A clinically useful diabetes electronic medical record: Lessons from the past; pointers toward the future

Abstract

We have analysed the deficiencies of paper medical records in facilitating the care of patients with diabetes and have developed an electronic medical record that corrects some of them. The diabetes electronic medical record (DEMR) is designed to facilitate the work of a busy diabetes clinic. Design principles include heavy reliance on graphic displays of laboratory and clinical data, consistent color coding and aggregation of data needed to facilitate the different types of clinical encounter (initial consultation, continuing care visit, insulin adjustment visit, dietitian encounter, nurse educator encounter, obstetric patient, transplant patient, visits for problems unrelated to diabetes). Data input is by autoflow from the institutional laboratories, by desk attendants or on-line by all users. Careful attention has been paid to making data entry a point and click process wherever possible. Opportunity for free text comment is provided on every screen. On completion of the encounter a narrative text summary of the visit is generated by the computer and is annotated by the care giver. Currently there are about 7800 patients in the system. Remaining challenges include the adaptation of the system to accommodate the occasional user, development of portable laptop derivatives that remain compatible with the parent system and improvements in the screen structure and graphic display formats.

Impact of a Diabetes Electronic Management System on the Care of Patients Seen in a Subspecialty Diabetes Clinic

“…The DEMS is designed to allow entry of clinical information (real time) as the provider is in the room with the patient (25). It is structured to allow an empowered data-entry person to enter information before the providers encounter with the patient.…”

“…These and other systems often require additional support and processes for data entry that occurs outside the setting of the clinical encounter. It has been suggested that computer-generated clinical data sets will become a decision support tool as valuable as the stethoscope when the data entry is done by the provider and patient concurrently during a clinical encounter (12,13,23,25,26). We report that the use of such a system (DEMS) significantly enhances the documentation provided by board-certified specialists in the care of patients with diabetes.…”

“…We have previously reported on a prototype diabetes electronic management system (DEMS) that is used in real time by the provider during the clinical visit (25). By concentrating on the human-computer interface and aggregating data according to clinical assessment and administrative tasks, we have been able to construct a robust system that offers potential advantages in disease management that are not seen with the use of the paper record.…”

Towards an optimal model for community‐based diabetes care: design and baseline data from the Mayo Health System Diabetes Translation Project

“…Practice Model B consists of a guideline implementation team effort along with implementation of DEMS in the clinical care of patients with diabetes at that site. A description of the features of an earlier version of DEMS has been reported ( Gorman et al 1996 ). For the current project, several modifications were made to DEMS including; (1) a more user‐friendly computer–human interface; (2) incorporation of guidelines for good diabetes care with alerts and reminders to the practitioner to comply with these guidelines; and (3) an emphasis on entry of clinical information by an empowered ‘pre‐evaluation’ person prior to the physician's visit to facilitate the overall diabetes encounter.…”

Diabetic Retinopathy: Focus on Minority Populations

“…These include patient registries and diabetes collaboratives to improve the quality of diabetes care [102-104,107], provider reminders (such as prompts in electronic medical records) [108,109], to aid providers in tracking which patients have missed screening appointments, population-based screening programs [110], diabetes management programs, including those that have been undertaken by HMOs [93,111,112], and community based diabetes management and DR screening programs [93]. Telemedicine [113,114], mobile screening [114-121], and the placement of diabetic retinopathy screening equipment in primary care offices may also help decrease the number of cases of DR that progress to vision-threatening complications; this is particularly valid in populations with limited health care access, including rural Native American tribes and various other rural communities.…”