Reducing Medical Device Complexity Through Telehealth

By Victor A. Oliva

Reducing Medical Device Complexity Through Telehealth

Numerous industries are shifting their operations away from in-person interactions as we look to explore new opportunities presented by a wider acceptance of a more virtual approach. Healthcare in particular has been reaping the benefits of remote technology through the increased use of telehealth. One area of diabetes care that has traditionally been conducted in person is medical device initiation and training. The pre-pandemic model would see device company representatives and diabetes educators using in-person visits to provide more information on device options, help people living with diabetes (PWDs) get started on a new device, and offer ongoing support to upload and interpret their data.

Given the unique challenges that PWDs face in light of the pandemic, medical device training has shifted to a virtual model out of necessity. Telehealth experts, like Certified Diabetes Care and Education Specialists (CDCESs) at Cecelia Health, are equipped to provide training for devices such as Continuous Glucose Monitors (CGM), insulin pumps, and Closed Loop Systems. It provides PWDs with the support and training they require to successfully initiate and adhere to a new device. This approach also lessens the burden on specialty clinics and endocrinologists, streamlining patient visits and allowing them to focus primarily on the care management plan instead. Moreover, the increased efficacy of remote monitoring technologies allows for providers to monitor key health indicators of PWDs to effectively manage their patients.

The Challenge of Starting…

Initiating on a new medical diabetes device presents a number of challenges. A person’s ability to successfully initiate is impacted by a number of critical factors that can be grouped into the following categories:

  1. Cognitive: A range of sophisticated medical terminology and complex instructions can be overwhelming for a person to grasp at initiation, particularly if they are recently diagnosed with diabetes.
  2. Physical: A person’s age as well as their mobility and dexterity can impede the ease in which they can operate a medical device.
  3. Emotional: Many devices used by PWDs can lead to serious side effects if used incorrectly which may lead to fear and anxiety for new users. Their trepidation may result in device rejection or non-adherence.

The current healthcare environment is characterized by limited access to specialists given the shortage of endocrinologists in the United States. A dedicated CDCES is often the best avenue for support since they can ease the significant transition of initiating a new device by providing training that directly addresses each person’s unique concerns and potential barriers.

… And Continuing

People struggle with adherence to their medical devices when there is a disconnect between a person’s needs and usage of the device. For example, insulin pumps provide life-saving medication, but the tubes in many of these devices can be perceived as either aesthetically displeasing or impractical. When PWDs work with a CDCES, they can learn of alternative options, such as tubeless pumps, patches, or other methods of insulin delivery altogether, all of which can lead to higher adherence rates.

Unfortunately, not every medical device is designed with patient centricity at its core. A CDCES can reconcile where devices fall short and educate patients on the overall benefits, which will significantly boost adherence.

What Works and What Doesn’t

During the COVID-19 Pandemic, video calls to provide training for diabetes device initiation and adherence have become increasingly commonplace out of necessity. Some of the biggest companies in the diabetes medical device space have successfully adopted this remote training model. For example, Insulet conducted more than 1,000 training sessions worldwide in the first month of the pandemic. However, this method of delivering training has lasting utility beyond the pandemic given the ample benefits for patients, providers, and medical device manufacturers.

To underscore the value of remote device initiation, consider some of the other methods that are commonplace for diabetes device initiation:

  1. DIY: Some companies offer written manuals or pre-recorded videos and leave it up to PWDs to figure out how to use the device. As mentioned before, various factors can impede a person’s confidence and understanding of the instructions provided within these guides. This method lacks a critical component of a specialist walking them through using the device and being able to address any questions or concerns in real-time.
  2. Specialist in-person training: This training conducted by diabetes educators or device company representatives holds many of the merits of virtual telehealth training, such as patient-centered guidance and the ability to use valuable appointment time with an endocrinologist to focus on a PWDs care management plan instead. Placing COVID-19 concerns aside, the flaw in this approach is that it assumes convenient access to nearby educators to conduct in-person training. For rural communities, the convenience of training conducted over video calls ensures time-consuming transportation does not need to be considered. Additionally, this approach is not nearly as cost effective as a virtual one.
  3. Providers: In other instances, it is left up to the provider to train PWDs on device initiation and usage. This places an unnecessary burden on the provider to use valuable appointment time to train or troubleshoot technical difficulties. The providers themselves might not even be familiar with the device or be able to provide PWDs with devices that are best suited for their specific needs.

Conducting medical device training through telehealth can provide patient-centered diabetes care. Virtual calls can provide the benefits of a one-on-interaction of an in-person visit with a CDCES, while taking place in a more convenient setting.

More Complexity Requires More Training

As technology advances, so does the availability and complexity of medical devices on the market for PWDs. This, in turn, requires a higher degree of understanding from PWDs to use these devices to their full potential.

A majority of PWDs who discontinue using a Closed Loop System, do so because of its difficulty, despite the numerous benefits it has in helping keep blood sugars under tighter control. This identifies a clear need for PWDs using complex medical devices, an often-standard component of diabetes care, to receive training that matches the complexity of the device.

Understanding Device Data is Key

Initiating and adhering to a device is only the first step towards a balanced diabetes care management plan. Being able to understand and interpret the data coming from a CGM is important for achieving better health outcomes. With proper device data management and understanding, endocrinologist visits can be properly utilized and more streamlined.

In addition to facilitating proper device data uploads, a virtual call with a CDCES can provide PWDs with an avenue for discussing physical and mental health concerns, activity levels, and nutrition plans. Doing so will allow them to walk into provider appointments with a better understanding of their overall health.

Medical devices have been instrumental in helping lessen the burden of diabetes management for PWDs, but increased device diversity and complexity poses initiation and adherence barriers. Remote CDCES training and education have been proven to help address these barriers to help PWDs live an empowered life and achieve positive health outcomes.


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Orignially published on August 5, 2020, updated on August 18, 2020

Topic: Industry Innovation

Victor A. Oliva

About Victor A. Oliva

Victor Oliva is an MPH candidate at Columbia University Mailman School of Public Health focusing on community outreach, sexual and reproductive health, and health inequities. He has an administrative background in Alzheimer’s disease clinical research.