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TRANSCRIPT
Innovative mobile technology to support the care of women with gestational diabetes mellitus
Dr Marlien Varnfield
M♡THer
CSIRO AEHRC
Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
BIOMEDICALINFORMATICS
Biostatistics, imaging and genomics based -
clinical workflows
HEALTHINFORMATICS
Improving health system performance & productivity from
electronic health data
HEALTHSERVICES
Improving access to services &
management of chronic diseases
CVD
‘Cardihab’
CKD
PD-Buddy
COPD
M-COPD
Diabetes
• M♥THER• Insulin Stab
Mental health
Health-e Minds
mHealth projects
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
Women with GDM
Midwife
Obstetrician
Endocrinologist
Diabetes Educator
Dietitian
Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
Key problems
SuboptimalCo-ordination
of Care
Inconvenient
Ineffective
Women with GDM carry a paper based blood glucose level diary
Results not always 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 1st 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 Nominee, 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
• 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
Implementation study MSH
Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO
Real world…
Adapted from https://www.kingsfund.org.uk/projects/nhs-65/alternative-guide-new-nhs-england-2013
NDIS
GPs
PIR
FDA
Marlien Varnfield, AEHRC, CSIRO
• 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
Implementation challenges
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