Elsevier

Diabetes & Metabolism

Volume 37, Supplement 4, December 2011, Pages S53-S56
Diabetes & Metabolism

Improving diabetes management with electronic health records and patients’ health recordsAméliorer la prise en charge du diabète à l’aide du dossier médical électronique et du dossier de santé tenu par le patient

https://doi.org/10.1016/S1262-3636(11)70966-1Get rights and content

Abstract

The lack of patient engagement and clinical inertia both contribute to suboptimal diabetes care. However, both obstacles are amenable to informatics- and Internet-based interventions.

The use of electronic medical records (EMRs) is now established as being useful for improving diabetes care. Intelligent records that integrate computerized decision-support systems are now able to recommend care protocols tailored to risk levels. Web-based personal health record (PHR) systems, shared with healthcare providers, could also provide added value by promoting self-management of the behaviours related to diabetes. These Web-based programmes include patients’ access to EMRs, uploading of glucose monitoring results, a glucose diary, secure e-mail with providers, manual or automated feedback on blood glucose readings and other risk factors, an educational website, and an online diary for entering personal information on exercise, diet and medication. The integration of Web-based patients’ systems into the EMR used by physicians is the next frontier. In addition, the input from “smartphones” that are able to provide real-time support to patients could contribute to the reorganization of diabetes care.

Convincing data on HbA1c improvements with such systems are available for type 2 diabetes, but are still equivocal for type 1 diabetes. Obstacles include patients’ compliance with the technology, their ergonomic design and the need to reimburse providers for their care. Designing appropriate electronic tools and tailoring them to the conditions in France merits our attention.

Résumé

Le défaut d’investissement du patient et l’inertie clinique contribuent à une prise en charge insuffisante du diabète. Ces deux obstacles pourraient être levés par une intervention basée sur les outils informatiques et Internet.

Il est maintenant établi que l’utilisation d’un dossier médical informatisé améliore la prise en charge du diabète. Des dossiers intelligents, intégrant des systèmes automatisés d’aide à la décision, sont capables de recommander des protocoles de soin ajustés sur le profil de risque du patient. Par ailleurs, des dossiers de santé personnels pour le patient sont apparus qui, lorsqu’ils sont partagés avec le soignant, ont une valeur ajoutée en favorisant l’autoprise en charge des comportements inhérents au diabète. Ces programmes accessibles sur le Web fournissent plusieurs fonctions: dossier médical, téléchargement des glycémies capillaires, tenue d’un carnet glycémique, messagerie sécurisée en lien avec le soignant, feedback manuel ou automatique sur les glycémies, site Web éducatif, journal en ligne (exercice, alimentation, médicaments). L’intégration du dossier de santé patient et du dossier médical informatisé médecin est la prochaine étape. Enfin l’intégration de smartphones pouvant fournir une aide en temps réel pourrait contribuer à réorganiser les soins du diabète.

Des données convaincantes sur l’HbA1c sont disponibles avec ces outils pour le diabète de type 2, elles sont encore équivoques pour le diabète de type 1. Les obstacles sont l’adhésion du patient à la technologie, l’ergonomie à parfaire, et la rétribution financière des soignants. La mise au point de tels outils adaptés au contexte français devrait être considérée avec attention.

Introduction

Despite the availability of international guidelines and major efforts towards improvements, the care of diabetic patients remains suboptimal. Two important barriers are the lack of patients’engagement with therapeutic care plans (related to insufficient knowledge, motivation and decision-support help) and the lack of medication adjustment by physicians (related to clinical inertia) during clinical encounters. Both obstacles are believed to be amenable to informatics-based interventions and, especially, Internet-based strategies.

Section snippets

Electronic record-based clinical decision-support systems

From the physicians’ point of view, efforts have been made to allow electronic medical record (EMR) systems to provide adequate decision-making support for patients’ management. A recent survey conducted among 46 practices, involving 27,207 diabetic patients, established that the use of an electronic health record was associated with improved diabetes care compared with sites using paper records [1]. However, an appropriate computerized database cannot rely solely on basic features such as the

Web-based shared systems for diabetes self-management

From the patients’ point of view, Web-based personal health record (PHR) systems, shared with healthcare providers, have been advocated as a means of improving diabetes care. A growing subset of PHRs has also opened up the possibility of engaging patients in their own care by promoting self-management of the complex behaviours related to their diabetes, such as glucose monitoring, insulin and other medication management, psychotherapy and social support, physical activity promotion and

Integration of patients’ electronic health and healthcare records

The coexistence of two electronic information systems, one managed by the patient and the other by the healthcare provider, raises several practical issues. Few Web-based patients’ systems are linked directly to the EMRs used by physicians. The integration of both records into what some call the “patient Web portal” (PWP) has been associated with better patient outcomes in some reports. In one study, a diabetes-specific PHR that imports clinical and medication data, provides patient-tailored

Conclusion

Electronic health-record technology using Internet-based strategies is believed to improve diabetes patient outcomes through enhanced education and patient support, and through reduced clinical inertia on the part of the healthcare provider. So far, however, no HbA1c improvement with such an approach has been reported in large series of T1D patients. It appears that such improvement is more likely to occur in T2D patients. Major obstacles to the wider implementation of these technologies

Conflicts of interest statement

The author declares having perceived some fees from Sanofi for his participation to a scientific board dedicated to new technologies and telemedicine.

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