Table 2.

Timeline

Date	Event or intervention
1/22/2020	First COVID-19 case confirmed in the United States [21]
2/27/2020	CDC investigates first confirmed community spread of Sars-CoV-2 in the United States which occurred in California’s Bay Area [22]
3/6/2020	Initiative to explore the expansion of telemedicine begins at the health center level.
Intervention week one: zero telemedicine visits per week in Teen Clinic.
3/9/2020	First UCSF primary care pediatrics COVID-19 planning meeting
3/10/2020	1-Hour optional training course for pediatric care providers on conducting video visits, supplemented by online training videos
3/11/2020	First UCSF AYA faculty meeting to plan COVID-19 response and transition to telemedicine for AYA Clinic.
3/12/2020	All hands meeting of clinical faculty and staff across primary care pediatrics with training in UCSF’s telemedicine platform.
3/13/2020	Plan for near-total transition to telemedicine disseminated and revised by faculty and advanced practice nurses with discussion of expected limitations of telemedicine and a plan for weekly or biweekly evaluation of clinic protocols for all clinical services. Meeting between AYA clinic leadership and hospital nutrition leadership to establish a plan for telemedicine involvement of registered dietitians. First UCSF-wide weekly town hall to disseminate regional and intuitional plans and update campus on current and projected clinical demands.
3/13/2020 to present	Brief daily division leadership phone calls and weekly calls with MDs and NPs are implemented to facilitate rapid and responsive changes to the clinical services.
Intervention week two: 56 telemedicine visits per week in Teen Clinic.
3/16/2020	All attending physicians, fellows, and nurse practitioners in the practice are telemedicine trained and ready. Daily telemedicine sessions begin for urgent care, mental health (e.g., depression and anxiety assessments, medication management), eating disorder, and addiction treatment follow-up with established patients. Telemedicine clinics are augmented by daily two-hour in-person clinic sessions or nurse-only visits for vital sign checks and laboratory work for select patients.
3/17/2020	Six Bay area counties become the first region in the nation to mandate inhabitants “shelter in place,” closing schools and nonessential businesses, and banning all nonessential travel [23]. Addiction treatment program: first buprenorphine follow-up visit via telemedicine with established patient with OUD.
Intervention week three: 44 telemedicine visits per week in Teen Clinic.
3/23/2020	Clinicians continue to meet weekly to discuss challenging cases, creative problem-solving strategies, and plans for expanding telemedicine to a wider range of health concerns and visit types.
3/24/2020	Addiction Treatment Program: first addiction psychiatry intake via telemedicine with an established patient.
3/25/2020	Daily team huddles begin with the clinical staff, clerical staff, and one of the practices attending physicians to allow for rapid problem solving and clear communication between clinic providers and staff.
Intervention week four: 80 telemedicine visits per week in Teen Clinic.
3/30/2020	Department of Health and Human Services announces that it will not enforce rules against using HIPAA noncompliant video chat software for telemedicine visits [24]. CMS modifies its payment policies to encourage telemedicine or telephone encounters [25]. Clinic’s daily telemedicine sessions continue with additional provider schedules added to meet demand. Two-hour in-person clinic sessions scaled back from 5 days per week to 3 days a week because of low patient demand. Addiction Treatment Program: first new patient intake via telemedicine (non-OUD).
3/31/2020	DEA and SAMHSA issue guidelines allowing credentialed providers to treat new patients with OUD initiate buprenorphine using telemedicine [26].
4/3/2020	California’s Governor Gavin Newsom releases an executive order to allow providers to use video chat services to deliver health care without risk of penalty in alignment with the federal Department of Health and Human Services guidelines [27].
4/6/2020	Addiction Treatment Program: first new patient intake via telemedicine for patient with OUD

AYA = adolescents and young adults; CDC = Centers for Disease Control and Prevention; CMS = Centers for Medicare and Medicaid Services; DEA = Drug Enforcement Administration; HIPAA = Health Insurance Portability and Accountability Act; MD = physician; NP = nurse practitioners; OUD = opioid use disorder; SAMHSA = Substance Abuse and Mental Health Services Administration; UCSF = University of California San Francisco.