Diabetes Metronome

[ Past project - Summary from 2007 ]

The "Diabetes Metronome" is an informatics-based pilot program testing an alternative strategy of care delivery that relies on visit-independent clinical actions. Once a patient has been identified and consented by the enrolled physician, the Diabetes Metronome application will set a three-month HbA1c "metronome". That is, the application will monitor for HbA1c results, send a reminder letter with lab slip to the patient 2.5 months after the most recent HbA1c result with a follow-up at 3.5 months and 4 months if no result is recorded. The goal of this program is to reduce the interval between Hba1c results, and iteratively assist physicians in the management of chronic disease.

Once an HbA1c result is obtained, a contextually-rich e-mail is immediately generated and sent to the physician. This e-mail will contain all the clinical information required to guide a clinical decision by the provider.

1. If the HbA1c is at goal, the provider will have the capacity with "one-click" to refill existing hypoglycemic medications and to edit a pre-written patient letter informing and congratulating the patient and setting the expectation for repeat testing by three months.
2. If the HbA1c is above goal, the provider will have the capacity with "one-click" to choose from a menu of medication adjustment options for advancing therapy. This choice will trigger a sequence of events (generate a patient letter, update the EHR, set the expectation for repeat testing) and continue the 3 month metronome.
3. Alternatively, the provider can select "no action" and will have the opportunity to document reasons for not intensifying therapy. This documentation will be updated into the EHR.