Continuous Glucose Measures May Soon Be Incorporated Into EHR

A new consensus report aims to establish standards for integration of continuous glucose monitoring (CGM) data into the electronic health records (EHRs) of people with diabetes.

It is the first standard for integration into the EHR of data from a wearable device, according to a statement from the Diabetes Technology Society (DTS).

"The current state of the art for most providers is transcription. You open a web-based portal, you look at a printout of the average glucose, and then you type that into your notes," project co-chair Juan Espinoza, MD, of Children's Hospital Los Angeles, University of Southern California, told Medscape Medical News.

He presented an overview of the project on November 4 during the virtual DTS meeting.

The project, organized by DTS, is entitled, "The Integration of Continuous Glucose Monitoring Data Into the Electronic Health Record (iCoDE)." The 108-page document, entitled, "2022 iCoDE Report: CGM-EHR Integration Standards and Recommendations" was published November 7 on the DTS website and can be downloaded for free.

"What we've been doing with the iCoDE project is setting up both the technical and workflow components that make it possible to look at CGM data in the EHR," added Espinoza.

Stakeholders involved in iCoDE include over 130 individuals representing the four US CGM manufacturers (Dexcom, Abbott, Medtronic, and Senseonics), major EHR vendors, the US Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Institute of Electrical and Electronics Engineers, information technologists, and clinicians, as well as privacy lawyers and IT consultants. And several medical professional societies are reviewing the documents to determine if it meets criteria for endorsement, Espinoza said.

The report has five main sections: an introduction with background on the project and key concepts/definitions, detailed technical standards and considerations, practical clinical implementation considerations, a template CGM-EHR project implementation guide, and a summary of 54 formal recommendations. An appendix contains references, resources, a participant list, and funding information.

Standards Offer Improved Documentation, Workflow

The clinical implementation section specifies how clinicians will interact with the system, including placing a query into the EHR to pull in the data from the CGM manufacturers' cloud databases.

"You place an order in the EHR, the same way you'd order lab tests or a procedure. That triggers a mechanism to pull in the data that you review in the results section," Espinoza explained.

Patient consent is built into the system. "Permission is critical...The patient knows that a connection will be established between the EHR and their CGM account. They can revoke if they choose," he noted.

Once implemented, the standards should be helpful to clinicians in several ways. "It will improve documentation because now instead of transcribing or scanning results they will appear automatically in the EHR. You can treat it like any EHR data — copy and paste it, forward into notes, build clinical decision support around it, the same way as vitals or labs," he said.

Moreover, it should improve workflow. "Any practice that deals with CGM data knows what a time sink it can be if it's not done before the visit. We know you get better diabetes management if you're reviewing the data [beforehand]. Clinicians need to have fast and easy access to the data so they can take better care of patients."

And a third advantage, Espinoza said, is "now we can actually track quality based on CGM data. Once it's in the EHR you can track it, measure it, and improve on it."

The DTS website includes links for submitting comments, suggestions for updates, error reports, or questions about implementing CGM-EHR.

Espinoza has reported receiving research funding from the NIH and FDA.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. She is on Twitter: @MiriamETucker.

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