M ♡ THer Innovative mobile technology to support the care of women with gestational diabetes mellitus Dr Mar arlie lien Var arnfie ield ld
CSIRO AEHRC BIOMEDICAL HEALTH HEALTH INFORMATICS INFORMATICS SERVICES Biostatistics, imaging Improving health Improving access to system performance and genomics based - services & & productivity from clinical workflows management of electronic health data chronic diseases Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
mHealth projects CVD Diabetes • M ♥ T HER ‘ Cardihab ’ • Insulin Stab CKD COPD Mental health PD-Buddy M-COPD Health-e Minds Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
GDM - What is the problem? • GDM is one of the most common medical complications of pregnancy • Usually occurs around the 24th to 28th week of pregnancy • Associated with short and long term risks for both mother and baby, especially if blood glucose levels are not well controlled • Incidence of GDM is increasing • New diagnostic criteria for GDM were introduced in 2014 • At Redland Hospital, 16% of women engaged in Maternity Services diagnosed with GDM Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
Challenges Endocrinologist Diabetes Obstetrician Educator Women with Midwife Dietitian GDM Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
Key problems Women with GDM carry a Inconvenient paper based blood glucose level diary Suboptimal Co-ordination of Care Results not always Ineffective available to the MDT team in a timely manner Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
Our solution Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
Our solution Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
Redland Feasibility Study (n=40) Primary outcomes: • User adoption and user satisfaction Secondary outcomes: • Number of BGL clinical reviews • Frequency of antenatal contact • Occasions of service related to GDM attended by women • Time to commencement of therapy Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
Study Cohort Inclusion criteria confirmed 1 st OGTT diagnosis of GDM diagnosed between K24-28 • • at least 16 years of age • referred from general practitioner for antenatal care at Redland Hospital prior to K20 • owning and ability to use smart mobile phone (both Androids and Apple phones) • ability (and willingness) to upload data either via WiFi or Mobile Data • ability to speak and understand English Exclusion criteria • other types of diabetes • other illnesses that would limit participation e.g. chronic kidney disease (stage3-4) • a known history of major psychiatric illness Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
Recruitment Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
Study Outcomes • Survey responses from the women showed the app is user friendly, convenient, and continuation is highly recommended • Treating clinicians reported improved communication with the women they treat and showed an increase in multi-disciplinary co-ordination amongst themselves BGL clinical reviews were significantly higher with the introduction of M ♡ THer, as was • frequency of ante-natal contact. Time to treatment and ante-natal clinic visits were comparable • 8 women were identified with elevated readings in the first week of using the app enabling early intervention • Due to elevated fasting BGL’s 12 were commenced on Metformin, 8 were commenced on insulin Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
Interest • Health Round Table Winner , Category: “Improving self - care”, Brisbane, July 2017 • RN Breakfast Show interview, May 2018 • Media report, Essentialbaby, May 2018 • Presentation, Australian Diabetes Educators Association (ADEA) QLD State Conference, Gold Coast, May 2018 • 2018 iAwards Nomin ee, Queensland Awards, Brisbane, Jun 2018 • Show cased at the Australasian Diabetes in Pregnancy (ADIPS) Conference, Adelaide, Aug 2018 • Metro South Health Board Chair’s Award , Winner in Category: “Innovation Through Digital Technology”, Brisbane, Sep 2018 • International Hospital Federation, Gold Award Winner : “Excellence Award for Quality & Safety and Patient Centred Care” Brisbane, Oct 2018 • Invited presentation, Australasian Diabetes Advancements and Technology Summit. Sydney, Nov 2018 • Queensland Health Award of Excellence , Highly Recommended Dec 2018 Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
Implementation study MSH • Funded for further implementation at all MSH Antenatal Clinics • Translating platform into different languages • Offering MoTHer to all women diagnosed with GDM • FHIR enabled platform development • Commencing July 2019 Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
Real world… NDIS PIR FD A GPs Adapted from https://www.kingsfund.org.uk/projects/nhs-65/alternative-guide-new-nhs-england-2013 Marlien Varnfield, AEHRC, CSIRO
Implementation challenges • Medical advances, emerging technologies, consumer choices and expectations • Providing high assurance security measures to put patients' privacy and security first • Managing digital security to reduce the risk of downtime and breaches • Integration with clinical systems • Lack of standardised terminology, system architecture, indexing and regulation • Change management Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
Acknowledgments Principal Investigator: Dr Wendy Dutton Divisional Director of Women’s and Children’s Services, Metro South Health (MSH) Co-Investigators: Dr Joel Iedema , Director of Medicine, Redland Hospital; Liesel Higgins , Redesign Manager, Transformation, Innovation, Collaborative Team, MSH Georgia Hellen , A/Project Manager Redesign, Transformation & Innovation Collaborative Planning Engagement Reform, MSH Naomi Scolari , Project Officer and Dietitian, Redland Hospital; Roisine Warwick , Diabetes Educator (Clinical nurse consultant), Redland Hospital; Janet Knowles , Nurse Unit Manager, Women and Birthing, Redland Hospital; Barbara Kleine , Senior Dietitian, Redland Hospital; Denis Morton , Chronic Disease Team Leader, Redland Hospital; Dr Rachel Stoney , Director Nutrition and Dietetics, Redland Hospital. Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
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