To reduce the spread of infection, UCSDH prioritised the need to screen patients outside of the clinic and through channels such as phone, email, and EMR messaging.

At the beginning of the pandemic, the organisation deployed new EMR templates with screening guidance and triage instructions that are easily accessed and used by call centre staff and nurses. Front-line staff follow a standardised script when screening patients, and certain responses trigger provider alerts with guidance for follow-up clinical care. Templates are updated in real-time on the back end with the latest local, federal, and global recommendations, enabling a consistent protocol across the organisation while also making it easier for front-line staff to keep up with the ever-changing guidance.

To quickly respond to evolving needs, UCSDH assembled a seven-person "Ambulatory Covid Team" that included infectious disease physicians, PCPs, and nurses. This team uses the secure messaging platform in the EMR to rapidly communicate updates and share PHI when necessary. The platform enables 24/7 secure communication across clinical teams, and team members can quickly access patient charts attached to messages on computers or mobile devices.

Pre-populated Covid-19 lab order sets were added to the EMR for inpatient, ED, and ambulatory settings. UCSDH conducts in-house testing for patients in the hospital or ED, but tests done in its ambulatory settings were initially sent to a reference laboratory due to capacity limitations, and then brought in-house a couple of weeks later. The pre-populated lab orders include directions specific to the care setting to avoid confusion among providers and breakdowns in the testing process.

Clinical decision support was also added to the workflow at the point of ordering to make sure providers are documenting the testing criteria.

The enterprise reporting team at UCSDH created easily accessible reports in the EMR as well as a Covid-19 operational dashboard that includes real-time data on patients tested, test results, ICU bed availability, and ventilator availability. The dashboard is reviewed in five daily readiness huddles and helps staff members make evidence-based decisions at a time when emotions are high and misinformation is spreading. The dashboard is sent to all health sciences employees and provides visibility into what is happening at any given time, and it helps curb the growing anxiety of clinicians by making the unknown, known.

UCSDH had previously built telemedicine functionality within its EMR's patient portal, but the capability was not widely used—fewer than 2% of all ambulatory encounters were video visits. To avoid unnecessary exposure to Covid-19, UCSDH expanded telemedicine to all outpatient areas, created self-guided learning videos on virtual care delivery, and repurposed an EMR optimisation team to train and onboard clinical staff.

Over 2,000 clinicians have been trained, and the health system conducted more virtual visits in the first three days since expanding telemedicine offerings than in the previous three years. After 2 weeks, over 50% of all ambulatory visits were virtual.