Evaluating the Role of Technology Navigators in Enhancing Data Access for Diabetes Care, Pt 1
In part one of this two-part series, Subbulaxmi Trikudanathan, MD, MMSc, discusses how a technology navigator improves diabetes care at the University of Washington Medicine Diabetes Institute. Dr Trikudanathan shares how the role provides one-on-one tech support, updates staff on device changes, and enhances patient engagement, improving care efficiency and satisfaction.
Additional Resource:
- Edmiston P, Klippel SL, Baran JD, Khakpour D, Hirsch IB, Trikudanathan S. The role of a “technology navigator” in an academic diabetes clinic. Diabetes Technol Ther. 2024;26(1):65-69. doi:10.1089/dia.2023.0406
TRANSCRIPTION:
Subbulaxmi Trikudanathan, MD, MMSc: So, my name is Dr Subbulaxmi Trikudanathan I'm a clinical professor in the division of endocrinology, metabolism, and nutrition at the University of Washington and also the medical director for the University of Washington Medicine Diabetes Institute. So we have a specialized diabetes institute whose mission is to integrate basic science, clinical care, and clinical research in the same area. And we have this really great building at in South Lake Union in Seattle, and we opened a clinic, like we moved the clinic to in 2019, and do very focused care for people with diabetes, complications from diabetes and just the integrated care out there. And it's a very high volume clinic, we have grown a lot over years and we are probably around 20,000 visits per year. So that's with a lot of incorporation of advanced technology and a lot of clinical research phase two and three trials that happen.
Consultant360: How did the concept for a technology navigator role come about? What are the specific barriers that patients and clinic staff face without a technology navigator, and how does this position address those challenges?
Dr Trikudanathan: So our clinic was always on top of technology and we all know diabetes technology has rapidly sort of exponentially grown over the last 5 years. We've been always at the forefront of getting our patients continuously with monitors, insulin pumps, we have a very large volume of type 1 patients. And we've seen how things have grown, but one of the things that happens in our clinic for, I would say, decades is that devices, diabetes devices are always downloaded in the clinic, and the data is presented to the clinician at the time of the visit so that they can share the data with the patients and make a very informed decision on adjusting medications insulin and educating patients and training and having an opportunity at looking at those numbers as well.
So when we hit pandemic, we pivoted to telemedicine very quickly in our organization. So in the University of Washington, we were one of the first clinics, we went right to the telemedicine. And what we encountered was how, I mean, these patients are all gonna be coming into the clinic to download. And so how are we going to get that? And it also was the period when the different device companies started capturing or getting this data via cloud so that it can come remotely into our hospital system. Or we could look at this information without the patient having to come into the clinic. And so we then realized that there are several steps to this and of patients knowing how to share the link and how we sent them the instructions and helping them to send that information remotely and found that our medical assistants were already, you know, working very hard with so many different demands and paperwork. And so we envisioned that we need a dedicated person who would be able to support this needs and create a more structured workflow.
And so what we wrote was a very small grant for philanthropy support to fund these 0.5 FTE positions, or a halftime a technology navigator, and they had multiple things and they started off with so many different things to bring that structure.
So what they did was 3 days prior to the appointment they reminded the patients you have a visit with us, these are the instructions how you can upload your device on your computer or you know, at home and how, after which, there are several times, once you do that for the first time, the data gets transmitted to us automatically, but that first piece is so important. So they sent those instructions and patients would then respond back like, “Oh, can you clarify this,” or, “This is not working.” And so the technology navigator worked with them to help them download. And what then they did was grabbed that information, the data as a PDF, and they would attach it to the patient's visit. So when we started the clinic visit, we had a PDF document, which gave them the glucose metrics, say for example, a continuous glucose monitor, we had what we call as an ambulatory glucose profile, which tells us all the glucose course metrics, their daily view, when their blood sugars are going high and low. And if it was an insulin device, we get to look at the download and the entirety in that PDF document. And so we had that available at the time of the clinic visit.
Now, again, there were sometimes the day prior to the visit, the patients were still not able to download or had not seen the message. And so then the medical assistant in the morning of the visit when they roomed the patient in the telemedicine visit would do that. But it certainly reduced the volume and the burden of what the medical assistants would deal, because a big majority of them would have already been dealt by the technology navigator.
And so that was one of the big structure or workflow we incorporated. And in this, I mean, we have about 5000 to 6000 unique patients. So we got all of them or most of them to share the data within our clinic in this process.
The next thing, what we also had the technology navigator do is there were several instances—I mean, we have patients of all kinds, right, with very different tech savviness and with limited social support or limited resources. And so we wanted to have a avenue in which we could have the technology navigator spend at least one-to-one time to help them understand what's the barrier in being able to connect to the clinic and what's the barrier in transmitting their data to the clinic. So very often what would happen is if we had a patient who had issues in downloading, then we would get them to meet with a technology navigator one-to-one, and what the technology navigator would then do is take them through the different steps. Live in that meeting, this is where you connect your device, or this is how the first step is, or to get your password, or help them create a username and account, and all those finer details. But they gave them that one-to-one support.
I mean, there are some times where it goes beyond our efforts that we have to ask them to call directly the device company. But a big majority of them, we could sort them out during these one-to-one visits. And it's sort of very important that we level the playing field to help all our patients with varying comfort to use technology to be able to support them to transmit this information.
So that was another major role of the technology navigator that our patients really appreciated. And then we always have so many updates with these devices. So It's really hard for every medical assistant to keep track of this. And so our technology navigator was this point person for the vendors and to get all the updates and then transmit that through the entire clinic, train the medical assistants, if there is a new way of getting into the portal or a different requirement, she would bring those instructions and train the medical assistants and let all the clinicians in the clinic and all the CDEs know what the updates are. So they had this other vital function to be like a conduit for passing that information in the clinic. And it also was easy then that the vendors were just reaching out to one person to tell them, “Okay, this has been updated,” and it just goes to the clinic. So those were the big areas where our technology navigator played a role in helping our patients, empowering them to get that information to the clinic.
C360: What specific advantages does having a technology navigator provide to patients in managing their diabetes from home?
Dr Trikudanathan: I think what the technology navigator did was to put a structure to the patient that with for every clinic visit you would expect a message from us to upload and you would follow those instructions to upload. So it gave a structure to what is expected of them before the visit and also provided a support like if you didn't know how to do this or if you were having difficulties, we can communicate one-to-one and help you do that. So I think that was a big advantage because then the patient has this, you know, they're not just corresponding with messages, you know, there is a human factor or someone available for them to talk and troubleshoot if they had particular concerns or spend more time if they had difficulties in their technology system.
I mean, it's really hard to keep up with all this, right? And sometimes the patients would have had their username created several years back and now to ask them to remind them to do it or somebody else would have created another family member would have created for them and now that family member is not in the visit and then they need that help to navigate how to do this again, how to reset the password, how to again go into the portal and what do they do. So I think this the technology navigator provided that support and that structure and the framework for patients and helped them with that.
And it was also, all our patients appreciate that this data is shared and discussed and shown to them during their clinic visit. And that creates a very powerful impact to them, you know, on how they engage with their treatment plans. It's when they see how the data looks where your blood sugar is going up after a meal, after the dinner, then they see that. And when we show that along with the suggestion or the guidance and recommendations, they themselves, “Oh, I think I have to cut my carbs.” And, “Okay, I agree that we might have to go up or start a shorter-acting insulin just for my dinner because I can see my blood sugars are going up to 300. This is what I suspected.” And so, you know, it gives that, that visual impact is so helpful for our patients and our technology navigators indirectly helping us be able to take that information to the patient and help them make treatment choices and the physician to make that treatment decision.
So, they have a lot of these indirect benefits, but of course, that clinic workflow, the clinical practice workflow is more efficient, more structured, more streamlined. This more patient provider satisfaction, the time that they have to spend or that the appointments are faster, they don't have to wait for several, you know, 15 to 30 minutes to get that device downloaded or, you know, this is done before. So it's much smoother on the day of the clinic.