Telehealth has quickly become a standard service feature for many doctors where it’s primarily used for follow-up appointments after the initial assessment and treatment of their patients. While telehealth is a recent addition to healthcare services, studies have already been published showing that it can be just as effective as in-person appointments. In the current COVID-19 climate, telehealth is only set to become more prevalent. The AM Diabetes and Endocrinology Center in Memphis, TN, has been using telehealth with patients for a while. Drawing on their collective experiences, Belinda Hilliard-Presley DNP-FNP, CDE has compiled the top 10 best practice tips for integrating diabetes care virtually to your patients.
1. The Right Telehealth Platform
Choose the telehealth platform that works best for your practice – a helpful feature for virtual diabetes chronic care visits is screen-share capability. Diabetes is a data-driven condition and being able to share and view data reports together is invaluable for the patient and care team for collaborative decision making and to optimize care. Other important considerations, including Electronic Health Record (HER) integration, are listed in this vendor checklist provided by the American Medical Association (AMA).
2. Data Availability
Speaking of data, have a plan for how and when patients should share data reports from their various diabetes devices and health apps with your practice ahead of time so everyone is prepared. Just like any other visit, review patient concerns, their data reports, and health record ahead of time so time together is well spent.
For instructions on how patients can generate and share their integrated data Insights by InPen report, consult this article. For more information about how to use the data in the report, consult this guide to using the Insights by InPen report.
3. Designing a Telehealth Workflow
Although each practice workflow may be different there are key considerations when building a telehealth workflow as part of your existing clinical practice:
- Determine a plan for how telehealth visits will be scheduled, documented and billed.
- Plan how telehealth visits will fit into the practice schedule.
- Establish clear roles and responsibilities as well as training and preparation needs.
4. The Visit Environment
Select an environment for conducting telehealth visits that is clinically appropriate, is free of background noise, has adequate lighting and ensures privacy. Choose the same level of professional attire as in-person care.
5. Use the Right Equipment
A desktop computer versus a tablet, high speed internet, a web camera and microphone with headphones are the best options. Having dual screens is useful for EHR documentation and note taking. Turn off other web applications and all notifications ahead of time. Adjust the webcam to eye level to ensure eye contact.
6. Patient Engagement and Education
Identify patients that are likely to succeed. Educate patients on the offering and set expectations for use. The AMA offers a patient prep guide you can send to participating patients ahead of time.
7. Virtual Rooming
Assign staff that can be sure the “arriving” patient’s connection can support the visit and that data and lab reports have been sent and are ready for review. This is also a good time for the patient to consider their most pressing concerns or questions and any prescription refills or referrals that are needed and for any applicable co-pays to be collected. Having all medications gathered and available to review can be helpful during the visit.
8. Virtual Communication Etiquette
When conducting the visit speak clearly and deliberately, pausing to allow transmission delays. Narrate actions with the patient if you need to turn away, look down to take notes, etc. Make a special effort to choose empathetic language, use non-verbal language to signal you are listening and ask the patient to share their top concerns they hope to have addressed by the end of the visit. With permission, use cameras to check or demonstrate for example, correct injection technique, injection sites, and site rotation schedule. Patients can show you their current medication bottles and share any concerns or questions. Clarify next steps, such as follow-up appointments and adjustments to the care plan.
9. After the Virtual Visit
Be sure to document the length of the visit to meet any reimbursement and state requirements. Share a visit summary and follow-up care plans with the patient. Make sure there is a plan for scheduling follow-up appointments. For guidelines on billing options for Telehealth and Remote Patient Monitoring, refer to this Telehealth and Remote Patient Monitoring Guide. For a useful guide to available digital health solutions explore this digital health directory from the Consumer Technology Society and the American Telehealth Association.
10. Learning Together
The clinical team at AM Diabetes & Endocrinology Center recently conducted a telehealth visit with Fox Newscaster, Darrell Greene. He was diagnosed with Type 1 Diabetes in 1993 and uses a continuous glucose monitor and InPen for his multiple daily injections. In this recording, he reviews his most recent Insights by InPen report with his CDE. We are all learning together, and the diabetes therapy data provided by InPen makes it possible to provide care virtually.
Putting it all together
In the current COVID-19 climate, telehealth is enabling clinical teams to stay connected with their patients, especially when paired with diabetes technology such as the InPen, which provides full visibility of patient data. InPen is the first FDA-cleared smart insulin pen system for people with type 1 or type 2 who use mealtime insulin. To request more information about InPen, complete this request form.
By Belinda Hilliard-Presley DNP-FNP, CDE
AM Diabetes & Endocrinology Center, Memphis, TN
For Companion Medical