Objective: To describe the implementation of technological support important for optimizing clinical management of the COVID-19 pandemic. Materials and Methods: Our health system has confirmed prior and current cases of COVID-19. An Incident Command Center was established early in the crisis and helped identify electronic health record (EHR)-based tools to support clinical care. Results: We outline the design and implementation of EHR-based rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology related to COVID-19. Discussion: The EHR is a useful tool to enable rapid deployment of standardized processes. UC San Diego Health built multiple COVID-19-specific tools to support outbreak management, including scripted triaging, electronic check-in, standard ordering and documentation, secure messaging, real-time data analytics, and telemedicine capabilities. Challenges included the need to frequently adjust build to meet rapidly evolving requirements, communication, and adoption, and to coordinate the needs of multiple stakeholders while maintaining high-quality, prepandemic medical care. Conclusion: The EHR is an essential tool in supporting the clinical needs of a health system managing the COVID-19 pandemic.

We used existing data sources to describe the relationship between the amount of time physicians spend logged in to the EHR—both during daytime hours as well after clinic hours—and performance on a validated patient satisfaction survey. Our null hypothesis is that there is no relationship between increased time logged in to the EHR and patient satisfaction.

Background: The authors draw upon their experience with a successful, enterprise-level, telemedicine program implementation to present a ''How To'' paradigm for other academic health centers that wish to rapidly deploy such a program in the setting of the COVID-19 pandemic. The advent of social distancing as essential for decreasing viral transmission has made it challenging to provide medical care. Telemedicine has the potential to medically undistance health care providers while maintaining the quality of care delivered and fulfilling the goal of social distancing. Methods: Rather than simply reporting enterprise telemedicine successes, the authors detail key telemedicine elements essential for rapid deployment of both an ambulatory and inpatient telemedicine solution. Such a deployment requires a multifaceted strategy: (1) determining the appropriateness of telemedicine use, (2) understanding the interface with the electronic health record, (3) knowing the equipment and resources needed, (4) developing a rapid rollout plan, (5) establishing a command center for post go-live support, (6) creating and disseminating reference materials and educational guides, (7) training clinicians, patients, and clinic schedulers, (8) considering billing and credentialing implications, (9) building a robust communications strategy, and (10) measuring key outcomes. Results: Initial results are reported, showing a telemedicine rate increase to 45.8% (58.6% video and telephone) in just the first week of rollout. Over a 5-month period, the enterprise has since conducted over 119,500 ambulatory telemedicine evaluations (a 1,000-fold rate increase from the pre-COVID-19 time period). Conclusion: This article is designed to offer a ''How To'' potential best practice approach for others wishing to quickly implement a telemedicine program during the COVID-19 pandemic.

Objective To evaluate informatics-enabled quality improvement (QI) strategies for promoting time spent on face-to-face communication between ophthalmologists and patients. Methods This prospective study involved deploying QI strategies during implementation of an enterprise-wide vendor electronic health record (EHR) in an outpatient academic ophthalmology department. Strategies included developing single sign-on capabilities, activating mobile- and tablet-based applications, EHR personalization training, creating novel workflows for team-based orders, and promoting problem-based charting to reduce documentation burden. Timing data were collected during 648 outpatient encounters. Outcomes included total time spent by the attending ophthalmologist on the patient, time spent on documentation, time spent on examination, and time spent talking with the patient. Metrics related to documentation efficiency, use of personalization features, use of team-based orders, and note length were also measured from the EHR efficiency portal and compared with averages for ophthalmologists nationwide using the same EHR. Results Time spent on exclusive face-to-face communication with patients initially decreased with EHR implementation (2.9 to 2.3 minutes, p = 0.005) but returned to the paper baseline by 6 months (2.8 minutes, p = 0.99). Observed participants outperformed national averages of ophthalmologists using the same vendor system on documentation time per appointment, number of customized note templates, number of customized order lists, utilization of team-based orders, note length, and time spent after-hours on EHR use. Conclusion Informatics-enabled QI interventions can promote patient-centeredness and face-to-face communication in high-volume outpatient ophthalmology encounters. By employing an array of interventions, time spent exclusively talking with the patient returned to levels equivalent to paper charts by 6 months after EHR implementation. This was achieved without requiring EHR redesign, use of scribes, or excessive after-hours work. Documentation efficiency can be achieved using interventions promoting personalization and team-based workflows. Given their efficacy in preserving face-to-face physician–patient interactions, these strategies may help alleviate risk of physician burnout.

H epatitis A virus (HAV) is transmitted through the fecal-oral route either by person-to-person contact or by ingestion of contaminated food or water (1). With the availability of the hepatitis A vaccine in 1995 and the routine vaccination of children in highincidence states (including California) since 1999 and nationally since 2006, the incidence of HAV infection has declined dramatically in the United States (2,3). Hepatitis A vaccine is highly effective; it has a sero-conversion rate of ≈100% (4). Nevertheless, despite the substantial decline in HAV infection, sporadic cases and outbreaks continue to occur. During 2016-2018, San Diego County, California, experienced one of the largest hepatitis A outbreaks in the United States in 2 decades (5). This outbreak was characterized by hepatitis A spread through person-to-person contact among persons experiencing unstable housing situations with or without illicit drug use (5). Since 2017, similar outbreaks have been reported in 25 states; some of the index cases in those outbreaks were linked to San Diego. As of November 1, 2019, a total of 27,634 cases, 16,679 hospitalizations, and 275 deaths have been recorded in the United States (6). The public health response to the outbreak in San Diego focused on a 3-pronged strategy to vaccinate, sanitize, and educate (7). Local health systems, including University of California San Diego Health (UCSDH), closely and proactively collaborated with San Diego County Public Health (SDCPH) to participate in the outbreak control initiatives. We report the public health contribution of the academic medical center through the implementation of hospital-level prevention and outbreak management activities. Methods Study Setting Our study was a retrospective review of hepatitis A diagnoses and vaccinations administered by SD-CPH and UCSDH. SDCPH first declared a hepatitis A outbreak on March 8, 2017, and traced the first case to November 22, 2016 (Figure 1). The outbreak control vaccination initiatives began on March 10,