Challenges with Patient Adoption of Automated Integration of Blood Glucose Meter Data in the Electronic Health Record.

Providers often encourage patients with type 1 diabetes (T1D) to contact them with blood glucose (BG) values between visits. However, patients and families find it cumbersome to share their BG values with clinical providers, creating a barrier to communication. Although many phone applications exist to help patients track BG values, most do not integrate with the electronic health record (EHR). Recent advances in technology can integrate the glucose meter (GM) data into the EHR. This pilot and feasibility study aimed to understand how an automated integration system of GM data into the EHR and remote monitoring by health care providers would impact patient-provider communication. Patients or parents of patients with T1D (n = 32, average hemoglobin A1c [HgbA1c]: 8.5%, SD: 1.7, average age: 13.9 years, SD: 3.8) who owned an Apple iPod® or iPhone® (5s or higher) participated, and their number of contacts through telephone calls or MyChart™ messages between clinic visits was recorded during each of the three phases: run-in, intervention, and learned. Twenty-eight families completed all phases, and despite guided review of BG trends and automated integration of BG values, the number of patient-initiated calls (P = 0.23) and HgbA1c values (P = 0.08) did not improve, nor was there a clinically significant change in the number of BG checks per day. Barriers to adoption and effectiveness of this technology exist, and patient motivation is still needed.