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Criego AB. 3-CT-SY17. Presented at: Scientific Sessions of the American Diabetes Association; 25-29 June 2021 (virtual meeting).
Disclosure:
Bergenstal reports research support and advisory or advisory fees that are contracted to and paid to by Abbott, DexCom, Hygieia, Johnson & Johnson, Lilly, Medtronic, Novo Nordisk, Onduo, Roche, Sanofi, Senseonics and United Healthcare through the HealthPartners Institute. Criego reports that it has received consulting fees, research support, or other support from Abbott, Bigfoot Biomedical, Dexcom, Eli Lilly, Insulet, Medtronic, and Sanofi.
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A pilot process that integrates patients’ continuous glucose monitoring data directly into the electronic health record improves clinician access to valuable glucose information and should be expanded, according to a spokesman.
Amy B. Criego
“The takeaway message when integrating CGM data directly into the EHR is that it can be done.” Amy B. Criego, MD, MS, Division director of pediatric endocrinology at the Park Nicollet Clinic and medical director at the International Diabetes Center in Minneapolis, said Healio. “Not only can an ambulatory glucose profile report be viewed, but discrete glucose data can be viewed over time. This will benefit the person with diabetes for treatment talks. Population health data related to glucose readings can also be more easily accessed to improve the quality of care. “
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New ways to treat diabetes
The HbA1c measurement has been used as a marker of good glycemic management for years; However, HbA1c alone has not helped clinicians improve diabetes care, Criego said during a virtual presentation at the American Diabetes Association’s Scientific Sessions.
“Part of the reason HbA1c does not see any effects on hypoglycemia or glucose variability,” Criego said during the presentation. “Also, HbA1c tests in people with pre-existing conditions may not be as accurate as we’d like them to be.”
Instead, the data from CGM reports can provide the clinician with insights into a person’s daily glucose excursions, time spent with hypoglycemia and hyperglycemia, to tailor treatment. However, the main obstacle to analyzing CGM reports in the clinic is the ability to easily obtain them, Criego said.
“There are many barriers to getting this data as it is,” said Criego. “There are different links [needed] to find your patients’ data, even if it is shared with the clinic. There are separate websites; You have your own usernames and passwords. Sometimes you can’t find your patients [in the system]. There are so many pages of reports that it is hard to decide which one to choose. Your healthcare organization may have firewalls that can be time consuming to circumvent. “
Access data ‘within seconds’
To improve access, the International Diabetes Center has partnered with Abbott in a pilot initiative from spring 2020 to make FreeStyle Libre CGM data available at the point-of-care in selected clinics. The goal, Criego said, was for clinicians to place an order in the EHR for a patient with diabetes who would agree to share their CGM data. Data from Abbott’s cloud-based LibreView system would then be transmitted in real time via an EHR platform, so doctors can automatically view patients’ CGM data in their laboratory results and diabetes flow sheet. Data metrics include time in the recommended glucose range and visual warnings for values out of range.
The ambulatory glucose profile is also built into the EHR in a PDF format so clinicians can track the patient’s glucose trends over time and adjust treatment regimens as needed, Criego said.
Researchers at HealthPartners Institute developed the process together with risk management and the internet security and technology team that helped develop legally compliant standards for health organizations to obtain patient-specific health data from a source outside the EHR, with discrete data being built directly into the EHR the EMR, said Criego.
“We decided to test the process not only in an endocrine clinic, but also in endocrine clinics for primary care as well as endocrine and pediatric clinics,” said Criego. “Future plans include the ability to use this discrete population health data so we can identify areas for quality improvement as a whole.”
Orders are available today within clinics participating in the HealthPartners system to incorporate CGM data directly into the EHR once connected, Criego said. Once connected, the data is retrieved “within seconds” of ordering, Criego said.
“For those of you who work with data, you know there are many different ways to view a lab report,” said Criego. “Every provider sees things differently. … The key takeaway is that it’s discrete data in a flowchart that can be viewed over time to help treat diabetes. “
“Blueprint” for other health systems
Richard M. Bergenstal, MDNicollet, executive director of the International Diabetes Center Park Nicollet and Health Partners in Minneapolis who helped develop the ambulatory glucose profile for CGM, said the initiative could completely transform diabetes management in primary care settings where more and more efforts are being made to use it increase of CGM for people with diabetes.
Richard M. Bergenstal
“You open a patient record in the electronic medical record, and that [CGM] Data is appearing, ”Bergenstal told Healio. “It has to be on this path. It’s not a solution in and of itself – you still need to have the workflow to use the data. But if you don’t have it, you won’t use it. “
The next steps include implementing the program system-wide and conducting outcome studies, Criego said.
“Now that we have the data integration process in place, we’re moving forward with the system-wide integration of the process and assessing its impact on workflow improvement and ultimately the impact on glucose management,” Criego told Healio. “So that this can be used in other health organizations, they have to integrate the process into their own electronic health record. However, with the framework in place, other organizations will have a blueprint to follow. “
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