Much has been written about alternative means to deliver health care. In view of changing insurance policies, the need for healthcare providers to care for patients in remote areas, and rapidly changing technology, telemedicine services have become a viable option in healthcare. Telemedicine is an extremely effective means to remotely provide diabetes education and care. And Children’s National has been extremely fortunate to have philanthropic support that included telemedicine capabilities in our recently opened Diabetes Care Complex.
Last Thursday was the inaugural telemedicine clinic that provided remote care to two patients at Peninsula Regional Hospital in Salisbury, Maryland. Peninsula Regional Hospital is located across the Chesapeake Bay in the Eastern Shore region of Maryland. The area is accessed by the Chesapeake Bay Bridge. Many children and adolescents with diabetes drive across the bridge to our Annapolis outpatient site, or to Delaware, or Baltimore to receive care. The provision of telemedicine services to many patients unable to travel for care is an ideal vehicle in which to provide care.
Telemedicine is a complicated process- there needs to be support at both endpoints. A camera must be available in the “clinic” so that the healthcare provider can interact with the patient and family. In addition, there must be another healthcare provider to obtain vital signs and perform the “laying on of hands” which is not possible for the physician/NP on the “providing” end. And, data transfer, especially in diabetes, is essential. Ideally, there should be a program in which both the patient and healthcare providers can all log into displaying blood sugar downloads and other informative data such a pump or continuous sensor data. A secure means of data transfer is necessary in order to transfer documents electronically from one site to another.
To illustrate the flow of our first clinic, our patients were given our standard ambulatory treatment records to fill out documenting their insulin regimen, problem solving, and major behavioral concerns. Vital signs were obtained by the registered nurse at the patient site and recorded. At this time, blood sugars were downloaded on the patient’s home computer, as we are currently awaiting an upgrade to our current diabetes software to enable logging in from outside Children’s National. The information from the ambulatory treatment records and blood glucose downloads were scanned into our secure software and I was able to type directly onto the ambulatory treatment record (ATR) after downloading to my computer. I was able to visually review information and analyze blood sugar information. The nurse on the patient end checked specific aspects of the physical exam and I was actually able to visualize injection sites. Patients were asked to obtain lab work prior to the visit as necessary in order for me to compare hb A1c’s with the existing data. Some facilities will have the ability to perform point of care hb A1c’s via a DCA 2000.
I was able to line up the ATR’s, analyze the information, have a dialogue with child and family, and answer all questions. Results of the physical exam, blood glucose averages, laboratory values, and recommendations for all the patients were documented. The information was saved and uploaded into the secure software program. The patient was then able to take home all the typed information on the ambulatory treatment record after printing from the clinic computer at Peninsula Regional Hospital.
The work process became easier as I gained experience. Overall, the encounters lasted about 45 to 60 minutes; however, with greater efficiency and experience on both terminals, I believe we could probably see patients a bit faster and thus provide care to more patients.
A great start for Diabetes Telemedicine at Children’s National Medical Center! After more experience, I am hoping that we can expand our services to other underserved areas!
I would love to hear your thoughts in regard to diabetes care via telemedicine!