Using blood glucose data as an indicator for epidemic disease outbreaks.

In the future, transfer of vital sensor data from patients to the public health care system is likely to become commonplace. Systems for automatic transfer of sensor data are now at the prototype stage. As electronic health record (EHR) systems adapt such functionality, widespread use may become an actuality in the foreseeable future.To prevent spreading of diseases, an early detection of infection is important. At the time an outbreak is diagnosed, many people may already be infected due to the incubation period. This study suggests an approach for detecting an epidemic outbreak at an early stage by monitoring blood glucose data collected from people with diabetes. Continuous analysis of blood glucose data may have the potential to prevent large outbreaks of infectious diseases, such as different strains of Influenza, Cholera, Plague, Ebola, Anthrax and SARS.When a person gets infected, the blood glucose value increases. If the blood glucose data from a large number of patients with diabetes are collected in a central database, it may be possible to detect an epidemic disease outbreak at an early stage. Advanced data analysis on the data may detect predominant numbers of incidences, indicating a possible outbreak. This gives the health authorities the possibilities to take actions to limit the outbreak and its consequences for all the inhabitants in an affected area.At the Norwegian Centre for Telemedicine, a mobile system for automatic transfer of blood glucose values has been constructed. By using wireless communication standards such as Bluetooth and GSM, the system transfers blood glucose data to an electronic health record system. Combined with a system accessing and querying data from EHR systems for patient surveillance we are extending our work into an Epidemic Disease Detection using blood Glucose (EDDG) system.

Wireless transfer of sensor data into electronic health records.

The purpose of this study is to explore how wireless transfer of sensor data can be implemented in existing Electronic Health Record (EHR) systems. Blood glucose data from people with diabetes Type 1 has been selected as the case.As proof of concept, a prototype for sending blood glucose measurements into an EHR system was developed for the DIPS EHR system. For the prototype to be transferable to a general setting, care was taken not to introduce any additional workload for the diabetes nurses or the diabetes Type 1 patients. In the prototype, the transfer of blood glucose data is automatic and invisible to the user, and the data is presented to the nurses within the existing DIPS laboratory module.To determine whether deployment of such a system would present any risks or hazards to patients (medical or financial), a risk analysis was performed. The analysis indicates that storing blood glucose values in the patient's EHR does not represent any significantly increased risks for the diabetes patient.The study shows that existing EHR systems are well suited to receive sensor data. The three main EHR systems in Norwegian hospitals are all supported with application programming interfaces (APIs), enabling external vendors to add modules. These APIs are sufficient to implement modules for receiving sensor data. However, none of the systems currently have commercially available modules for receiving such data.

Parent-child interaction using a mobile and wireless system for blood glucose monitoring.

BACKGROUND: Children with type 1 diabetes and their parents face rigorous procedures for blood glucose monitoring and regulation. Mobile telecommunication systems show potential as an aid for families' self-management of diabetes. OBJECTIVE: A prototype designed to automatically transfer readings from a child's blood glucose monitor to their parent's mobile phone was tested. In this formative stage of development, we sought insights into the appropriateness of the concept, feasibility of use, and ideas for further development and research. METHODS: During four months, a self-selected sample of 15 children (aged 9 to 15 years) with type 1 diabetes and their parents (n = 30) used the prototype approximately three times daily. Parent and child experiences were collected through questionnaires and through interviews with 9 of the parents. RESULTS: System use was easily integrated into everyday life, and parents valued the sense of reassurance offered by the system. Parents' ongoing struggle to balance control of their children with allowing independence was evident. For children who measured regularly, use appeared to reduce parental intrusions. For those who measured irregularly, however, parental reminders (eg, "nagging") appeared to increase. Although increased reminders could be considered a positive outcome, they can potentially increase parent-child conflict and thus also undermine proper metabolic control. Parents felt that system appropriateness tapered off with the onset of adolescence, partly due to a potential sense of surveillance from the child's perspective that could fuel oppositional behavior. Parental suggestions for further developments included similar alerts of irregular insulin dosages and automatically generated dietary and insulin dosage advice. CONCLUSIONS: User enthusiasm suggests that such systems might find a consumer market regardless of whether or not they ultimately improve health outcomes. Thus, more rigorous studies are warranted to inform guidelines for appropriate use. Potentially fruitful approaches include integrating such systems with theory-based parenting interventions and approaches that can aid in interpreting and responding to experiences of surveillance, virtual presence, and balances of power in e-mediated relationships.