Automated Integration of Glucometer Data into the Electronic Health Record

Pediatric patients and families with T1D have difficulty meeting target HgbA1c. Providers encourage families to contact them with BG values between visits. Currently it is cumbersome to share BG with clinical providers creating a barrier to communication. Many applications on smart phones exist to help patients track BG, but most do not integrate with the electronic health record (EHR). Recent advances in technology can integrate the glucometer data into the EHR. This pilot and feasibility study aims to understand if automated integration of glucometer data into the EHR along with remote monitoring by health care providers improve patient initiated provider communication, self-management and HgbA1c. Patients and families with type 1 diabetes and an Apple iPod or iPhone (5s or higher) were invited to participate. Participants enrolled in MyChart, downloaded the HealthKit application and connected the AccuChek Aviva Connect (Roche) glucometer to the HealthKit. Through the EHR, BG values were automatically integrated to the EHR via WiFi. The number of patient initiated contacts via telephone or MyChart messages between clinic visits were recorded during each of the 3 phases (lasting 3 months each): run-in phase (providers waited for participant initiated phone calls), intervention phase (provider initiated calls to participants to review BG trends) and learned phase (providers waited for participant initiated phone calls). The number of participant initiated calls for each phase was measured and compared using a paired t test. Thirty-two families (mean Hgb A1c 8.5 ± SD 1.7, mean age 13.9 years ± SD 3.8) completed all phases. Despite automated integration of BG values and guided review of BG trends, the number of patient initiated calls (p=0.17) and HgbA1c values (p=0.67) did not improve. Families did felt safer knowing providers had automated integration of BG values into the EMR. However, barriers to adoption and effectiveness of this technology exist and patient motivation is still needed.