Conclusion: Real time ultrasound/echo and virtual Fetal
cardiology/MFM telehealth clinics consolidate resources
without sacrificing quality of medical care, are preferred
by patients and empower general OB providers to care for
pregnant women locally. This approach should be strongly
considered when subspecialty resources in a community are
insufficient to meet patient needs.
11) Telemedicine for Diabetes Care:
Serving Patients Where They Are
Michelle Griffith, MD, Matt Ryan, Amber Humphrey, David
Charles, MD, Shubhada Jagasia, MD, MMHC
Vanderbilt University Medical Center
Background: Diabetes mellitus is a modern scourge, affecting
29 million Americans. It is a leading cause of death and
disability, and drives over 20% of health spending. Gestational
diabetes is a form of diabetes diagnosed during pregnancy, and
it can cause serious complications for both mother and baby.
Good control of blood sugar reduces the risk of complications
and death. For many patients, control requires self-monitoring
of blood sugar and medication adjustments guided by a health
care provider. High-quality diabetes care can be provided via
telemedicine (Toledo 214; Liu 2016).
Methods: At Vanderbilt University Medical Center, we have
launched two telemedicine service lines for diabetes care: 1)
Direct-to-patient service designed for the frequent follow-up
needs of patients with gestational diabetes, 2) Clinic-to-clinic
service to allow patients to access care closer to their homes,
with reduced need for travel, located at a multispecialty clinic
with a mix of traditional and telemedicine visits. We also
incorporate diabetes education into our care plans and utilize
other diabetes technology available to patients, such as insulin
pumps with home download capability for transmission to the
clinician for analysis.
Results: Patient satisfaction is high for both service lines.
90%+ of surveyed patients from each service line agreed or
strongly agreed that they were satisfied overall. The majority of
patients have opted to continue with telemedicine care rather
than resume travel to the distant clinic.
Conclusions: Telemedicine is well suited to diabetes care and
can be effective for a variety of populations and settings. Both
clinic-to-clinic and direct-to-patient models can be used to meet
the unique needs of individual patients and increase access
to expert diabetes care. Existing diabetes technology tools
can be incorporated into telemedicine workflows to maintain
standards of care. References: 1) Toledo et al, Diab Care 2014;
37:e179-e180 ; 2) Liu W et al. Journal of Diabetes Science and
Technology 2016; 1-8
40 | Telemedicine Telehealth Service Provider Summit
12) Implementation of Tools in a Virtual
Telehealth Organization
Carey Hart, MBA, John Butler, MD, Alexander Mason, MD
Specialist TeleMed
Background: Operations in telehealth require developed,
organized tools, and processes. Specialist TeleMed, a national
physician services organization, was challenged to develop
tools that could be shared simply and virtually. While the
organization maintains a physical office, the clear majority of
operations is completed remotely. A second challenge with the
remote nature of the organization was facilitation of physician
activity, including onboarding, and ensuring appropriate patient
care was delivered. Finally, Specialist TeleMed’s working
relationship with its contracted sites depended on a fluent and
consistent process.
Methods: Specialist TeleMed identified its biggest pain points
by soliciting feedback from physicians, staff, and clients. The
organization also reviewed tasks within Specialist TeleMed
to identify where most of the time and energy was spent.
Specialist TeleMed enlisted technology, including secure
file-sharing tools, was used as a starting point to solve their
challenges. These tools began as simple in nature as the
organization found that physicians and staff would be hesitant
to use complicated methods that were time-consuming.
Results: Through research, the biggest issues were
communication and transparency, especially pertaining
to where a physician was in his or her onboarding and
credentialing status. This issue applied not only to physicians,
but also to Specialist TeleMed’s clients.
Conclusions: Overall staff and physician satisfaction increased
once the tools and process improvement was implemented.
The organization shifted its focus from reactive status to
proactively identifying and managing areas of need.
13) Inpatient Dialysis Made Possible by
Telemedicine
Kristi Iannucci, MBA and Fredda Kermes, MHI, RN
Summit Healthcare Regional Medical Center
Background: Summit Healthcare Regional Medical Center
is an 89-bed hospital located in rural northeastern Arizona.
Without a nephrologist on staff or the ability to perform
dialysis for patients requiring inpatient care many patients with
chronic kidney disease or requiring dialysis had to be flown or
transferred to another facility averaging 200 miles away, most
often resulting in expensive flight costs averaging $42,000.
Methods: Summit partnered with a nephrologist group out
of area with 4 nephrologists already credentialed at Summit
that support an outpatient dialysis facility in the local area.
The physicians had no prior experience with telemedicine