COMMENTARY

Virtual Reality: Diabetes Care During COVID-19 and Beyond

Anne L. Peters, MD

Disclosures

April 23, 2020

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This transcript has been edited for clarity.

We are in a whole new world of virtual reality.

I was doing telehealth before the arrival of COVID-19, but I wasn't all that good at it. It wasn't something that I did often, and I always felt sort of discombobulated and clunky doing it.

Now, suddenly, we are doing pretty much all of our visits via telehealth. I still don't feel all that fluent at doing telehealth visits, but I'm getting better.

Advance Preparation Is Key

What are some things I've learned? First, you and your patients have to be organized. My patients who are on devices are encouraged to upload everything they can in advance. Otherwise, you don't have the data you need to help manage patients. I try to make sure that my patients and I can see the data on the screen and each other; I like being able to show the data to my patients, and it allows me to have visits that are much like the visits I used to have in person. However, each visit takes more time because the previsit organization takes more time.

Visits also take me more time because my patients and I aren't really used to each other in this new mode. There's a lot of discussion—necessary discussion—about the world and how it has changed in regard to COVID-19 and diabetes. Usually, by the end of the visit, my patients and I are feeling pretty comfortable and the follow-up visits become easy.

Trouble Spots

An issue that I still have with telehealth is that of timing. In the old days, the staff would knock on the door to tell me that a patient was waiting, but now I don't have that cue. I really have to look at the time and figure out how to be sure that I end one visit and then get to the next.

I really have trouble charting during visits because I'm looking up to see the patient on the Zoom camera, and that doesn't make it easy for me to look down and chart. I don't want to be rude, and in fact, our connection with patients is one of the most important things we can offer them.

I'm not fluent in all of this yet and I tend to do a lot of my charting later in the evening. I'd like to get back to the system where I was able to see patients, chart, and take care of everything all at once, but I'm not as good at that as I used to be.

A big issue for me with telehealth is doing things like prior authorizations and all the paperwork that I need to get devices covered. That's hard because I'm not in the office where I can sign things all the time, and I don't necessarily have as many tools as I once did to fulfill those patient needs.

I'm working it out with my office staff, many of whom are working remotely, and I'm trying to make sure that my patients get what they need out of their telehealth visits. I'm doing better than when I started, but it's been a really steep learning curve for many of us.

Looking Beyond COVID-19

As I begin to get a little more comfortable with telehealth, I do feel like I'm starting to regain my life—at least a little bit—and I'm slowly thinking about things beyond COVID-19. Like probably many of you, I had all sorts of things planned. I had meetings planned, lectures I was supposed to give, and travel I was supposed to take. All of the medical organizations are trying to switch everything to virtual platforms, and it's going to be interesting to learn how to deal with education and interact with our colleagues in a virtual way.

The American Diabetes Association Scientific Sessions are not going to be held in person but will be on a virtual platform. It's going to be interesting to see how we all adapt to learning virtually. As time passes, we're going to become increasingly interested in our world of diabetes again in addition to the world of COVID-19. Eventually, we'll all come back to a new normal, but it's going to include elements of the things we've learned.

I tend to be an optimist. I'm hoping that the lessons learned through this crisis will become tools we take to better our practices and patient care in the future.

Anne L. Peters, MD, is a professor of medicine at the University of Southern California (USC) Keck School of Medicine and director of the USC clinical diabetes programs. She has published more than 200 articles, reviews, and abstracts, and three books, on diabetes, and has been an investigator for more than 40 research studies. She has spoken internationally at over 400 programs and serves on many committees of several professional organizations.

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