Diabetes mellitus is a common disease causing significant mortality and morbidity. It is a serious debilitating and deadly disease, but you can control it and you can learn to live with it as once you are a diabetic, it’s very difficult to reverse it.
In Malaysia, the First National Health and Morbidity Survey (NHMS I) conducted in 1986 reported a prevalence of diabetes of 6.3% and in the Second National Health and Morbidity Survey (NHMS II) in 1996, this had risen to 8.3%. The third National Health and Morbidity Survey (NHMS III) was conducted between April to July 2006 and showed a dramatic increase in the prevalence of diabetes for adults aged 30 years and above to 14.9% – an increase of 80% over a period of just 10 years (8.3% in NHMS II vs 14.9% in NHMS III ) representing an average 8% rise per year.
Can electronic health records (EHRs) serve to help patients manage their health and to provide treatment to patients with chronic diseases, such as diabetics?
EHR systems widely implemented in Wisconsin, USA are improving coordination and making health care more efficient, lowering costs and identifying and treating at-risk patients to improve their health.
Image credit : JSOnline, Milwaukee, Wisconsin, USA.
Eida Berrios, a registered nurse and certified diabetes educator, leads a discussion in early July during a class for patients with insulin pumps at the Sixteenth Street Community Health Center in Milwaukee.
Here is how it works in diabetes management using EHRs for patients at the Sixteenth Street Community Health Centers in Milwaukee, Wisconsin as reported from the July 16, 2012 JSOnline, the online version of The Milwaukee Journal Sentinel – the primary newspaper and the largest newspaper in Milwaukee :
- patients who may have a three-month average blood sugar level higher than the recommended 7% may be flagged by the systems to receive extra help to manage their chronic disease
- doctors can run reports of patients who missed their cholesterol panel check last year and, in that way, focus on patients out of range and get them in for an appointment sooner
- graphics generated from data of individual patient history reports received since 2010 allow doctors compare their patients against national trends and other doctors’ patients
- doctors look at treatment plans and the most recent test results, while providers use the data to create intervention plans, to identify which screenings are getting missed and to refer patients to diabetic educators to help them manage their chronic illness
- the coordinated care and testing that a patient receives when doctors and diabetic educators monitor their patients using the EHR systems provides a holistic view of care, and it can also be shared by doctors to avoid retesting
- doctors become more proactive in providing care by identifying patients who are far away from their health care goals, even if the patient hasn’t been in the clinic for a while, and the patient becomes more informed and they tend not to fall out of care, preventing costly emergency hospitalisations
- the EHR systems remind doctors to address certain screenings and lab tests with their patients
- the EHR systems sends out reminder calls for example about a missed appointment or a missed flu shot
- data in the EHRs system help to document statistics for example, 74% of the 1,895 patients that saw their doctors twice last year have an average blood-sugar level under 8%; it also shows 70% of their diabetic patients have a blood pressure of less than 130/80
- providing monthly reports for example of regular neuropathy exams – to see if diabetics had loss of sensation in their feet, could highlight that too many patients weren’t getting a documented foot exam, and remind doctors to keep up with testing
- information from in-house reports divided by blood-sugar controls, blood-pressure management, cholesterol level and screenings of neuropathy foot exams and retinal exams allows for specific follow-up to target areas patients are struggling with, such as exercise, nutrition, emotional support and diabetes education classes
- researchers use the information from the the EHR systems to identify at-risk groups that live within specific geographic areas by linking clinical information in the EHR system to public health data to identify and map the prevalence of diabetes compared with levels of economic hardships
This is one good example how EHRs serve as a platform to manage health education, to help patients manage their health and to provide treatment.
Abridged by R. Vijayan, from the original article “Diabetes management using electronic medical records” by By Aisha Qidwae of the Journal Sentinel, July 16, 2012.
