Multivendor Continuous Glucose Monitor Integration into the Electronic Health Record: Real-World Experience of an Academic Pediatric Endocrinology Clinic.

BACKGROUND

The rapid advancement of diabetes technology, including continuous glucose monitors (CGMs), insulin pumps, and automated insulin delivery systems, has revolutionized diabetes management. However, current care delivery paradigms have not kept pace, prolonging suboptimal health outcomes for youth with type 1 diabetes (T1D). A significant obstacle is the siloed nature of clinical data. This article explores integrating CGM data for multiple vendors into electronic health records (EHRs) to unify diabetes data in health care practices.

METHODS

This article describes the integration of diabetes device data, following Integration of Continuous Glucose Monitoring Data into the Electronic Health Record (iCoDE) specifications, in the EHR at an urban, tertiary, academic pediatric medical center serving approximately 500,000 pediatric lives in Southwest Ohio. The Diabetes Center provides specialized interdisciplinary care for about 2200 patients with diabetes, with an average of 200+ new onset cases/year. This project is part of the Cincinnati Children's Diabetes Clinic Initiative (ConnecT1D), funded by the Helmsley Charitable Trust, aiming to reorient diabetes care from quarterly visits to continuous, proactive care.

RESULTS

By evaluating 6 key factors for integration (data sources types, clinical workflows, level of integration, visualizations, sustainable account management, and optimization), we successfully achieved structural interoperability of CGM device data for 3 vendor platforms into the results section of the EHR using HL7 v2.x.

DISCUSSION: We present practical tips to optimize the integration experience: identify the problem, mobilize resources, negotiate contracts early, evaluate and optimize the workflow, celebrate early wins, prepare for (inevitable) stumbling blocks, keep asking questions, implement change management techniques, and evaluate integration acceptance, iterate, and monitor.

CONCLUSION

While beneficial for patients and clinical workflows, integration of vendor CGM data into the EHR currently requires significant resources. Challenges remain in optimizing workflows, mapping data, and vendor variability. Ongoing monitoring, maintenance, and optimization are necessary as technology and workflows evolve.