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Recap of broadband video-based endo visit

Discussion in 'Parents of Children with Type 1' started by kevin@diabetech.net, Dec 1, 2007.

  1. kevin@diabetech.net

    kevin@diabetech.net Approved members

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    Hey All,

    Just wanted to share today's online journal entry from a very good friend of mine who happens to be a pediatric endocrinologist and whom I've had the pleasure of working closely with on this project.

    Basically, patient + parent + automated shared blood sugar logbook + highly accurate mail-in A1c + other data shared in advance + PC/Internet over broadband w/ webcams + online appt scheduling + pediatric endo as a follow-up quarterly visit.

    As you can see in his post, he describes his perspective on what this means to him and what the future may hold for all of us T1 families in the future. This is only a pilot but it looks very promising based on yesterday's session.

    The mom from Houston told me "that it felt like landing on the moon" :) and that she and her daughter thought it was very effective and of course convenient.

    What do you think are the big questions around participating in something like this just having heard that a quality peds endo visit over broadband video w/ data support is possible and maybe for the first time? Maybe some of you have already used video with your endo or CDE. What was your experience?
     
  2. Tori's Mom

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    Living in a rural area with our endo being 2 1/2 hours away I can say I would be quite interested.
    If, however, I was in an urban area I have to say I would still prefer the face to face in person.
     
  3. kyleesmom

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    Id be interested! My father in law has Alzheimers and we meet with his doctor thru an interactive video set up. We live in a rural area and the doctor is in Las Vegas, 6 hours away. Its works pretty well, he has a nurse on this end that takes care of things and then we talk to him and tell him any problems we are having and he tells us what he wants us to do.
     
  4. kevin@diabetech.net

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    Is it rural vs. urban or distance? In the case of the family that had this video visit on Friday, they live in Houston and have historically traveled to each visit in order to see their preferred endo in another city.
     
  5. funnygrl

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    I like the idea. However, I would change 2 things. I wouldn't want to be tied to 1 glucose meter, so I'd prefer any logging system could be used. There are lots of programs that let you send reports to doctors. Or a plan old Excel sheet would work.

    The other thing I would change would be the a1c. It's just as easy, and probably more accurate, to get an a1c done at a local lab and have the results sent.
     
  6. Mama Belle

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    That sounds pretty cool! I probably wouldn't use it, as I'd rather take advantage (in person) of the fact that I live only 30 minutes aways from one of the best D clinics in the country. I guess one concern I have is that he says he performed a "complete pediatric diabetes follow up visit", only I don't really view that as a complete visit. At each and every visit our endo checks testing and infusion sites for scarring and hypertrophy. Additionally my daughter's eyes are checked and she is given a thorough physical exam in order to catch any early signs of complications. That cannot be accomplished via webcam. I would worry about missing out on these aspects of the exam 75% of the time. GP's and even internists are not trained to look for these types of things, so leaving it up to them is not really a solution.
     
  7. kevin@diabetech.net

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    Thanks Funny Girl. Just some backup on the two choices you would change... first, you can probably understand why the endo wants a standardized logbook to facilitate his review so everyone has to use the same format. I think the process is open to any meter as long as the data is available and can be trusted and is shared at the right times. The ADMS just makes this part easier on the patient than the manual process you suggest.

    Regarding the A1c, the choice there is based on accuracy and convenience. If a patient would prefer a venipuncture over a finger-stick that's kind of a patient issue. However, the HomeCheck A1c is the most accurate A1c available even more accurate than the average laboratory and office-based finger-stick analyzers. The blood sample for determining the A1c was collected from the patient at home (doesn't get easier than that) and the sample was analyzed at our specialized laboratory first for determining a valid sample, in-range red blood cell count, and then screened for hemoglobin variants then processed using a highly accurate laboratory method called HPLC-BA for a verifiable result that is always +/- 0.1 This is clearly the best A1c possible and it is usually reserved for use in pharmaceutical efficacy trials. You don't find that kind of accuracy in any other A1c.

    We are working on every aspect of this protocol to make sure that it's the 'best' in terms of medicine and patient experience. These two areas have been thoroughly researched, developed and field tested.

    Another area that Mama Belle brings up is important, too. We think that having a diabetes competent pediatrician linked into this long-distance program will be very important.

    Does it feel better when you consider that aspect as a compensator for the lack of face to face each quarter? The standard in place already dictates that the endo and patient must have a face to face relationship before their first video session and annual face to face at a minimum.
     
    Last edited: Dec 2, 2007
  8. Flutterby

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    i'm not to sure I'd take advantage of this.. I like bringing Kaylee to her endo.. its only about 45/60minutes away, depending on traffic. I like that fact that she goes through ever aspect, like Mama belle's endo. We live with so much technology right now the dr. appointment I need to see the dr. face to face. I can see how it is an advantage to those that live so far from their providers, or even if you need to see another specialist, or for consultations.. or brief chats.. but for a complete quarterly exam, I need Kaylee to go see the dr. in person:)
     
  9. Adinsmom

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    I can see the advantages. I have rescheduled three times with our Ped Endo because of scheduling conflicts. I finally scheduled our appointment for the middle of January when in reality Adin should have been seen at the end of September (to go over pump start info) and then again in November. I think dh and I would prefer to make the 3 1/2 hour trip for the Endo visit but in this type of situation or once a year being able to do a broadband visit would be very helpful.
     
  10. funnygrl

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    I can't fine anywhere on that site that says how much this HomeCheck a1c is. And I doubt insurance would cover it.

    After my insurance, lab draws are free for me.

    Plus, I just have a hard time accepting in my mind that the blood sample would still be perfectly viable after being shipped to a lab, and not hemolyzed or anything.

    You say that the sample is very accurate, sometimes more accurate than the lab. If the lab isn't your control, what is?
     
  11. kevin@diabetech.net

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    I'm hesitant to answer your buy questions in this thread because what I'm really interested in is feedback on what a remote video consult with 30+ minutes of dedicated time with your endo means to this community? Within that context, we have to have a reliable and trusted A1c to facilitate the video consult. If patients were to get their own A1c's done at various laboratories then we would have to certify each of those labs since laboratories are highly variable in their adherence to recognized QC methodologies and different methods mean different things - it gets very confusing for the provider and that affects the quality of this program.

    Are you a laboratorian? Sounds like you have some expertise in this area?

    If you would like to start another thread that would be fine but I want to respect Jeff's rules on marketing products in the forums.

    The sample is actually incubated in an aqueous solution that comes with the kit (not dry chemistry or immunoassay) ensuring long-term viability of the sample and is processed when received at healthcordia labs which is regulated by CLIA and consistently passes the CAP (College of American Pathologists) proficiency testing every 3 or 4 months. For high quality laboratories, CAP-PT and CLIA audits are the quality control mechanism.​
     
    Last edited: Dec 3, 2007
  12. funnygrl

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    Sorry to get the thread a bit off topic.

    Going back on topic- if I could get 30 dedicated minutes with my endo satellite or otherwise, I'd be interesting.
     
  13. kevin@diabetech.net

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    That was probably my fault for not indicating the 30 minutes w the endo feature when I started this thread and relied and people to link over and read the original post.

    How many people would be interested in it given the 30 minutes of dedicated time aspect?
     
  14. cadesmom

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    Hi Kevin, Thanks for asking for others input.
    When I was asked if we would like to participate in this on line dr. visit I did'nt have to think about it to long, I feel blessed that I am in a position to do this, It will save us alot of money and time. We live in an area where there is no ped.Endo so we have no choice but to fly to our dr visits.
    I can't wait to get hooked up.
     

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