work very closely with them. We worked with them on their policies and procedures, to ensure that their employees and the inmates that they care for are safe. Now one of our largest partners is the school system. Duval County Public schools.

And so with Duval County Public schools, in non-COVID times, we provide school health nurses to help provide services onsite to school children, to ensure that they don't continue to stay in school when they're ill. To take care of any bumps and bruises. But during this time of the pandemic, we've had to ramp up our services within school.

And so with that, we've partnered with Duval County Public schools to identify any positives. In some cases, they identify positives from parents and employees calling in to state that they themselves, or their child are positive. In other instances, we have identified the positives.

And so with that, once a positive is identified in the school system, a contact investigation ensues. In some cases, disease intervention specialists may come onsite. In other instances, we work directly with the school health nurses that are on the scene to decide who needs to be isolated or quarantined and who does not. And also decide who is impacted.

Individuals who need to be excluded are identified, and their parents are notified. And if they're an adult, they are notified. And so this has been a great partnership, and we work very well to decrease the number of cases that are generated in the school. Majority of the cases have come from outside of the walls of the school, into the school. And thus far, we have done a great job of mitigating any spread of disease within the school walls.

Like I stated before, one of the biggest things we do is contact tracing. And what happens with this essentially, if someone tests positive they're asked to self-isolate at home. We will monitor them, periodically check on them. And one of the things we do also, is connect people with services.

If they have to self-isolate and they have issues with their health or with food insecurity, or things of that nature, we try to connect them with services to ensure that they have what they need to safely stay in place. So once folks are asked to self-isolate because they themselves are positive, we start to find out a little bit more about them and who they may have been in contact with.

And so with that, we reach out to their contacts. And so what we try to get people to understand is this is a very confidential process. And so if a person identifies contacts, when we reach out to those contacts, we are sure not to indicate who the index case was. We use the same process with STD, HIV.

So contact tracing is one of those things that's well established in the public health community. It's not something new. It's just gotten a lot of press with COVID-19, but it is one of those mainstays of public health that we have done for decades. And it is proven to be very helpful in terms of identifying the spread of disease and mitigating the spread of disease.

And so once we identify people and we get their contacts, then we advise their contacts as to next steps, and as to how long they should quarantine. And so with that, the object is to keep the community safe and prevent the spread of disease. And so there are times when we have to institute legal means because people are not cooperative. But I can say here in Duval, the majority of people have been cooperative and we've been very successful in terms of those contact tracings. Of course, there are always challenges with contact tracing.

You have people who think when you're calling, it's a hoax. Or they may have given us a wrong number or wrong address. And so there are times when it is difficult to track down people, but we have other means-- electronic means of figuring out where people are at any given time.

And so certainly contact tracing is a mainstay of public health and it has helped us to mitigate the spread of disease in the community. And again, not just for COVID-19, but also things like HIV and STD. And so we continue to do that. We partner with the Centers for Disease Control to onboard contact tracers to assist us in this work. And the state has been very helpful in terms of providing staffing for this work.

If we reach out to folks and we can't get them, we continue to try. And in some instances, we will send someone out to the home to check on them, to make sure they are aware that they are positive or that they are a contact, and they are isolating or quarantining as appropriate. And so we're very proud of the work that we do here in Duval.

It's exciting work. Certainly COVID-19 has made it that much more so. But again, contact tracing is one of the biggest things that we do.

So as we look toward the future, what are we looking to do? Well, we want to make sure everyone knows that they can do their part to prevent the spread of COVID-19 and other respiratory viruses. We still emphasize the need to wear masks, to social distance, to ensure that you are protecting yourself and others. And as we go into the flu season, we encourage people to get the flu vaccine again, to mitigate the number of people who will need to access the healthcare system.

And so certainly, we also want to identify additional areas for collaboration and partnership. This is not work done in isolation, for sure. We've worked with a number of partners, including the University of Florida and Mayo to accomplish the goals in the community of decreasing the spread of disease. Ensuring people have access to testing and ensuring that people are educated appropriately.

And so with that, we continue to develop those partnerships and identify other areas to collaborate in. And so it's always a pleasure to work with our community partners to ensure that we get the word out to the community, and we do right by the community. If you're interested in learning more information, certainly there is a lot of information out there, but the Florida Department of Health's website is always a good place to go. And the Centers for Disease Control. And of course, the World Health Organization.

Both the CDC and WHO have provided a wealth of information that have helped to drive our response to the pandemic. And so again, these are some helpful websites for you. If you have any questions, we're your partners in health.

And so I can be reached at the email address listed, as well as the phone number. Always available to speak to the issues and assist in collaborations in the community to help make us the healthiest state. Thank you.

ANGELA DONALDSON: Thank you, Dr. Rolle. That was amazing information. I'd now like to introduce our next speaker.

Our next speaker is Monica Albertie. She is an assistant professor of Healthcare Administration. She's an operations manager for the Center of Health Equity and Community Engagement Research. And she's going to talk to us about the role of community partnership in addressing COVID-19.

MONICA ALBERTIE: Thank you. Good evening. As Dr. Rolle said, addressing COVID-19 cannot be done by individual institutions alone. And community partnerships are key to addressing the pandemic, especially for racial and ethnic minorities, and those living in under-resourced communities.

So when we talk about partnering for a common goal. So at the onset of the pandemic, healthcare institutions immediately focused their efforts on keeping their patients, staff, and the surrounding community safe. And early on, we saw that there was evidence that some communities did not have access to PPE, testing, or even accurate easy to understand information about COVID-19.

As time went on, we found that COVID-19 disproportionately impacted racial and ethnic minority communities, and especially those that live in under-resourced communities. And when we think about under-resourced communities, we're thinking about those communities that lack built infrastructure. They could lack access to healthcare facilities. They could be in rural areas. Areas that are isolated, that make it hard for testing to take place or for information to be disseminated in those communities.

There was a clear need that the impact of COVID-19 in these communities needed to be addressed. So the importance of building institutional and community partnerships in order to address COVID-19 is key. So when we think about community partnerships, they could be faith-based institutions, civic and volunteer organizations, local nonprofits, businesses, advocacy organizations, and governmental organizations as well.

There are some basic steps that you should think about when you are wanting to build institutional and community partnerships. So the first step is really thinking about connecting with those organizational and community leaders. And when we think about community leaders, they aren't always going to be the head of organizations or maybe the CEO, or executive director.

Sometimes they are the most knowledgeable person that lives in a particular neighborhood. Or they could be a longtime advocate for health and wellness, or a community health worker. So first, it's identifying and connecting with those leaders.

Second, you really want to think about, as you connect and you all have come together, really defining and prioritizing partnership goals. So as it relates to COVID-19, in the partnerships that I will talk through in the next slide. We really worked with community organizations. Mayo clinic worked with community organizations to really talk about what is going to be the goal of this partnership.

What do we want to do in the communities to really help lessen the impact of COVID-19? The third step is agreeing upon roles and responsibilities. So when institutions-- academic medical institutions, healthcare institutions want to partner with local community organizations, it's important that roles and responsibilities are thought about and discussed upfront. And then finally, you want to define what success looks like. Oftentimes, success to an academic medical institution or healthcare institution is different than to a local neighborhood or to a local community organization.

So there are some benefits, in general, to community partnerships. So there is this idea of collective impact. And so really what collective impact is, is when groups get together and they're able to make a bigger impact on the health of the community. Bigger than they would if they just did this alone.

Bi-directional communication. So oftentimes in large institutions, it may be difficult for us to understand what the community needs. What are the issues that the community is facing. And so having community partnerships really creates this bi-directional communication to where we can learn from the community and communities can learn from us.

There's also shared power. So there isn't just one entity in this partnership that makes the rules or that decides what's going to happen. That's a shared power. And also sustainability.

Again, when an institution alone tries to address community needs. Or particularly, not only in a pandemic, but just in general. Oftentimes it's tough because it's not sustainable. But when there are partnerships, it allows for a sustainability because every single partner has its role.

So. I'm going to talk a little bit about a partnership, the roadmap, and how we address COVID-19 here in Jacksonville. So at the beginning of the pandemic, community members through phone calls and emails, and texts, really expressed the need for-- initially, more PPE and information. So community members were really having trouble finding how to get free masks and enough masks for their family.

And also, they needed accurate information. So we knew-- Mayo clinic knew that we couldn't do this alone. So we worked with local organizations, including the health department, local faith-based organizations, universities, to really pull together these leaders and better understand the need.

So together we developed a plan for how we were going to disseminate PPE and information, particularly in communities that lacked resources or that were hard to reach. Our community partners through a series of phone calls and Zoom calls, worked together to identify different venues or different locations throughout Jacksonville, where PPE could be disseminated. Where community members would easily be able to access the PPE. And also, where we could also give out accurate information to individuals.

We worked with community leaders to deliver PPE and COVID-19 information. There were weekly calls that were held with community leaders, where community leaders asked Mayo Clinic experts questions about the disease, about the virus, about safety measures, about masking and quarantining.