Abstract
Management of complex chronic diseases such as diabetes requires the assimilation and interpretation of multiple laboratory test results. Traditional electronic health records tend to display laboratory results in a piecemeal and segregated fashion. This makes the assembly and interpretation of results related to diabetes care challenging. We developed a diabetes-specific clinical decision support system (Diabetes Dashboard) interface for displaying glycemic, lipid and renal function results, in an integrated form with decision support capabilities, based on local clinical practice guidelines. The clinical decision support system included a dashboard feature that graphically summarized all relevant laboratory results and displayed them in a color-coded system that allowed quick interpretation of the metabolic control of the patients. An alert module informs the user of tests that are due for repeat testing. An interactive graph module was also developed for better visual appreciation of the trends of the laboratory results of the patient. In a pilot study involving case scenarios administered via an electronic questionnaire, the Diabetes Dashboard, compared to the existing laboratory reporting interface, significantly improved the identification of abnormal laboratory results, of the long-term trend of the laboratory tests and of tests due for repeat testing. However, the Diabetes Dashboard did not significantly improve the identification of patients requiring treatment adjustment or the amount of time spent on each case scenario. In conclusion, we have developed and shown that the use of the Diabetes Dashboard, which incorporates several decision support features, can improve the management of diabetes. It is anticipated that this dashboard will be most helpful when deployed in an outpatient setting, where physicians can quickly make clinical decisions based on summarized information and be alerted to pertinent areas of care that require additional attention.
Highlights
Diabetes is a chronic metabolic disorder that is characterized by persistent elevation of blood glucose
The glycemic control can be assessed by fasting plasma glucose and glycated hemoglobin A1c (HbA1c), whereas lipid control can be monitored by serum total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides
The renal function is monitored by estimated glomerular filtration rate and urinary albumin:creatinine ratio (UACR)
Summary
Diabetes is a chronic metabolic disorder that is characterized by persistent elevation of blood glucose. Patients with diabetes need to be treated to meet certain targets, which are based on laboratory assessment, to minimize the risk of development of long-term complications. They are monitored by regular measurement of laboratory markers related to glycemic control, lipid control and renal function [3]. The renal function is monitored by estimated glomerular filtration rate (eGFR) and urinary albumin:creatinine ratio (UACR) Each of these laboratory tests has its own recommended target that guides clinicians on treatment adjustment, and should be repeated at certain time intervals [3]. This makes monitoring of these laboratory markers a highly complex cognitive task
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