About Dr. Whitney Goldner
Whitney Goldner, M.D., is a professor of Medicine, Division of Diabetes, Endocrinology, and Metabolism at the University of Nebraska Medical Center, Omaha, Nebraska. She is an endocrinologist and director of the Thyroid and Endocrine Tumor Program at the Fred and Pamela Buffett Cancer Center. She is also a member of the board of directors for the Endocrine Society and an active member of the American Thyroid Association. She is on the Endocrine Specialty board for the American Board of Internal Medicine and on the NCCN guidelines committees for Thyroid Cancer and Adrenal and Neuroendocrine Tumors.
Medical School: University of Nebraska Medical Center
Internal Medicine Residency: University of Utah
Endocrine Fellowship: University of Iowa
About University of Nebraska Medical Center
The University of Nebraska Medical Center (UNMC) is a public center of health sciences research, patient care and education in Omaha, Nebraska. Founded as a private medical college in 1880, UNMC became part of the University of Nebraska System in 1902. Rapidly expanding in the early 20th century, the university founded a hospital, dental college, pharmacy college, college of nursing and college of medicine. It later added colleges of public health and allied health professions. Visit https://www.unmc.edu/.
Medical Travel & Digital Health News (MTDH): Please tell us about yourself.
Dr. Whitney Goldner (WG): I am an endocrinologist at the University of Nebraska Medical Center/ Nebraska Medicine in Omaha, NE. I see patients with diabetes and endocrine disorders and specialize in thyroid nodules, thyroid cancer and endocrine tumors as well as do research in these areas. I am also very involved in the education of residents and endocrine fellows at the University of Nebraska Medical Center and serve on the endocrinology specialty board for the American Board of Internal Medicine. I am an active member of the Endocrine Society and the American Thyroid Association and serve on the board of directors for the Endocrine Society.
MTDH: I’d like to talk about patients with endocrine disorders first—the problems they are having now accessing care and the role of digital health.
WG: We have been using telehealth during the pandemic quite a bit for many of our patients. Early in the pandemic, it was solely telehealth when everything was completely locked down. Even though we are able to see some patients in person now, we continue to see patients through telehealth also.
Our division of endocrinology at the University of Nebraska was already doing telehealth prior to the pandemic because we have a lot of people who live a long distance away from our clinics, and this was a way we could still provide clinical services to patients without them having to travel such long distances. A couple of my partners were doing telehealth in the more traditional definition of “telehealth” prior to the pandemic. We would partner with a clinic in a satellite location. The patients would go to the closest satellite clinic to have their visit. They would be checked in and have vitals and initial check in at the satellite clinic. Then they would see the provider over the computer screen for an audio/video telehealth visit, so it was really clinic-to-clinic telehealth.
Since the pandemic, we have been able to continue our traditional form of telehealth, but we have also been able to do other forms of telehealth. These additional forms include audio/video telehealth visits through a secure site or patient portal for any location, like the patient’s home, or telephone visits for those who do not have the ability to do a video visit.
MTDH: Are there any digital components to care now? For example, monitoring blood pressure and glucose levels?
WG: Yes, we use a lot of different technology to obtain glucose values to monitor diabetes. Many of our patients who use either insulin pumps or continuous glucose monitors or sensors will share their data, which can be uploaded into the cloud from their home computer for us to download for their telehealth visit. That has been fantastic. With some pre-clinic preparation, we can make sure we get all that data for the video visits and we are even able to show the patients their data on the screen. For those people who do not use insulin pumps or continuous glucose monitors, they are able to obtain glucose readings from their glucose meters and send them to us via the patient’s portal or email in preparation for their visit.
A lot of patients have home blood pressure machines, and so they are also able to check at home and report their numbers at the time of the visit.
MTDH: How available or accessible are these digital devices and are they expensive?
WG: Insulin pumps and continuous glucose monitors are available to many persons with diabetes. There are requirements regarding type of diabetes and type of therapy to be eligible to get them. There are also some requirements regarding the number of times they check their blood sugar per day. However, the rules have not really changed during the pandemic. They’ve been around for a while and continue to improve. The cost of the technology is dependent on individual insurance and is largely independent of what’s going on with the pandemic. However, there are efforts to reduce the cost of insulin and other diabetes supplies at the national level, that will hopefully help diabetes care be more affordable and accessible.
MTDH: Do you communicate via telehealth with colleagues and other providers?
WG: Yes,we have been doing that for years. With the electronic medical record, whenever we write a note, a consultation or a follow-up note for patients, we then send a copy to their other doctors involved in their care. We do not necessarily have multiple providers on the line at the same time for the virtual visit. But the virtual visit can happen in a timely fashion—just like a regular visit.
MTDH: Theoretically then, when people start traveling again for pleasure or business or for medical travel opportunities, they can take advantage of lower cost or surgical procedures outside of the country, and virtual care digital health will be available for diabetic patients?
WG: There are many unknowns about what’s going to happen in this arena. Currently, depending on the state, telehealth may only be able to be provided to patients within their homes or within a particular state or region. We don’t know if this will change in the future.
Telehealth, however, is a great option for people who cannot get off work to travel long distances to their appointment, or do not have transportation or time to get to their appointment. In the past, these people may not have been able to come to their appointments, but now, we’re able to provide visits at their convenience.
I think it is really advantageous for the patients to be able to continue to have routine medical care remotely, especially for chronic conditions like diabetes that involve multiple follow-ups on a regular basis. Post-pandemic, I think we are more likely to see a hybrid model. There will be some visits that still need to be in person, but those could potentially alternate with telehealth visits in between.
MTDH: How do you approach lifestyle and weight loss programs through digital health platforms?
WG: We are all learning how best to use telehealth and continue to try to hone the best approach. Certainly, talking to someone on video is more advantageous than a phone call, but you can do it either way. Sometimes televideo visits can be really helpful in helping us get to know patients better. People can show us their home environment and the types of access they have to exercise and food. This can help us individualize our recommendations.
At ourclinic, our dieticians and diabetes educators are also available through telehealth services. Patients can implement a program at home now rather than waiting until the end of the pandemic. Also, classes are being offered online for physical therapists and trainers. This presents great opportunities if we are able to continue to provide telehealth services.
MTDH: Let’s talk about the comorbidities with diabetes, liver disease, fatty liver disease and cardiovascular disease. What is the impact of having access to virtual visits and managing chronic disease management?
WG: We do want to make sure that we are able to appropriately assess and manage these chronic conditions. As I mentioned, it’s going to be a hybrid of seeing people in person and telehealth. There are some things that must be done in person, such as evaluating the heart with an EKG and stress test. However, there may be other things we can do over telehealth that will provide timely care and help us determine next steps in management.
MTDH: Talk about the Endocrine Society and your role in that.
WG: I am a member of the board of directors for the Endocrine Society and have been on multiple clinical education committees within the Endocrine Society prior to joining the board. The Endocrine Society is a great organization that does a tremendous job of supporting clinicians, educators and researchers in Endocrinology. One of the things we did earlier in the pandemic was host a live telehealth webinar where many of the practitioners who had a lot of clinical experience with telehealth gave their best practices advice. That was extremely beneficial for clinicians who were trying to implement this into their practices.
The Endocrine Society is also very active on the advocacy front for all endocrine related issues and advocacy for patients. Telehealth has been one of the things that the Endocrine Society has been a strong proponent of, advocating for extensions of covering telehealth after the pandemic is over so that people will continue to have appropriate access to healthcare if telehealth is one of the only ways they could potentially receive that.
MTDH: Do you foresee Congress approving the extension of telehealth?
WG: That is my hope!