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
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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Cited by (38)
Moving Beyond the Rhetoric of Shared Decision-Making: Designing Personal Health Record Technology With Young Adults With Type 1 Diabetes
2020, Canadian Journal of DiabetesCitation Excerpt :A PHR is an Internet-based application that allows patients to access, input, manage and share their health information, access decision support tools and education and communicate with their care team. PHR technology is a promising approach for overcoming some of the identified barriers to implementing SDM in practice (19) and to improving diabetes care (20). In a pilot study linking a patient portal for youth with chronic disease and their providers’ EHR, the caregivers of youth (n=30) identified access to provider’s patient record, ease of communication with providers and efficiency of care as very beneficial to support SDM with providers (19).
Real-time continuous glucose monitoring versus internet-based blood glucose monitoring in adults with type 2 diabetes: A study of treatment satisfaction
2014, Diabetes Research and Clinical PracticeCitation Excerpt :According to a systematic review and meta-analysis of 19 randomized trials, compared to self-monitoring blood glucose (SMBG), continuous glucose monitoring (CGM) was associated with significant improvements in HbA1c among adult patients diagnosed with type 1 and type 2 diabetes. Studies of IBGM have also yielded favorable results [6–10]. For instance, among patients with a baseline HbA1c ≥ 7% (53 mmol/mol), Kwon et al. [8] found that individuals randomized to an IBGM group had a significantly lower mean HbA1c compared to the control group 7.4% (57 mmol/mol) vs. 8.1% (65 mmol/mol).
Impact of patient use of an online patient portal on diabetes outcomes
2014, Canadian Journal of DiabetesCitation Excerpt :Electronic health records systems were initially developed as tools for physicians and their staffs and as such have been in wide use for more than a decade. They have been shown to provide modest improvement in diabetes outcomes (1–3). In recent years, advances in web-based electronic health record technology have provided patients with online access to their health information through patient portals; such access has been considered to complete the “circle of care” (4), which is defined as patients' being surrounded by interdisciplinary care teams that include a diabetologist, diabetes nurse, dietitian, family physician and other relevant healthcare providers.
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