Findings From Provider and Patient Integration of Blood Glucose Monitoring Into Electronic Health Records

Title

Findings from Provider and Patient Integration of Blood Glucose Monitoring into Electronic Health Records

Background

Self-monitoring of blood glucose (SMBG) has been shown to improve average blood sugar control for patients with diabetes, leading to reduced chance of complications. Two key factors impacting the effectiveness of SMBG seem to be patient adherence and provider involvement. Electronic tracking of blood glucose data allowing for provider remote monitoring may enhance accountability and provider-patient communication, leading to improved patient health.

Aim and Objectives of the Study

To our knowledge, there is no randomized trial or prior research testing the causal effects of integrating of data from patient SMBG into electronic medical records on a wide-scale. This study aims to test the effectiveness of both provider and patient driven methods of increasing adoption and integration of blood glucose monitoring into electronic medical records, and to measure the impact of widescale adoption on health status of patients with diabetes.

Methods

A randomized experiment was use to evaluate the impact of an instruction and technical support session for providers at the practice level. This session encouraged placing bulk orders of electronic blood glucose flowsheets for all patients with diabetes who have active MyChart accounts. The study sample included approximately 7860 patients from 20 selected Inova primary care practices. Patients receiving flowsheet orders were further individually assigned to 4 possible reminder text groups: (1) no reminders (2) generic reminder signed by Inova Medical Group (IMG) (3) generic reminder signed by IMG with notification of chance to receive a gift card if flowsheets are completed (4) reminder signed by the primary care physician. Flowsheet orders, glucose entries, patient HbA1c, patient/physician secure messaging, appointments, and prescription data was collected for all patients through the electronic medical record. The Institutional Review Board reviewed and approved this study, and it is registered on ClinicalTrials.gov.

Conclusions and Implications

The study was successfully implemented and data collection was completed as of November 2018. Analysis is expected to be completed by early 2019. The study will report the impact over a period of 3 and 6 months of both (i) provider instruction and technical support sessions and (ii) patient reminder messaging on the primary outcomes of patient flowsheet completion and patient HbA1c test results. Effects of the interventions on several secondary outcomes will also be reported including (i) frequency of patient and physician communication via secure messaging (ii) frequency of patient telephone and in-person appointments (iii) changes to patient active medications and prescriptions. The results of this study will be highly relevant for patient outcomes and determining policy relating to use of electronic medical records for blood glucose tracking among patients with diabetes.