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The new implications and guidelines put in place recently due to current pandemic has changed the way we practice in the outpatient setting drastically.  I am currently a nurse practitioner in an outpatient endocrinology practice where I specialize in diabetes technology.  Majority of my patients utilize continuous subcutaneous insulin infusion or insulin pumps and continuous glucose monitoring for their diabetes management.

My practice is located in the hospital so early on, as the COVID-19 cases were increasing we had limited our in-person visits and transitioned to tele-medicine. This learning curve came along with a new EHR system as well!  My patients were used to coming to an office and handing their devices to a staff member where we would download the device and trouble shoot all the reasons it wouldn’t download for them and then they would magically get it back while their providers reviewed the data and made changes to their settings. 

Sometimes I wish I could offer a mobile insulin pump/CGM downloading service where I could drive to my patient’s house and just quickly get the information I need.  Teaching and encouraging my patients to learn how to upload their devices at home has been very challenging. I think I say “tell me what your screen says now” at least 15 times an appointment. 

Another challenge has been sticking to scheduled time with tele-medicine.  When majority of my visit includes providing directions on how to upload a device my clinical time is cut down drastically.  In order to make safe clinical choices and provide the best care to my patients I feel it is imperative to retrieve the data from their devices. I now have the next patient on schedule calling and asking where I am because I am 5 minutes late to their tele-medicine appointment.  I know these “growing pains” will go away. 

There are so many more advantages to tele-medicine than down sides. I am now able to sit at my patient’s kitchen table with them! I am able to get accurate medication reconciliation because they have access to their medications.  I am able to meet their pet dog or little sister that isn’t able to come to their appointments.  I am also now seeing patient’s who no longer have to take off work to see their provider or travel the two hours from upstate to see a specialist.  After we work through the hiccups of uploading, I feel I am able to provide continuity of care and meet the patient’s where they are instead of them meeting me where I am.  My office has designated me to be the lone provider in our office that will offer tele-medicine until September but I really hope we are able to continue to utilize it past this “emergency time”.  I have been able to care for patients who are on dialysis at home and coming into the office is very difficult and takes two support staff.  I am able to care for residents in long term care facilities and speak with the nursing staff, care staff and family all at the same time, that would never happen in an outpatient visit.  There is a balance and learning curve for both the patient and provider but I think tele-medicine has a very important place in healthcare!