Adding CGM data to EHR could boost use in primary care diabetes management
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A pilot process that incorporates patients’ continuous glucose monitoring data directly into the electronic health record improved clinician access to valuable glucose information and should be expanded, according to a speaker.
“The take-home message regarding direct integration of CGM data into the EHR is that it can be done,” Amy B. Criego, MD, MS, department chair in pediatric endocrinology at Park Nicollet Clinic and a medical director at the International Diabetes Center in Minneapolis, told Healio. “Not only can it be done to view an ambulatory glucose profile report, but discrete glucose data can be viewed over time. This benefits the person with diabetes for treatment discussions. Data for population health around glucose metrics can also be more easily accessed for improving the quality of care.”
New ways to manage diabetes
For years, the HbA1c measurement has been used as a marker of good glycemic management; however, HbA1c alone has not helped clinicians improve diabetes care, Criego said during a virtual presentation at the American Diabetes Association Scientific Sessions.
“Part of the reason why is HbA1c does not recognize any implications for hypoglycemia or glucose variability,” Criego said during the presentation. “In addition, HbA1c assays may not be as accurate as we would like them to be in people who have underlying health conditions.”
Instead, data from CGM reports can offer the clinician insight into a person’s day-to-day glucose excursions, time spent in hypoglycemia and time spent in hyperglycemia, to allow for more tailored treatment. Yet, the main barrier to analyzing CGM reports in the clinic is the ability to easily obtain them, Criego said.
“There are many barriers to obtaining this data in the current state,” Criego said. “There are different links [needed] to find the data for your patients, even if it is shared with the clinic. There are separate websites; you have your own usernames and passwords. Sometimes you cannot find your patients [in the system]. There are so many pages of reports, it is hard to know what to choose. In your health care organization, you might have firewalls that can be time-consuming to work around.”
Access data ‘within seconds’
To improve access, the International Diabetes Center partnered with Abbott on a pilot initiative beginning in spring 2020 to make FreeStyle Libre CGM data available at the point of care in select clinics. The goal, Criego said, was for clinicians to place an order in the EHR for a patient with diabetes who agreed to share their CGM data. In real time, data would then be transferred from Abbott’s cloud-based system, LibreView, via an EHR platform, allowing physicians to automatically view the patients CGM data in their lab results and diabetes flow sheet. Data metrics would include time in the recommended glucose range and visual alerts for out-of-range values.
The ambulatory glucose profile is also integrated into the EHR in a PDF format, allowing clinicians to track the patient’s glucose trends over time and adjust treatment regimens as needed, Criego said.
Researchers at HealthPartners Institute developed the process along with risk management and the internet security and technology team, which helped develop legally compliant standards for health care organizations to pull patient-specific health data from a source outside of the EHR, with discrete data integrated directly into the EMR, Criego said.
“We decided we would pilot the process not just in an endocrine clinic, but in primary care, adult endocrine and pediatric endocrine clinics,” Criego said. “Future plans include the ability to use this discrete data for population health so we can identify areas for quality improvement as a whole.”
Today, orders within the HealthPartners system participating clinics are available to directly integrate CGM data into the EHR after connection is established, Criego said. Once a connection is established, data are obtained “within seconds” after the order is placed, Criego said.
“For those of you who work with data, you know there are many different ways to view a lab report,” Criego said. “Every provider views things differently. ... The important take-home is that it is discrete data in a flow sheet that can be viewed over time to manage diabetes.”
‘Blueprint’ for other health systems
Richard M. Bergenstal, MD, 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 change diabetes management in primary care, where there has been a growing effort to increase CGM use for people with diabetes.
“They open a patient’s chart in the electronic medical record, and that [CGM] data appears,” Bergenstal told Healio. “That has to be in this path. It is not, in itself, a solution — one still has to have the workflow to use the data. But if you do not have it available, you’re not going to use it.”
Next steps include implementing the program systemwide and conducting outcomes studies, Criego said.
“Now that we have the process for data integration established, we are moving forward with integrating the process systemwide and evaluating its impact on improving workflow and eventually the impact on glucose management,” Criego told Healio. “For this to be utilized in other health care organizations, it will require them to have the process built within their own electronic health record; however, with the framework established, other organizations will have a blueprint to follow.”
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Criego AB. 3-CT-SY17. Presented at: American Diabetes Association Scientific Sessions; June 25-29, 2021 (virtual meeting).
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