Evaluating the Role of Technology Navigators in Enhancing Data Access for Diabetes Care, Pt 2
In part two of this two-part series, Subbulaxmi Trikudanathan, MD, MMSc, highlights the critical role of integrating technology into diabetes care. She discusses how visual data aids in personalized patient feedback, the challenges of funding and automation, and the necessity of human support for patients with diverse needs.
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 does the increase in data availability before appointments impact clinical decision-making during patient visits?
Dr Trikudanathan: You know, again, the visual data of how, when we look at these data along with the patients and hearing what was “Okay, that was that day that blood sugar went up because I know I was in a birthday party celebration,” there's so much information when you show it to them in the clinic that you get the context, you help them understand and make better decisions. You know how to adjust your medications, insulin, make changes to your treatment plan on solid objective evidence, right? And so then you learn about the long-term impact of the diabetes and help them correlate that this puts you at a higher risk for complications later on because you are not in the target time and range.
And so it gives that very direct feedback right away with very strong evidence and objective data that helps patients to incorporate your recommendations more favorably or give you the context to it where you then may say this is something that just happened that week they were on vacation so we'll have to wait and watch how they are doing when they are back on their routines before making that change. So it's just so valuable for the clinician, so valuable for the patient, it's a win-win scenario.
C360: Were there any unexpected challenges or limitations encountered in implementing the technology navigator role, and how were these managed?
Dr Trikudanathan: Again, as everything, the biggest challenge is funding, right? Funding the position is definitely a challenge. Trying to get into support from your health care system to help them understand the importance of this role is challenging. And especially when there's so much of financial crunch around the system, but we were able to initially get a pilot like a grant from philanthropic support and then with what we found and also showing that we were able to get reimbursements for our interpretation of continuous glucose monitoring, we were able to convince our hospital that this role has an important place in the clinic that needs to be funded. And so I think that was the biggest challenge.
C360: What do you want other experts in your field to take away from this research?
Dr Trikudanathan: I think since we've done, there has been more automation, things have become more smoother on how we get, you know, device information, but still we have a lot of gaps and unmet means where it's not still seamlessly integrated into electronic medical record. But what we learned in this project is irrespective of things of how automation comes and we have all this. There is an unrecognized labor or a human factor that goes in to bring this automation into, you know, to go live.
And so it is important to recognize that plan for that and have a structure for that. And so even when we have, we now have one of the devices that can integrate into one of the largest EMR, but still there is a human factor in collecting the information, consenting the patient, and providing that initial support. And those are, you know, time for a medical assistant. And we're putting all these demands and all that. So it is important to recognize that and sort of think that and plan head and probably have someone like this up front to do this process.
The second part I think it's important to recognize is we have patients with, you know, with diverse backgrounds in terms of resources, health literacy, technology literacy, tech savviness, their comfort level to use technology and all that. And so sometimes you need a person who is able to guide them or help those who need that extra support. And it's very important to recognize that, particularly patients with language barriers, it's really helpful to have another human factor to help them navigate this technology and devices.
So there's an important role in spite of all the automation we are going to be seeing, which I completely welcome, and I think it's the way forward. But there is also this unrecognized labor and human factor, which either our medical assistant provides, but we provided this as a structure as one person who takes up so that it's more efficient. I think technology is going, you know, it's going to continue to update, reach everyone, people aren't ready to take it. We just have to help them facilitate so that all of them are going to benefit from these advances.
So keeping in mind that sometimes we need a leveling factor to help everyone incorporate the technology and look at the barriers. Now, we in this project did more looking at how to get our device download to the patient, but in the future, the administrative paperwork that goes both for a clinic and for a patient's end in getting hold of the devices is enormous trying to appeal to insurances or the durable medical supplies and getting and that's also a big burden for patients that we have to all recognize and probably think of a structure or a framework or an extra person to help within our health systems for our patients because that's the only way they then patients are going to utilize all the advances in technology, which is all going to finally translate in improving their health, reducing the complications from diabetes, improve the quality of life, and their overall health.