Telehealth to the rescue

Sarah Shipley, DPM offers advice during a telemedicine visit
Sarah Shipley, DPM, a Northeast Medical Group podiatrist, offers advice during a telemedicine visit with Blanca Matamoros.


The last thing Katie Tenenbaum of Wilton wanted to do at the height of the COVID-19 pandemic in Connecticut was drive her seven-year-old son, Dylan, to Yale New Haven Children’s Hospital Pediatric Specialty Center in Greenwich for a follow-up visit.

In April, Blanca Matamoros, 85, developed a serious pressure wound on her left heel that needed attention. But leaving her Stamford home to see a physician was out of the question, given her increased risk of contracting the coronavirus as an older adult.

Today, Tenenbaum and Matamoros are thriving, thanks to telehealth. They are among the thousands of people who discovered the benefits of telehealth services during the pandemic. Patients and caregivers have embraced telehealth as a safe, secure and effective option for most healthcare needs that don’t require hands-on treatment.

“Telehealth has been a game-changer, because it has given patients greater access to safe, quality care,” said Ellika Mardh, MD, medical director of Greenwich Hospital’s Outpatient Center and associate director of the Internal Medicine Residency program.

Also referred to as telemedicine, telehealth uses video and audio technology to connect practitioners and patients remotely over phone lines and the internet. Telehealth has been around for years, though not widely used, partly because Medicare, Medicaid and private health insurers did not adequately reimburse care providers. But when the COVID crisis intensified, preventing millions of homebound Americans from visiting practitioners in person, telehealth surged exponentially, especially when reimbursement restrictions loosened.

Today, telehealth remains a viable option for patients who choose practitioners associated with Yale New Haven Health (YNHHS). Patients can schedule remote video visits through the MyChart app, downloaded to their computer, tablet or smartphone. This links them to practitioners who use the health system’s electronic medical record system, which stores patients’ health information. Read about MyChart on page 5.

Although YNHHS began deploying telemedicine more than a decade ago, visits jumped from about 40 per week to nearly 4,000 a day at the peak of the COVID-19 crisis, according to Lisa Stump, the health system’s chief information officer.

Daniel Dickstein, MD, conducts a telemedicine visit
Daniel Dickstein, MD, conducts a telemedicine visit at Greenwich Hospital’s Outpatient Center.


For many patients, telehealth plays a critical role in continuing ongoing care. Therese Collett-Gardere, APRN, a Yale Medicine pediatric nurse practitioner, has been treating Dylan for a gastrointestinal condition since he was five years old. When his condition persisted, Dylan’s parents were referred to Anthony Porto, MD, a pediatric gastroenterologist and director of Yale New Haven Children’s Hospital Pediatric Specialty Center in Greenwich. After one in-person visit in February, they switched to telehealth for regular appointments.

Katie and Dylan Tenenbaum on a four wheeler
Katie and Dylan Tenenbaum have more time to play now that telemedicine has reduced the need for frequent in-person follow-up visits.

“I log onto the MyChart app and connect with Therese, and we talk about how Dylan is doing,” said Katie Tenenbaum, Dylan’s mother. “Then Dr. Porto comes onto the video.” Together, they discuss his treatment, which includes medications.

Sometimes, while playing on an indoor swing or building with Legos, Dylan can more easily open up about how he’s feeling, physically and emotionally, his mother said. “They can capture his attention and speak to him at a level where he is more comfortable than being on a table in the doctor’s office,” she said, “so that works much better for us.”

Dr. Porto agrees. “Since COVID, we’ve been able to follow Dylan very closely. Telehealth gives us a bird’s-eye view of what’s going on in his life.” For instance, a dietitian joined one video visit and could see the food items in the family’s cupboards and refrigerator. “It provides us with insights we couldn’t have in an office visit,” Dr. Porto said.

That same comfort level helped Sarah Shipley, DPM, a Northeast Medical Group podiatrist affiliated with Greenwich Hospital, treat Matamoros during telehealth visits. Matamoros has dementia, rheumatoid arthritis and other chronic conditions that make it difficult to leave home. She developed a pressure wound on her left heel, and with assistance from her granddaughter, Valerie Lopez, connects remotely with Dr. Shipley.

“I send her pictures of the wound and questions through MyChart before each appointment,” Lopez said. During video visits, Lopez uses the camera on either her laptop computer or smartphone to zoom in on the wound.

“I could see if it was too wet or dry,” said Dr. Shipley, who coordinated with a visiting nurse and Lopez to apply ointment and change bandages daily. “Telehealth was a great tool for ensuring the wound didn’t get infected, and her heel is now healed.”

“The quality of care has been amazing,” Lopez said. “And as an unintended consequence, I’m now a true partner on my grandmother’s care team.”

Greenwich Hospital’s Outpatient Center, which serves primarily Medicare and Medicaid patients with 28 medical resident physicians, transitioned to telehealth when COVID struck. “Switching to telehealth allowed us to maintain social distancing protocols and reduce the number of people coming into the hospital at the height of the pandemic,” said Dr. Mardh.

“Our top priority was to make sure our patients’ needs were met and to reassure them that we were here for them. We triaged patients and scheduled in-person visits where it was medically necessary. Telehealth enabled us to provide comprehensive care to those patients whose needs we could safely meet through a virtual visit,” said Kirsten Suarez, program director for practice management who also oversees the Outpatient Center.

Joshua Hrabosky, PsyD
Joshua Hrabosky, PsyD, said telemedicine has allowed Greenwich Hospital to reach a broader group of behavioral health patients.

Telehealth allowed Greenwich Hospital to treat behavioral health patients during the pandemic. “Many patients needed continued support during that scary period, so we quickly transitioned to telehealth,” said Joshua Hrabosky, PsyD, program director for outpatient behavioral health. While some patients felt uncomfortable not seeing their therapist face-to-face, most transitioned well to video and phone visits for individual or group sessions. Many continue to choose telehealth, even as in-person visits have resumed.

“Telehealth allows us to see patients farther geographically from Greenwich Hospital,” Dr. Hrabosky said, “and noshows and cancellations have been reduced. It has improved access and reliability of care, which has been great for our patients and practitioners.”

Clearly, telemedicine is here to stay. This year Connecticut passed a law that supports continued reimbursement for telehealth and expanded the types of providers covered. About 96 percent of Yale New Haven Health telehealth patients responded favorably on a satisfaction survey. They also reported saving about two hours with video visits. Yale New Haven Health received $3.3 million in federal funds this year to further strengthen its telemedicine system. “Our goal is to deliver about 30 percent of our outpatient visits via telehealth,” said Stump.

“COVID taught us that not only is it possible to do telehealth from a technology point of view,” said Dr. Porto, “but that it actually is helpful for both patients and providers.”