Diabetes Telemedicine- Initial Experiences at Children’s National Health System.

Dr. Fran Cogen Health Pro

    In October 2013, The Washington Nationals Diabetes Care Complex at The Children’s National Health System inaugurated the first synchronous telemedicine services to Peninsula Regional Medical Center in Salisbury, Maryland. Via application of teleconferencing abilities in our teleconference center and secure software, three patients were seen for their routine diabetes follow-up visits.


    According to Malasanos and Ramnitz (Diabetes at a distance- Telemedicine bridges the gap, Diabetes Spectrum 26, No. 4, 2013, 226-231), the American Diabetes Association recommends routine follow-up clinic visits for patients with type 1 diabetes every three months. “Visits to a distant center often place substantial hardships on families, requiring parents to miss work and children to miss school. Similarly, the burden on specialists to spend hours on the road to attend outreach clinics greatly reduces clinical productivity.”

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    Peninsula Regional Hospital is a 300 bed hospital located on the Eastern Shore of Maryland across from the Chesapeake Bay Bridge. It is approximately 120 miles away from Children’s National and takes 2 hours and 30 minutes to drive there without traffic. Families travel great distances to attend clinics at Peninsula Regional Hospital. Heretofore, children and adolescents that needed diabetes care were followed either by University of Maryland (the diabetes team cared for patients at Peninsula), John’s Hopkins, or Children’s National wherein the patients attended diabetes clinic on the campus of JHU or in the Annapolis regional outpatient site respectively.  Due to the loss of the University of Maryland diabetes team attending at Peninsula Regional, increased services were required to care for the increasing number of children and adolescents with diabetes that required care.


    Enter synchronous telemedicine services that just became available in the Washington Nationals Diabetes Care Complex!  According to Malasanos and Ramnitz, “data from the few published studies on clinic to clinic diabetes care suggest that the use of telemedicine clinics in place of quarterly in-person clinic visits provides the same level of medical care.”  Thus far, our experience after three months supports that statement.


    In order to provide the appropriate care, there needs to be personnel available at both terminals. A family nurse practitioner (FNP) became the link between Children’s National and Peninsula Regional. The FNP came to visit our outpatient clinics at both Children’s and in the regional outpatient sites to become familiar with our practice, clinical medical record, required laboratory tests and patient flow. After three or four visits across the bay and after familiarizing herself with the most recent literature in the management of diabetes, we were ready to pilot our first telemedicine visits. In order to have a secure transfer of documents including medical recommendations we instituted secure software that enabled the practitioners to document information in real time by using a computer that can be visualized on the telecom by both parties across the miles. In this manner, I was able to review all the documents indicating insulin regimens and blood sugars, and other pertinent medical information. Eventually, we hope to upgrade our diabetes software so that it can be accessed via the web and meters will be downloaded directly into the program as we do at Children’s National. In the meantime, families are asked to download the meters at home or at Peninsula using the specific meter software. The FNP documents vital signs and performs a physical exam onscreen in the exam room and documents all related diabetes findings including eye, thyroid, site and other pertinent physical findings.


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    Based on all the information, we have a conversation with the child/adolescent and family, make written suggestions and send the document through our secure software, which is then downloaded and printed for the family to take home. Laboratory work is obtained prior to the visit, as Peninsula Regional does not have a DCA analyzer to get a “point of care” hb A1c. The FNP then follows up on the suggested changes and lab work and reports back to Children’s.


    The first session resulted in a huge learning curve in how to manipulate documents and communicate via a television screen. One must rely on body language as best as possible as it is more difficult to do so remotely. Thus far, our telemedicine services have been an unmitigated success and we have been able to see patients that would not normally have been seen due to distance, economic, and social issues.


    Lastly, overall, we are in the “infancy” of diabetes telemedicine services as much work remains to be done. Once again, according to Malasanos and Ramnitz, “more studies are urgently needed to assess the long-term effects of diabetes telemedicine on outcomes, cost-effectiveness, and patient satisfaction. The health care and technology industries should be focused on developing less expensive, more user-friendly telemedicine systems with security that allows for safe transmission of patient information and data. Therefore, to encourage the growth of telemedicine services, Medicare, Medicaid, and private insurers must increase their reimbursement for these programs and multi-state licensing should be done.” 

Published On: January 06, 2014