Practice-Linked Online Personal Health Records for Type 2 Diabetes Mellitus

“Background  Web-based personal health records (PHRs) have been advocated as a means to improve type 2 diabetes mellitus (DM) care. However, few Web-based systems are linked directly to the electronic medical record (EMR) used by physicians.
Methods  We randomized 11 primary care practices. Intervention practices received access to a DM-specific PHR that imported clinical and medications data, provided patient-tailored decision support, and enabled the patient to author a “Diabetes Care Plan” for electronic submission to their physician prior to upcoming appointments. Active control practices received a PHR to update and submit family history and health maintenance information. All patients attending these practices were encouraged to sign up for online access.
Results  We enrolled 244 patients with DM (37% of the eligible population with registered online access, 4% of the overall population of patients with DM). Study participants were younger (mean age, 56.1 years vs 60.3 years; P < .001) and lived in higher-income neighborhoods (median income, $53 784 vs $49 713; P < .001) but had similar baseline glycemic control compared with nonparticipants. More patients in the intervention arm had their DM treatment regimens adjusted (53% vs 15%; P < .001) compared with active controls. However, there were no significant differences in risk factor control between study arms after 1 year (P = .53).
Conclusions  Previsit use of online PHR linked to the EMR increased rates of DM-related medication adjustment. Low rates of online patient account registration and good baseline control among participants limited the intervention’s impact on overall risk factor control.”
Abstract
Richard W. Grant; Jonathan S. Wald; Jeffrey L. Schnipper; Tejal K. Gandhi; Eric G. Poon; E. John Orav; Deborah H. Williams; Lynn A. Volk; Blackford Middleton, Arch Intern Med. 2008;168(16):1776-1782,

Group launches online Zip code atlas of population health

“A public health organization will launch an online database this fall that could help forecast the demand for health care services in specific locations for chronic conditions including diabetes, obesity, and HIV.
The National Minority Quality Forum has created the “Zip Code Analysis Project” to collect data on disease activity among both general and minority populations by postal code.”
Article
Kathryn Foxhall, Government Health IT, 18 September 2008

Practice-Linked Online Personal Health Records for Type 2 Diabetes Mellitus

“Background  Web-based personal health records (PHRs) have been advocated as a means to improve type 2 diabetes mellitus (DM) care. However, few Web-based systems are linked directly to the electronic medical record (EMR) used by physicians.
Methods  We randomized 11 primary care practices. Intervention practices received access to a DM-specific PHR that imported clinical and medications data, provided patient-tailored decision support, and enabled the patient to author a “Diabetes Care Plan” for electronic submission to their physician prior to upcoming appointments. Active control practices received a PHR to update and submit family history and health maintenance information. All patients attending these practices were encouraged to sign up for online access.
Results  We enrolled 244 patients with DM (37% of the eligible population with registered online access, 4% of the overall population of patients with DM). Study participants were younger (mean age, 56.1 years vs 60.3 years; P < .001) and lived in higher-income neighborhoods (median income, $53 784 vs $49 713; P < .001) but had similar baseline glycemic control compared with nonparticipants. More patients in the intervention arm had their DM treatment regimens adjusted (53% vs 15%; P < .001) compared with active controls. However, there were no significant differences in risk factor control between study arms after 1 year (P = .53).
Conclusions  Previsit use of online PHR linked to the EMR increased rates of DM-related medication adjustment. Low rates of online patient account registration and good baseline control among participants limited the intervention’s impact on overall risk factor control.
Abstract
Richard W. Grant; Jonathan S. Wald; Jeffrey L. Schnipper; Tejal K. Gandhi; Eric G. Poon; E. John Orav; Deborah H. Williams; Lynn A. Volk; Blackford Middleton; Arch Intern Med. 2008;168(16):1776-1782.

Journal of Telemedicine and Telecare, TOC, September 2008

Telemedicine can improve the health of youths in detention
“Young people in correctional care facilities often have physical or psychological disorders that contribute to their behavioural problems. In the US, the need for medical services in youth facilities far exceeds current resources, especially for paediatric mental health and specialty services. There is obvious potential for telemedicine to improve access to care and thus the level of health care for juvenile detainees. A few studies have indicated that in specific instances telemedicine has improved access to care, referrals, contact between providers, and has also reduced unnecessary referrals. The question remains, however, whether this improved access and timeliness to care has any effect on the major goals of the incarceration: treatment, education and rehabilitation. Further investigation of this linkage is needed.”
Abstract
Karen C Fox and Anna Lyn Whitt, J Telemed Telecare 2008;14 275-276, doi:10.1258/jtt.2008.008002

Emergency telepsychiatry
“Telepsychiatry can be used in two kinds of psychiatric emergencies: one-time clinical events and public health situations associated with mass disaster. Emergency telepsychiatry delivered by videoconferencing has the potential to improve patient care in many settings. Although experience is limited, it has been found to be safe and effective, as well as satisfactory to both emergency department staff and the psychiatric patients treated. The development of comprehensive and standardized guidelines is necessary. There has been little use of acute telemedicine in disaster situations to date. However, telemedicine is becoming part of routine emergency medical response planning in many jurisdictions. Emergency telepsychiatry has the potential to reduce emergency department overcrowding, provide much needed care in rural areas and improve access to psychiatric care in the event of a natural or manmade disaster.”
Abstract
Peter Yellowlees, Michelle M Burke, Shayna L Marks, Donald M Hilty, and Jay H Shore, J Telemed Telecare 2008;14 277-281, doi:10.1258/jtt.2008.080419

Hageseth’s principle of extraterritorial jurisdiction and international telemedicine
“At what point does an international telemedicine transaction create a sufficient commercial nexus to allow one country the authority to impose its laws on a foreign telemedicine providers? Some light on this matter was shed by the US case of Hageseth versus Superior Court. The authority for extraterritorial jurisdiction is found in the US Constitution, which requires the states to cooperate in matters of law enforcement. Similar cooperation from foreign nations cannot be expected. Unless a defendant is charged with a capital offence, nations are rarely willing to extradite their citizens. As the unlicensed practice of medicine is not a capital offence, it is unlikely that an unlicensed telemedicine provider would be extradited to the US. Because low-volume unlicensed offshore telemedicine providers are unlikely to be extradited or to be subject to trade sanctions, they may be able to operate beyond the law.”
Abstract
Thomas R McLean and Alexander B McLean, J Telemed Telecare 2008;14 282-284, doi:10.1258/jtt.2008.080416

The use of information and communications technology for health service delivery in Namibia: perspectives of the health service providers
“We surveyed health service providers in Namibia to find out how they used information and communication technologies (ICTs) to deliver health services to their patients. A structured questionnaire was administered to 21 health service providers in two regions of the country (one urban, one rural). There was overwhelming consensus among the health service providers that ICTs were very important, especially for medical services (100%). Ninety-one percent of health service providers viewed ICT as helping them to interact with other providers in other health institutions. The most commonly used ICT was the telephone, which was used in the admission areas of most health institutions (36%); the next most commonly used ICT was the PC (23%). The most commonly used channels for communication with patients were the telephone followed by TV. Some of the problems common to all health institutions in Namibia were poor budgetary resources and lack of basic infrastructure such as electricity or telephone lines. There is a need to promote ICT use for health service delivery and also to stimulate patients to use ICT to access health services and relevant information.”
Abstract
Meke I Shivute, Blessing M Maumbe, and Vesper T Owei, J Telemed Telecare 2008;14 285-289, doi:10.1258/jtt.2008.071204

Assessment of a remote monitoring system for implantable cardioverter defibrillators
“We conducted a multicentre study in five Italian hospitals to assess the feasibility of a remote monitoring service for the follow-up of implanted cardiac devices. The system was designed to monitor device performance as well as physiological aspects of the patient’s condition. Sixty-seven patients (mean age 64 years) affected by chronic heart failure and with a biventricular implantable cardioverter defibrillator for cardiac re-synchronization therapy (CRT-D) were enrolled for a three-month observation period. A total of 267 device recordings were transmitted through the ordinary telephone network, with a success rate of 99%. The telemonitoring service was more efficient than conventional face-to-face follow-up in terms of the time savings: both for physicians (4.7 minutes versus 15 minutes for remote and conventional monitoring) and for patients (6.6 minutes versus 116.3 minutes). In addition, a total of 23 clinical events occurred during the study, but only two cases required a clinic visit, thus reducing inappropriate hospital admissions. Finally, the service was well accepted by all the users.”
Abstract
Cristina Masella, Paolo Zanaboni, Francesca Di Stasi, Serena Gilardi, Patrizia Ponzi, and Sergio Valsecchi, J Telemed Telecare 2008;14 290-294, doi:10.1258/jtt.2008.080202

Quality of diabetes care among patients managed by teleconsultation
“We studied a new teamwork-based teleconsultation model for treating patients with diabetes, where a specialist in diabetes care, a diabetes nurse and a patient attended by videoconference. The study series consisted of all the patients (n = 101) at three health centres in northern Finland whose care was provided by a single physician at a remote diabetes clinic. A total of 101 patients with diabetes (19 of type 1 and 82 of type 2) were studied at baseline and at 10–14 months after the first consultation. Mean HbA1c was 8.0% at baseline and 7.6% at follow-up (P = 0.007). The proportion of patients with poor glycaemic control decreased from 32% to 13%. Mean LDL cholesterol was 3.3 mmol/L at baseline and 2.7 mmol/L at follow-up (P < 0.001). The percentage of patients with optimum lipid levels increased from 20% to 50%. Mean systolic blood pressure was 146 mmHg at baseline and had decreased by 6 mmHg at follow-up (P = 0.004). The percentage of patients with poor blood pressure control decreased from 19% to 8%. The most common changes in medication were the introduction or modification of insulin treatment and the introduction of statin and antihypertensive drugs and acetylsalicylic acid. Although the study was uncontrolled, there were improvements in glucose and LDL cholesterol levels and blood pressure in patients who were managed by teleconsultation.”
Abstract
Tuula Nikkanen, Markku Timonen, Kirsti Ylitalo, Olavi Timonen, Sirkka Keinänen-Kiukaanniemi, and Ulla Rajala J Telemed Telecare 2008;14 295-299, doi:10.1258/jtt.2008.080313

Impact of telemonitoring at home on the management of elderly patients with congestive heart failure
“We studied the effects of home telemonitoring in elderly patients with congestive heart failure (CHF) on mortality and rate of hospitalization, compliance with treatment, quality of life and costs of CHF management, by comparison with a group receiving usual care. Fifty-seven elderly CHF patients were randomized to standard care or to home telemonitoring-based care and followed for 12 months. In the subjects who were monitored, weekly reports on their clinical status were obtained and their management was modified accordingly. Home telemonitoring was associated with improvements in the composite endpoint of mortality and rate of hospitalizations (P = 0.006), a better compliance with therapy, more frequent use of beta-blockers and statins, lower total cholesterol level and a better reported health perception score. The improved results with home telemonitoring in CHF were probably due to better compliance and to closer monitoring of the patients.”
Abstract
Roberto Antonicelli, Paolo Testarmata, Liana Spazzafumo, Cristina Gagliardi, Grzegorz Bilo, Mariaconsuelo Valentini, Fabiola Olivieri, and Gianfranco Parati, J Telemed Telecare 2008;14 300-305, doi:10.1258/jtt.2008.071213

Acceptability to primary care providers of telemedicine in diabetes case management
“We studied the perceptions of primary care providers (PCPs) about the telemedicine intervention in a trial of telemedicine for management of diabetes in medically under-served areas of New York State. A survey was mailed to 206 rural and 159 urban PCPs. The response rates were 25% and 22%, respectively. Eighty percent of respondents believed that a diabetes telemedicine case management system would help their practice. An overall satisfaction score (possible range 0–80) suggested good acceptability (mean 66, SD 12). In multiple linear regression, the rural location and younger age of the PCPs were independent predictors of higher satisfaction (both P < 0.01). Within-PCP comparisons showed a higher perceived impact on patients, as compared to impact on PCP practices (P < 0.001). However, the findings should be interpreted with caution due to the low response rates."
Abstract
Walter Palmas, Jeanne Teresi, Ruth S Weinstock, and Steven Shea, J Telemed Telecare 2008;14 306-308, doi:10.1258/jtt.2008.080410

The use of telemedicine to aid in assessing patients prior to aeromedical retrieval to a tertiary referral centre
“We evaluated the effect of telemedicine compared with traditional telephone conversations when evaluating patients for aeromedical retrieval. A convenience sample of consecutive patients referred for retrieval from Palm Island over a six-month period was compared retrospectively with patients referred during the previous six months. There was a significant difference (P = 0.014) in the number of patients referred in the telemedicine period (113) compared to the previous six months (78), which may have been a seasonal fluctuation. There was a smaller proportion of aeromedical retrievals in the telemedicine period (78%) compared to the control period (92%), P = 0.009. Other significant differences between the telemedicine and control period included a larger proportion of patients not transferred at all (16% compared to 5%, P = 0.022) and a smaller percentage of rotary flights (52% compared with 73%, P = 0.004). Retrieval coordinators perceived that telemedicine use prevented 10 aeromedical flights and six night flights. The coordinators and referrers felt that telemedicine improved patient care in 75% and 65% of consultations, respectively. The coordinators felt that it improved communication with the referring doctor for 84% of the consultations.”
Abstract
Kate A Mathews, Mark S Elcock, and Jeremy S Furyk, J Telemed Telecare 2008;14 309-314, doi:10.1258/jtt.2008.080417

A pilot study of videotelephone-based support for newly diagnosed paediatric oncology patients and their families
“As part of the preparation for a randomized controlled trial, we conducted a pilot study to investigate the feasibility of providing videotelephone-based support to a sample of families (,em>n = with a child diagnosed with cancer, returning home for the first time after diagnosis and initial treatment. Seven of these families received support via videotelephone over a three-month period. Twenty videotelephone calls were made totalling 400 minutes (median 21 min, IQR 16–24). All videotelephone calls involved the specialist nurse providing support to mothers (85%) or fathers (15%) and involved communicating directly with the patient in most of the calls (55%). Social workers were involved in three calls (15%). All families expressed satisfaction with services delivered in this way. There were few technical problems. The use of a hybrid approach to providing videotelephony, using the family home computer and Internet connection for video and the home telephone line for full-duplex audio, was less costly than the custom-made device used in past studies.”
Abstract
Mark Bensink, Nigel Armfield, Helen Irving, Andrew Hallahan, Deborah Theodoros, Trevor Russell, Adrian Barnett, Paul Scuffham, and Richard Wootton, J Telemed Telecare 2008;14 315-321, doi:10.1258/jtt.2008.080505

Telemedicine in the work site: a study of feasibility, and patient and provider satisfaction
“We examined the use of telemedicine for improving access to care in a work-site clinic. A prospective study of 100 patients was conducted over a four-month period in a work site that housed 700 employees. Sinusitis (10 visits), upper respiratory tract infections (9 visits), otitis media (9 visits), hypertension (9 visits) and back pain (8 visits) were the most common reasons for the visits. In 99 visits, clinicians were of the opinion that the telemedicine visit felt similar to a face-to-face visit. For most of the visits (67), patients strongly agreed or agreed that telemedicine had a positive effect on their relationship with the health-care provider. The otoscope, microscope and stethoscope telemedicine peripherals were important in aiding diagnosis (and ruling out other causes) in about 55% of the visits (upper respiratory tract infection, sinusitis, otitis media, cough, sore throat, nevi, rhinitis and ear wax related concerns). The ability for the patient to watch their ENT examination and see any associated abnormalities was appreciated by many patients. Physicians, nurses and patients were capable of using the technology with little training.”
Abstract
Prathibha Varkey, Kay Schumacher, Claudia Swanton, Barbara Timm, and Philip T Hagen, J Telemed Telecare 2008;14 322-325, doi:10.1258/jtt.2008.080512

Internet program helps diabetics monitor sugar

“An Internet-based blood-sugar monitoring program appears to help people with type 1 diabetes better manage their condition, researchers report.”
Article
Joene Hendry, Reuters, 08 August 2008

Diabetes Online Health Guide Released on NHS Choices

“An online NHS health Guide for people with diabetes has been launched on the national NHS website, NHS Choices http://www.nhs.uk.
The guide, http://www.nhs.uk/Pathways/diabetes/Pages/Landing.aspx,takes patients through each stage, from before diagnosis, through to howto live and self-manage the condition. Throughout the next year, NHS Choiceswill be rolling out more guides from the 60 most common long-term conditions,giving people the information they require to make their own choices and decisions about their treatment.”
Article
Explain Health, 3 August 2008

Patients’ Engagement With “Sweet Talk” – A Text Messaging Support System for Young People With Diabetes

“Background: Guidelines for optimizing type 1 diabetes in young people advocate intensive insulin therapy coupled with personal support from the health care team. “Sweet Talk” is a novel intervention designed to support patients between clinic visits using text messages sent to a mobile phone. Scheduled messages are tailored to patient profiles and diabetes self-management goals, and generic messages include topical “newsletters” and anonymized tips from other participants. The system also allows patients to submit data and questions to the diabetes care team.
Objectives: The aim was to explore how patients with type 1 diabetes interact with the Sweet Talk system in order to understand its utility to this user group.
Methods: Subjects were 64 young people with diabetes who were participating in the intervention arms of a randomized controlled trial. All text messages submitted to Sweet Talk during a 12-month period were recorded. Messaging patterns and content were analyzed using mixed quantitative and qualitative methods.
Results: Patients submitted 1180 messages during the observation period (mean 18.4, median 6). Messaging frequency ranged widely between participants (0-240) with a subset of 5 high users contributing 52% of the total. Patients’ clinical and sociodemographic characteristics were not associated with total messaging frequency, although girls sent significantly more messages unrelated to diabetes than did boys (P = .002). The content of patients’ messages fell into 8 main categories: blood glucose readings, diabetes questions, diabetes information, personal health administration, social messages, technical messages, message errors, and message responses. Unprompted submission of blood glucose values was the most frequent incoming message type (35% of total). Responses to requests for personal experiences and tips generated 40% of all the incoming messages, while topical news items also generated good responses. Patients also used the service to ask questions, submit information about their self-management, and order supplies. No patients nominated supporters to receive text messages about their self-management goals. Another option that was not used was the birthday reminder service.
Conclusions: Automated, scheduled text messaging successfully engaged young people with diabetes. While the system was primarily designed to provide “push” support to patients, submission of clinical data and queries illustrates that it was seen as a trusted medium for communicating with care providers. Responses to the newsletters and submission of personal experiences and tips for circulation to other participants also illustrate the potential value of such interventions for establishing a sense of community. Although participants submitted relatively few messages, positive responses to the system suggest that most derived passive support from reading the messages. The Sweet Talk system could be readily adapted to suit other chronic disease models and age groups, and the results of this study may help to inform the design of future text message support interventions.”
Article
Franklin VL, Greene A, Waller A, Greene SA, Pagliari C, J Med Internet Res 2008;10(2):e20, doi:10.2196/jmir.962

The role of sociability in developing online health communities for people with diabetes

“The escalation in the incidence of chronic diseases has led to a significant number of people coping with conditions such as diabetes. The use of online communities to support patients in managing their condition is increasing as people seek information and emotional support from peer groups. This study examines the role of sociability in online diabetes communities and identifies key factors that contribute to the development of vibrant communities. It identifies key sociability factors that affect the commitment of owners and members to the community and enable people with diabetes to gain social networking benefits that enhance their ability to manage aspects of their condition. Early indications are that a vibrant sociable community can contribute to educating and encouraging people to maintain a higher degree of self management of their chronic disease.”
Article
Rosemary Stockdale, Kathryn Thompson, HealthCare & Informatics Review Online, 30 June 2008

Got diabetes? Connect!

“Social networking has come to the diabetes community in a big way with the launch of Diabetic Connect, a product of Alliance Health.
Alliance CEO Stead Burwell said it’s exciting that the demographics being drawn to Diabetic Connect are close to those of the actual diabetic population.”
Article
Dana Blankenhorn, ZDNet Healthcare, 14 July 2008

La mayor parte de las aplicaciones de telemedicina que se realizan en Cataluña son entre médicos

“El 46,2 por ciento de las entidades sanitarias de Cataluña ya llevan a cabo aplicaciones de telemedicina, que se realizan principalmente entre médicos (21,2 por ciento), entre un paciente y su médico local con un médico de referencia (13,5) y entre un paciente y un médico local (11,5 por ciento). Esta es una de las principales conclusiones del Mapa de Tendencias 2008 de la Fundación Tic Salut, dependiente de la Administración sanitaria, que se ha presentado en la sede de CaixaForum en Barcelona. El informe se basa en encuestas realizadas a centros hospitalarios y de Atención Primaria y tiene el objetivo de conocer el nivel de desarrollo de las Tecnologías de la Información y la Comunicación (TIC) en las organizaciones sanitarias de Cataluña e identificar y presentar las tendencias mundiales.”
Article (Spanish)
El Médico interactivo, 5 July 2008

Journal of Consumer Health on the Internet

Table of Contents for Volume: 12 Issue: 1

Article: The Refugee Health Information Network: A Source of Multilingual and Multicultural Health Information
Gale A. Dutcher; Page Range: 1 - 12; DOI: 10.1080/15398280802081402
The Refugee Health Information Network is an electronic resource designed to make accessible culturally and linguistically appropriate health and medical information in order to improve health services for refugees and asylees. Much of this information will clearly be of value to immigrants as well. This is also a network designed to facilitate collaboration and sharing among state refugee health coordinators and clinics providing services to refugee and immigrant communities.

Article: My HealtheVet: Fighting for Health with Information
Janet Schneider; Page Range: 13 - 21; DOI: 10.1080/15398280802081410
Patients are increasingly demanding access to health information and their own medical records. The Veterans Health Administration (VHA) recognized this desire in its patient population, and developed My HealtheVet as a national Web site that serves as an authoritative portal for veterans and their families to find health and benefits information, as well as refill VA-issued prescriptions, log personal medical information, and enter daily health metrics. The site has logged over 11 million visits since its national debut in November 2003 and has proven its value to veterans.

Article: Transforming Diabetes Self-Management or Not
Catherine M. Boss, Colleen Wolfe, Yen-Hong Kuo; Page Range: 23 - 36; DOI: 10.1080/15398280802081428
Funding from the National Network of Libraries of Medicine (NN/LM) in the fall of 2004 assisted in the establishment of the Health-e Learning Project by the librarians of Meridian Health, a health system in southeastern New Jersey. Health-e Learning’s project goal was to establish a self-sustaining educational initiative to steer older adults toward the reputable medical Web site MedlinePlus and to train them to navigate this site to self-manage a chronic condition. The Health-e Learning Project was not successful in transforming diabetes self-management as originally planned, with only a handful of older adults trained, too small a number to be statistically significant.

Article: Consumer Health Web Sites for Parents of Children with Autism
Robin M. Sabo, Julie M. Lorenzen; Page Range: 37 - 49; DOI: 10.1080/15398280802081436
Many parents of children with autism search the Internet to learn more about the condition. Unfortunately, variability in Web site quality, low literacy levels, and language barriers may prevent them from finding reliable information. To assist parents in locating high quality resources, this article provides an annotated list of Web sites on health aspects of autism. Both a health sciences librarian and a parent of a child with autism present their perspectives and discuss the broader is sue about how parents of children with medical conditions use the Internet.

Article: Food Allergy and Anaphylaxis Network (FAAN)
Donna MacLeod; Page Range: 51 - 56; DOI: 10.1080/15398280802081444
Food Allergy and Anaphylaxis Network (FAAN) provides its Web site to educate, advocate, and make available research information about food allergies to the public. Many helpful features include downloadable forms, brochures, and guidelines; support groups; further medical contact information; and the Kids/Teens Web sites. This resource is reviewed for scientific accuracy by a medical advisory board. There is also a Teen Advisory Group which contributes and reviews the Teen Web site’s content and style.

A second opinion, available from afar

“Although he had never met her, Dr. William Marshall knew a lot about Paulette Schlander.
He knew that Schlander, who lives in Duluth, had gone to Africa on safari with her husband last fall.
He knew, too, that the 58-year-old dental assistant started experiencing strange muscle pains about a month later.
Now he was trying to figure out whether the two events were connected.
In the past, Marshall, an infectious disease expert at the Mayo Clinic, would have invited her to Rochester for a full exam. This time, he didn’t have to.
For the past year, he and other Mayo physicians have been offering “virtual consults,” or second opinions by e-mail, to a Duluth clinic, SuperiorHealth Center, where Schlander is a patient.”
Article
Maura Lerner, Star Tribune (Minneapolis-St. Paul), 8 June 2008

Empowering Mr Green with ICT tools

Mr Green is a diabetic who is also wheelchair bound. For many years his diabetes has been hard to control, resulting in peripheral vascular disease and, being sedentary, this has resulted in frequent pressure sores and leg ulcers. At Chorleywood Health Centre, we have introduced a wide range of ICT tools to support the diagnosis and management of patients. Using remote patient monitoring we have established automatic daily monitoring of his blood sugar levels so that the clinical team have been able to respond to his needs. By observing the effect of the changes made to his medication, we have been able to intervene repeatedly and timely until his diabetes is properly under control. We have discovered that such data empowers the patient to receive the correct management. His vascular disease is followed using images and data, such as ABPI, recorded in the home. Electronic referral of the problem to the hospital consultant results in a teleclinic appointment, Mr Green attends at the local health centre with the home nurse present to provide clinical input, reassurance and advice. A care plan is agreed between all three parties, all without Mr Green needing to move more than 1km from his home.

Malcolm Clarke(1), Russell Jones(2), Linda Hands(3)
1. Brunel University, Uxbridge, UK
2. Chorleywood Health Centre, UK
3. John Radcliffe Hospital, Oxford, UK

To be presented at the ICMCC Event

Performance Measures Using Electronic Health Records: Five Case Studies

“This report examines the experiences of five provider organizations in developing, testing, and implementing quality-of-care indicators, based on data collected from their electronic health record (EHR) systems. HealthPartners used the EHR to compile blood pressure measurements, Park Nicollet Health Services developed a composite measure for care of people with diabetes, Billings Clinic tested an automatic alert on potential interactions between antibiotics and the anticoagulant warfarin, Kaiser Permanente used a natural-language processing tool for counseling about tobacco use, and Geisinger Health System explored ways of reconciling Problem Lists and provider-visit notes regarding high-impact chronic-disease diagnoses. Common themes emerged from these case studies. They included challenges—of ensuring the validity and reliability of data, efficient workflow, and staff support—but the providers’ successes in implementing their respective EHR-based quality measures demonstrated that such measures are adaptable to different EHR systems, amenable to improvement, and worth pursuing.”
Article
Jinnet Briggs Fowles, Ph.D., Jonathan P. Weiner, Dr.P.H., Kitty S. Chan, Ph.D. et al., The Commonwealth Fund, May 2008

Telehealthcare: the long road from concept to reality

“It will take time and effort to make telehealthcare a realty, according to Rolien de Jong, innovations manager at The Hague-based Meavita Healthcare. Presenting the experiences of her company at the eHealth 2008 meeting in Slovenia, de Jong pointed out that in order to make the breakthrough, it’s the providers who are taking the risk – not once, not twice, “but again, and again, and again”.”
Article
HealthTech Wire, 19 May 2008

Electronic Medical Record–Facilitated Care Process Redesign Enhances Access to Care, Reduces Hospitalizations and Costs for Patients With Chronic Illnesses

“Health care organizations that have information systems, including EMRs, often fail to take advantage of their capabilities, as they are not adequately integrated into care management processes and workflow. This problem is particularly significant for physician practices, which often do not take full advantage of such systems even when they have spent significant sums of money to purchase them.For example, a National Center for Health Statistics study found that, while 25 percent of office-based physicians reported using EMRs in 2005, an evaluation of the actual functions used suggests that only 10 percent are using the electronic systems in a meaningful way.”
Article
AHRQ, 12 May 2008

E-health anchors R.I. hospital project

“Memorial Hospital of Rhode Island has completed the first phase of Project Anchor, an initiative that tests an e-health enabled patient-centered medical home model of providing patient care.”
Article
Bernie Monegain, Healthcare IT News, 9 May 2008

Diabetic telemedical program shows positive results

“Diabetiva, a SHL telemedicine program tracking diabetic patients, has released its results from a pilot program. The program, run by SHL and Taunus BKK insurance, reduced hospital admissions for its patients as well as reduced average medical costs by 30 percent.
Article
Healthcare IT News.eu, 6 May 2008

Journal of General Internal Medicin Special Issue on Health Information Technology

Journal of General Internal Medicin Special Issue on Health Information Technology, Volume 23, Number 4 / April, 2008, 0884-8734 (Print) 1525-1497 (Online)

Introduction to the JGIM Special Issue on Health Information Technology

Moving Health Information Technology Forward

Uptake of Electronic Prescribing in Community-Based Practices

Variation in Electronic Prescribing Implementation Among Twelve Ambulatory Practices

Centers Speak Up: The Clinical Context for Health Information Technology in the Ambulatory Care Setting

Employing the Electronic Health Record to Improve Diabetes Care: A Multifaceted Intervention in an Integrated Delivery System

Electronic Medical Record-Assisted Design of a Cluster-Randomized Trial to Improve Diabetes Care and Outcomes

An Electronic Medical Record (EMR)-Based Intervention to Reduce Polypharmacy and Falls in an Ambulatory Rural Elderly Population

Electronic Result Viewing and Quality of Care in Small Group Practices

Application of a Decision Support Tool for Anticoagulation in Patients with Non-valvular Atrial Fibrillation

Use of a Handheld Computer Application for Voluntary Medication Event Reporting by Inpatient Nurses and Physicians

Overdose Rate of Drugs Requiring Renal Dose Adjustment: Data Analysis of 4 Years Prescriptions at a Tertiary Teaching Hospital

Impact of Computerized Decision Support on Blood Pressure Management and Control: A Randomized Controlled Trial

A Mixed Method Study of the Merits of E-Prescribing Drug Alerts in Primary Care

Comparison of Electronic Physician Prompts versus Waitroom Case-Finding on Clinical Trial Enrollment

The Effect of Computerized Physician Order Entry with Clinical Decision Support on the Rates of Adverse Drug Events: A Systematic Review

Use of an Interactive, Telephone-based Self-management Support Program to Identify Adverse Events Among Ambulatory Diabetes Patients

Informing Men about Prostate Cancer Screening: A Randomized Controlled Trial of Patient Education Materials

Screening for Chronic Conditions Using a Patient Internet Portal: Recruitment for an Internet-based Primary Care Intervention

Patient Difficulty Using Tablet Computers to Screen in Primary Care

Leveraging Computerized Sign-Out to Increase Error Reporting and Addressing Patient Safety in Graduate Medical Education

Development of a Web-based Resident Profiling Tool to Support Training in Practice-based Learning and Improvement

Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology

Health Information Technology Will Shift the Medical Care Paradigm

The Role of Systems Factors in Implementing Health Information Technology

Achieving the Potential of Health Information Technology

The Pervasiveness of Telemedicine: Adoption With or Without a Research Base

New EU project will help to predict glucose levels

“A new EU collaborative research project has been granted €7.1m to develop a personalised blood glucose prediction tool aimed at improving the lives of diabetes patients.
The grant award, made under the Seventh Framework Programme (FP7) of the European Community, will fund a four-year research and development project into the ‘DIAdvisor’ portable glucose prediction system.”
Article
e-Health Europe, 16 April 2008

Employing the Electronic Health Record to Improve Diabetes Care: A Multifaceted Intervention in an Integrated Delivery System

“INTRODUCTION Type 2 diabetes is one of the nation’s most prevalent chronic diseases. Although well-known practice guidelines exist, real-life clinical performance often falls short of benchmarks.
AIM Employ an electronic registry derived from a fully integrated electronic health record (EHR) as the cornerstone of an intervention to improve compliance with recommended diabetes performance measures in an integrated practice network.
SETTING Geisinger Health System’s network of 38 practice sites providing care to over 20,000 persons with diabetes located in a 40-county region of central and northeastern Pennsylvania.
PROGRAM DESCRIPTION A multidisciplinary group of physicians worked to create a “bundle” of best practice measures for diabetes. This measurement tool was then used as part of a multifaceted intervention to improve physician performance in diabetes care, including audit and feedback, computerized reminders, and financial incentives. Changes in performance of individual measures and the total “bundle” were tracked monthly over 1 year.
PROGRAM EVALUATION Significant increases were seen in all measures of diabetes care over the 12-month period of the study. Vaccination for pneumococcal disease and influenza improved from 56.5% to 80.8% (p?p?p?p?p? DISCUSSION Diabetes care improved significantly in response to a multifaceted intervention featuring the use of an EHR-derived registry in an integrated delivery system. More work is needed to demonstrate that such improvements will translate into improved patient health outcomes."
Article
Valerie Weber, Frederick Bloom, Steve Pierdon and Craig Wood, Journal of General Internal Medicine, Volume 23, Number 4 / April, 2008, DOI 10.1007/s11606-007-0439-2

EHR-based Program Improves Diabetes Care

“Using the Electronic Health Record in everyday care for diabetics leads to dramatic improvements for those patients, according to a new Geisinger report. Geisinger recently redesigned how it cares for its 20,000 diabetes patients, and results of the quality-driven program are discussed in this month’s Journal of General Internal Medicine.”
Article
Newswise, 7 April 2008

MDs launch online tool for patients

“Doctors may soon be tracking patients with high blood pressure or asthma over the Internet using online tools launched yesterday by the Canadian Medical Association.
The web portal, called mydoctor.ca, is geared to help doctors and patients work more closely together, especially to manage chronic diseases, including diabetes and heart disease. The secure portal also allows patients to input health information and lets them track their blood pressure, asthma and weight loss.”
Article
Megan Ogilvie, The Star, 2 April 2008

Stakeholders sign e-diabetes manifest in The Netherlands

The Dutch Health minister has signed a manifest with the main stakeholders to ensure electronic information exchange for diabetics within 5 years.

Article (Dutch)
Huisarts Vandaag, 27 March 2008

VDE paper supports telemonitoring for diabetics

“German industry association, VDE, has published a paper on telemonitoring for diabetic patients.
The paper urges politicians to make greater use of telemonitoring technology in order to reduce long-term complications of diabetes and costs for diabetic patients.”
Article
e-Health Europe, 19 March 2008

HealthBridge data exchange gives boost to e-prescribing, diabetes registry

“HealthBridge, a Cincinnati-based community health information exchange, has won a grant to enable e-prescribing and another to develop a disease registry. Both projects - already under way - will leverage HealthBridge’s core messaging system.”
Article
Healthcare IT News, Patty Enrado, 18 March 2008

TeleMedizin spart Milliarden ein bei Behandlung von Diabetes

Use of telemedicine could save billions, according to the VDE (German Association for Electrical, Electronic & Information Technologies). The German health system spends 30 billion euro a year on diabetes, an amount still growing.

Article (German)
Melanie Mora, Innovations Report, 7 March 2008

Automated telephone reminder messages can assist electronic diabetes care

“Abstract:
Telephone reminder systems have been used to assist in the treatment of many chronic diseases. However, it is unclear if these systems can increase medication and appointment adherence in patients with diabetes without direct patient-provider telephone contact. We tested the feasibility of using an automated telephone reminder system (ATRS) to deliver reminder messages to 253 adults with diabetes enrolled in a randomized controlled trial. Eighty-four percent of the patients were able to register using voice recognition and at least one reminder was delivered to 95% of registered patients over a period of 7.5 months. None of the demographic features studied predicted a patient’s ability to enrol or to receive reminder calls. At the end of the study, 63% of patients indicated that they wished to continue to receive ATRS calls. The level of system use as determined by the number of received reminder calls was not associated with a change in the number of physician visits or diabetes-related laboratory tests during follow-up. The clinical benefits and sustainability of ATRS remain unproven, but our results indicate that an automated reminder system can be effective for providing messages to a large group of older patients with diabetes.”
Abstract
Mollon, Brent; Holbrook, Anne M.; Keshavjee, Karim; Troyan, Sue; Gaebel, Kathryn; Thabane, Lehana; Perera, Gihan, Journal of Telemedicine and Telecare, Volume 14, Number 1, January 2008 , pp. 32-36(5)

Identifying undiagnosed diabetes: cross-sectional survey of 3.6 million patients’ electronic records

“Background Around 1% of the UK population has diabetes that is either undiagnosed or unrecorded on practice disease registers.
Aim To estimate the number of people in UK primary care databases with biochemical evidence of undiagnosed diabetes. To develop simple practice-based search techniques to support early recognition of diabetes.
Conclusion People with possible undiagnosed diabetes are readily identifiable in UK primary care databases through electronic searches using blood glucose data. People with borderline levels, who may benefit from interventions to reduce their risk of progression to diabetes, can also be identified using practice-based software.”
Abstract
Holt, Tim A; Stables, David; Hippisley-Cox, Julia; O’Hanlon, Shaun; Majeed, Azeem, British Journal of General Practice, Volume 58, Number 548, 1 March 2008 , pp. 192-196(5)

Doctor develops diagnostic diabetes software

“A GP has developed software that he believes could help identify up to 60,000 patients with undiagnosed diabetes.
The software has already been installed in EMIS practices following the research project conducted by Dr Tim Holt, a GP in Warwickshire and clinical lecturer at Warwick University Medical School.”
Article
e-Health Insider Primary Care