Redefining diabetes for telemedicine

Telemedicine allows for diabetes care to stretch across zip codes and county lines and give patients access to the care they need even when in-person visits are not an option. The ability to upload your data at home, regardless of what combination of devices you might use, has been of paramount importance as virtual appointments have become more routine over the past 20 or so months.

“Remote access to data which is owned by the patient, allows us to meet PWDs where they are in their journey to address their unique challenges.” Aimée José [Steady Health]

We believe telemedicine is here to stay, which means that here at Tidepool, we are working to make the process easier for both providers and patients alike. We asked our friends at Steady Health, Calvin Wu and Aimée José, to share their expertise on telemedicine and how they use existing tools and resources (including Tidepool!) to scale their impact as clinicians in a remote setting.

Do you believe you are able to see more patients thanks to telemedicine?

Calvin Wu: We actually transitioned to seeing patients virtually a couple of months into our launch, pre-pandemic as it so happened. In that way, we were ready for the transition and it didn't really change the number of patients we were seeing. There are many advantages to virtual care too - especially the fact that patients don't have to travel or wait in a waiting room to be seen.

Aimée José: We don’t measure our success by the number of people we see, rather by the number of touchpoints we have with them. How many times can we connect with a member in between those traditional doctor visits in an outpatient setting? We get to communicate multiple times a day if needed and at any cadence that is needed. At Steady Health, we have really leaned into quality vs quantity.

Has your impact as a clinician scaled? Does telemedicine allow you to provide a more personalized experience to your patients/make you a better clinician?

Calvin: In a traditional in person setting, we get to spend 20-30 minutes with patients. The visit and impact we have, though, ends when they leave the office. With our current model, the interaction is ongoing and seamless. There may be visits where we didn’t have enough time to cover all the topics, so we’ll transition to discussing those via messaging instead, or they can schedule another visit in short order. With all the additional touchpoints we have with our patients now, we get to be proactive about their care instead of reactive.

Aimée: At Steady Health, one of our philosophies of care is meeting the patient where they are with their journey with their diabetes. We discuss where they want to be, and help them meet their own ideals. This allows us to address things together and also forces clinicians to communicate more. We have a full team interdisciplinary approach to each and every one of our members.

For example, we had a visit on Friday and had a conversation about some of the other variables affecting her blood sugars including menstrual cycles and hormones. She asked some questions about what birth control she should be using, so I said let’s park this one because it is a significant topic and has such a huge impact on diabetes management. I reached out to Calvin because this deserves a dedicated conversation. By the time I check in with her next, Calvin will already have reached out. The team approach and collaboration is much easier in a virtual setting as there’s no need to walk down the hall and hope a provider isn't busy and can spend some time with you.

How do you use Tidepool resources to support your telemedicine efforts?

Calvin: Without Tidepool, we would have to straddle between multiple platforms for each of the different devices our patients use. The number of systems just added complexity and confusion. From an efficiency standpoint, it makes a whole lot more sense to streamline as much as possible, and Tidepool does it reliably and is consistent with the data visualization, regardless of what device we are looking at.

Tidepool is one of the best systems out there, especially for visualizing pump and CGM data together.

Do you have any tips for teams that may not be as familiar or comfortable with telemedicine? Any suggestions for tools and resources that might reduce their burden?

Aimée: We’re big believers in ‘Keep it Simple’, especially with telemedicine. It's just like a call to a friend, or a conversation over FaceTime. You don’t need anything fancy, it is just a different medium. One thing we do is ensure our patients know the virtual space is a judgement-free environment. This is key to our philosophy of care.

Calvin: We can’t control the ambience as much as a traditional face-to-face setting, so we have to set that stage from the beginning. This is a chance for collaboration, not a judgemental space.

Knowing what you know now, what would you have done differently to start?

Aimée: We opened our doors in 2019. Our original model required we see patients in person once a year with check-ins in between - but people would just see us and then they wouldn't interact. This disease is 24/7 so we need to continue the relationship and care. We started implementing intervention thresholds - if you're dropping below a certain Time in Range (TIR) - we reach out proactively instead of just waiting for questions.

The connections we make with simple check-ins are appreciated by our members and help us feel connected. Some of the patients I see I am actually more connected to than when I was in the office. I don’t know if starting with this process instead would have made us successful. The startup journey is necessary and humbling. We have no egos here - titles don’t mean much.

We all work as a team for the same end goal. Our patients are the ones that benefit not us.

Calvin: As a startup, we’re used to iterating and making changes quickly - that’s part of the process. The journey itself has been incredibly informative and shaped who are as a team and as clinicians. This is the new frontier and we are excited to make it work. You have to be ready for failures and to pivot. Because we're not huge, there is no red tape and we can easily make those changes.

The learning process is still ongoing - problems are opportunities to make things better for both patients and providers.

Telemedicine does put some administrative requirements on patients, namely uploading their data from home - what have been some of the biggest challenges you’ve overcome as some of your patients have had to take on more responsibility than may be the case with an in-person setting?

Aimée: A lot of handholding! We have had to immerse the patient in the value of sharing the data. They need to know what their data shows and how it helps us suggest changes. And how it positively impacts their diabetes outcomes. They do it not because we ask them to, but because they see the value in the data. The more we can make this a partnership and less about the transactions of an appointment, the better. If they are only seeing their doctor to get their refills, they aren’t going to be as engaged. They need to know that their data is meaningful.

As a nonprofit organization, we are able to focus on this larger impact on the diabetes community instead of on returns; but we need your help. We invite you to join us along the pathway we’re building to make an interoperable automated insulin dosing system a reality and drive change across all levels of the diabetes industry.

We can Redefine Diabetes together when you support Tidepool with a donation at tidepool.org/donate.