Development and Assessment of a Telematic Platform for Diabetic Patients Care Delivery
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Abstract
Background: Current situation is accelerating both the change in health and care delivery models and the needs of introducing new care delivery models in order to enhance system sustainability while reaching more patients and facilitating continuity of treatment for chronic patients at a lower cost. Telematic care delivery in chronic diseases with high prevalence, like diabetes, is proposed as an efficient shift from classic care delivery models, adding a direct communication capability with the patient. In this sense, the utilisation of normalised information and standard technologies is critical for spreading this model in a corporate environment.
Objective: To develop and assess an eHealth platform, specific for type-I diabetes patients care delivery, able to manage clinical variables (capillary glycaemia, blood pressure and weight), incorporating video-conference as the communication tool between patients and health professionals, and a patient personal health record able to communicate with him/her health professional in charge, with a strong interoperability-driven approach to share patients’ information between the systems involved in the care delivery workflow.
Methods: A web platform has been designed following a Service Oriented Architecture (SOA) strategy integrated with the clinical and care service-based information ecosystem hosted in the hospital. Glucometers and insulin pumps are used for telemonitoring capillary glycaemia level by connecting each device with their own platforms, which analyze the data and forward reports to the eHealth platform. Blood pressure and weight is manually registered in the eHealth platform. Effectiveness and efficiency of the telecare delivery model will be assessed versus the classic in-person model for metabolic control of type-I diabetes patients. In order to accomplish this assessment, a 6-month length prospective, quasi-experimental, comparative, open study including 74 (37 for each care delivery model) patients of 18 years old or above with type 1 diabetes treated with multiple insulin doses or insulin pump therapy and with suboptimal metabolic control (HbA1c>8%) has been defined. Patients and health professionals’ (endocrines, educators) satisfaction will also be analysed.
Results: From a technical standpoint, the platform is integrated with an Enterprise Service Bus (ESB) which manages messaging and communications between its components and orchestrates the connection between information systems belonging to the hospital environment. The platform has been developed according to the ISO13606 standard regarding to Electronic Health Record Communication in order to enable semantic interoperability, being the database model compliant with the standard reference model, and linking information to clinical knowledge making use of archetypes. Strong security measures have also been implemented in order to guarantee information privacy. The platform is currently developed and deployed in a production environment, available to health professionals and patients who demand it. Since November 2013 so far, 34 patients have been included in the control group, 9 patients have been included in the intervention group, and 28 records have been registered into the Electronic Health Record.
Conclusions: From a technological standpoint, the platform improves information consistency and homogeneity when shifting from an in-person context to an electronic health record context, thanks to archetypes utilization and reuse. From a clinical standpoint, in this model, the synchronous teleconsultation framework involving real-time, face-to-face contact via videoconferencing to connect caregivers and patients simultaneously was designed for individual scheduled visits. This framework has been also used for educational purposes and non-scheduled patients’ consultation. This framework is not only intended to be an alternative of classic in-person consultation model, also self-care and proactive collaborations between health care professionals and patients to manage diabetes care are promoted. Although no formal preliminary results are available yet, health professionals and patients perceive satisfaction and an appreciable platform use adherence.
Objective: To develop and assess an eHealth platform, specific for type-I diabetes patients care delivery, able to manage clinical variables (capillary glycaemia, blood pressure and weight), incorporating video-conference as the communication tool between patients and health professionals, and a patient personal health record able to communicate with him/her health professional in charge, with a strong interoperability-driven approach to share patients’ information between the systems involved in the care delivery workflow.
Methods: A web platform has been designed following a Service Oriented Architecture (SOA) strategy integrated with the clinical and care service-based information ecosystem hosted in the hospital. Glucometers and insulin pumps are used for telemonitoring capillary glycaemia level by connecting each device with their own platforms, which analyze the data and forward reports to the eHealth platform. Blood pressure and weight is manually registered in the eHealth platform. Effectiveness and efficiency of the telecare delivery model will be assessed versus the classic in-person model for metabolic control of type-I diabetes patients. In order to accomplish this assessment, a 6-month length prospective, quasi-experimental, comparative, open study including 74 (37 for each care delivery model) patients of 18 years old or above with type 1 diabetes treated with multiple insulin doses or insulin pump therapy and with suboptimal metabolic control (HbA1c>8%) has been defined. Patients and health professionals’ (endocrines, educators) satisfaction will also be analysed.
Results: From a technical standpoint, the platform is integrated with an Enterprise Service Bus (ESB) which manages messaging and communications between its components and orchestrates the connection between information systems belonging to the hospital environment. The platform has been developed according to the ISO13606 standard regarding to Electronic Health Record Communication in order to enable semantic interoperability, being the database model compliant with the standard reference model, and linking information to clinical knowledge making use of archetypes. Strong security measures have also been implemented in order to guarantee information privacy. The platform is currently developed and deployed in a production environment, available to health professionals and patients who demand it. Since November 2013 so far, 34 patients have been included in the control group, 9 patients have been included in the intervention group, and 28 records have been registered into the Electronic Health Record.
Conclusions: From a technological standpoint, the platform improves information consistency and homogeneity when shifting from an in-person context to an electronic health record context, thanks to archetypes utilization and reuse. From a clinical standpoint, in this model, the synchronous teleconsultation framework involving real-time, face-to-face contact via videoconferencing to connect caregivers and patients simultaneously was designed for individual scheduled visits. This framework has been also used for educational purposes and non-scheduled patients’ consultation. This framework is not only intended to be an alternative of classic in-person consultation model, also self-care and proactive collaborations between health care professionals and patients to manage diabetes care are promoted. Although no formal preliminary results are available yet, health professionals and patients perceive satisfaction and an appreciable platform use adherence.
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