Integrating cell phones with TuDiabetes.com?

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Permalink Reply by AndyRozman on February 6, 2009 at 9:48am

Hi Steve !
I am talking for me personaly here, not for any group.

What I personaly am looking for is application, which has ability that I enter at least bg data and food eaten (freetext with CH values or read from Db, where ch values are stored) and in return I get calculation of needed insulin (according to my CH/Insulin ratio and Insulin/BG ratio). And next application must have some sort of export of this data into text file, which can at later time be imported into other software.

I don't exactly understamd whjat concept of your software is. Do people send data to doctors, which then evaluate it and send back response, or is data sent to special software which then sends back response. What is this response? Amount of insulin needed?

What is general idea of your software? What does it do?

Andy

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Permalink Reply by Steve Goldberg on February 6, 2009 at 10:33am

Hi Andy,

First thank you for your feedback!

Now please let me try and explain. Currently, the application is designed to link the person with diabetes with the family doc or nurse (certified diabetes educator.) In one pilot project the bg data (before or after meal reading is also marked) is sent (from the cell, data transmitted and stored in the) WinGLUCOFACTS™ (Bayer) software loaded in PC connected to the internet and located at the diabetes center. This software has some intelligence and will interpret the sugar levels etc and report back recommendations. For instance you can gain this capability using this Bayer software, INET sync program (transmits the data between cell phone and WinGLUCOFACTS™) and a URL link in your cell phone to retrieve the cell phone application. Also if you wish both your nurse and/or family physician can download your data into WinGLUCOFACTS (using their PC connected to the internet) and by using the notes feature can give you their recommendations. These notes are transmitted back to your cell phone and read prior to entering your next bg data. The Bayer software is free to download at http://www.winglucofactspro.com (please review the professional version.) Please take a look at it to see if will meet your specific requirements. Also the Bayer software when using the cell phone will work with all meters, you don’t need any special meter or a Bayer meter to run WinGLUCOFACTS.

I hope this helps

Steve

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Permalink Reply by AndyRozman on February 6, 2009 at 11:36am

Hi Steve !

Thank you for explanation...

I have taken a look at this software (Winglucofacts), some time ago and I must say I was not impressed with it.At least not enough to use it (I am using Bayer meters for few years now).

Do you have different profiles for each user?
I mean the software itself has no insulin dosage prediction, at least I couldn't find any... (and I looked again now, before writing this and I again found nothing)...
For this to work you would need great teams of doctors or diabetes trained nurses to assist people... My previous diabetes doctor was not really computer savy. I waited for him to return mails for at least a day (and this was good case scenario in most cases his replies were after 2 days). My new doctor is in touch with new techologies, but his replies also take time...

Wouldn't be easier to just make mobile application which can intrepret insulin dosage and has option to send request to doctor (note functionality).

Take care,
Andy

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Permalink Reply by Steve Goldberg on February 6, 2009 at 1:27pm

Hi Andy,

I understand, but WinGLUCOFACTS is only one solution. As background the cell phone application is designed to transmit data back into any available software.

However, your feedback has helped me clarify the focus of my discussion. Please let me explain, the reason I started this discussion was to add value to a social network and improve the support among its members. My indention was to keep it really simple and see if the cell phone application can help report bg data on a daily basis (to report on members daily bg levels in a graph form) to further encourage communication, provide help, feedback and support on achieving and maintaining good control. For an example where this taking place please look at PatientsLikeMe.com. This does not include diabetes or the use of cellphone technology to link data back into the site. However it does show how members report their health status and receive help from other members. I believe once something like this is set-up for diabetes a possible next step is to see the best way to link with physicians and nurses in the process and how to add (if needed) more technology solutions.

Does this help clarify my direction and is this possible? What steps would you recommend?

Thank you, again!

Steve

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Permalink Reply by AndyRozman on February 6, 2009 at 2:38pm

Hi !

Now I think I am getting, what you would like to do... Interesting idea... I have taken a look at patienslikeme.com, interesting community... not for diabetics yet, but interesting...

If this should be help for a lot of users, you would need to extend it following ways:
1. Sending BG (that you have)
2. Sending BG and CH
3. Receiving back exactly how much of insulin to take. If you send only current BG you can only calculate what we call 'Correction bolus', this is amount of insulin needed to make your BG "normal", if you get CH data, you can also calculate 'Carb Bolus', which is amount of insulin needed to cover the food you are going to eat
4. Sending HbA1c data (to see in community)

there are a lot of other stuff that would be good to, for example good web interface to see data, graphs, ... etc.

And first step would definitly be to remove WinGluco Facts out of the equation...

Maybe get in contact we one of online diabetes web sites?

Andy

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Permalink Reply by Allen A on March 8, 2009 at 11:02am

Steve,

From my experience with doctors, I would say they're not interested in receiving daily updates on their patients BG. It's too much information for them. They just like to make decisions based on some abnormal patterns. The cellphone application is a good idea, but still suffers from the bottleneck of users having to enter their readings manually.

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Permalink Reply by Steve Goldberg on March 8, 2009 at 2:15pm

Hi Allen.

Thank you so much for your feedback, it is very much appreciated!

In regard to physicians participating in the program we found that this is dependent on their interest and compensation to support Chronic Disease management. As we see the healthcare system transition from treating acute care to managed care (where physicians are compensated) more physicians will be able to take more of an active role.

We did not see taking the reading manually as too much of a bottleneck. When reviewing the exit surveys from one pilot with 20 people the findings were very interesting. In summary, after using their cell phones, 19 out of 20 said they measured their blood glucose levels once a day or more often, a substantial improvement. Among these daily participants, the average user logged 2.8 readings. They reported liking “ease of use” (8 mentions), “improve feedback” (7 mentions), and “increased sense of accountability” (3 mentions). The participants said the program was “somewhat better” (4) or “much better” (11) than their previous method (i.e. manual logs.) Among those who said “much better” the main reason was that the program made them accountable or kept them honest (5). Almost all of the respondents (19) said the program made a “moderate” to “substantial impact” on their ability to control their sugar levels. Eleven were “very” or “extremely” interested in continuing the program and 16 said they would recommend it to their physicians.

However these are small pilot tests, too small to be generalizable to the larger population of diabetics. It appeared to be acceptable to most participants and a significant improvement over logs. It is possible that this group was more motivated than ordinary diabetics, or that inclusion in the pilot test prompted greater compliance with more frequent monitoring. The surprise finding is that daily recording in real time made a significant number of participants feel more accountable. This suggests that the program has a motivational aspect that could enhance self monitoring and compliance.

I hope this helps.

Steve

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Permalink Reply by Allen A on March 9, 2009 at 11:26am

It's all well and good to talk about people liking it, but they're not going to pay for it. In your survey, did you ask whether people would pay $0.50 per reading for a tracking/reporting service? So if people don't pay for it, you'll have to look at doctors for revenue.

Doctors want to bill for everything these days. I've heard of some family doctors charging patients an overhead cost for paperwork, anywhere from $150 - $300 per year. This is a real ethical issue. The OHIP and ODB budgets and billing rates are slowly shrinking and these are the games they play. It looks like just when the budget for chronic disease should be increasing, the actual health care budgets are decreasing.

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Permalink Reply by Steve Goldberg on March 10, 2009 at 5:57am

Hi Allen,

Good question, the idea is to provide this free of charge to people except for the cell phone data charges. As background, in the pilot projects each participant was responsible for paying for his/her cell phone data. For the people that could not afford this they used the same application on a PC connected to the internet.

In regard to the doctors, in Canada, the OHIP billing is looking to paying physicians to help support people with chronic disease. I'm not sure of the details but through my preliminary investigation it can be significant. For instance one change is to allow physicians to care for patients and get paid without the patient visiting their office (vs traditional OHIP practices) a key success factor in chronic disease management. It is believed, for example in diabetes, a program using the cell phone to monitor bg levels will go a long way to save both physician and the patient time with improved outcomes. From my findings it seems that US and Canada is focused on funding the prevention and management of chronic disease. But for the most part this is in transition, and just starting to be realized - unfortunately very slowly. I hope this process speeds up.

- Steve

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Permalink Reply by Allen A on March 11, 2009 at 2:45pm

Steve,
Is there a white paper or journal article you can point me to regarding the cellphone trial? I would be interested in looking at it.
20 participants isn't bad. It's 20 more than I knew existed before!

Allen

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Permalink Reply by Steve Goldberg on March 12, 2009 at 10:38am

Hi Allen,

A good summary of this pilot project is presented in a poster titled The Credit Valley Hospital pilot project "Supporting Diabetes Self-Care Through a Wireless Program". This poster was accepted for presentation at the Canadian Diabetes Association and Canadian Society of Endocrinology and Metabolism (CDA/CSEM) Professional Conference and Annual Meeting, October 24-27, 2007, Vancouver. For a copy of the poster please click this link http://www.inet-international.com/INET/Update/2008January/diabetes_...

For additional information please find a list of publications, talks and book chapters below for your review. This material has been produced through a research collaboration between INET and CMMT (Center for the Management of Medical Technology (CMMT), Stuart School of Management
Illinois Institute of Technology, Chicago, USA) about the development of an ICT (information and communication technology) delivery model to support chronic disease management.

Thank you.


Steve


Publications in journals:
1. Wickramasinghe, N. and S. Goldberg 2008 “Facilitating Superior Chronic Disease Management through a Knowledge-based systems development model” Intl J Electronic Health vol 4 issue 3 / 4 pp. 299- 311
2. Wickramasinghe, N., S. Goldberg and R. Bali 2008 “Enabling Superior M-health Project Success: A tri-Country Validation” Intl J. Services and Standards vol 4 no. 1 pp. 97-117.
3. Wickramasinghe, N. and S. Goldberg 2007 Adaptive Mapping to Realisation Methodology (AMR) to facilitate Mobile Initiatives in Healthcare” Int. J Mobile Communications vol 5. no. 3. pp 300-318
4. Wickramasinghe, N. and S. Goldberg 2004 "How M = EC2 in Healthcare" International Journal of Mobile Communications (IJMC) vol 2. no. 2 pp140-156.
5. Wickramasinghe, N., S. Sharma and S. Goldberg 2003 “A Standardized Mobile Internet (Wireless) Environment For Mobilizing Healthcare” International Journal Healthcare Technology and Management vol 5 Issue 3/4/5 pp 232-249.



Presentations:
1. Wickramasinghe, N. and S. Goldberg 2007 “Facilitating Superior Chronic Disease Management Through a Knowledge based Systems Development Model” Hospital of the Future Oct 3-5 Pisa, Italy
2. Wickramasinghe, N. and S. Goldberg 2005 “A Framework for Delivering m-health excellence” 18th Bled e-commerce conference proceedings.
3. Wickramasinghe, N and S. Goldberg 2004 “How M=EC2 in Healthcare” Int. Conference on Information Technology (ITCC) 5-7 Las Vegas pp. 252-257.
4. Wickramasinghe, N. and S. Goldberg 2002 “Mobilizing Healthcare” Proceedings of the 5th ICECR conference Montreal Oct.
5. Wickramasinghe N. and S. Goldberg 2002 "Mobilizing Health Care" appears in the proceedings of the 2nd Hospital of the Future Conference Chicago 27-29 July.
6. Wickramasinghe, N and S. Goldberg 2001 "m-commerce the mobile vision of e-commerce" IFIP TC 8 Conference Salzburg 22-23 June.

Book chpts:
1. Wickramasinghe, N., R. Bali and S. Goldberg 2008 “Knowledge Management and Value-Driven Healthcare” in Eds J. Liebowitz "Making Cents Out of Knowledge Management and Competitive Intelligence" The Scarecrow Press Inc. Maryland
2. Wickramasinghe, N. and S. Goldberg 2006. “M-health: A New Paradigm for Mobilizing Healthcare Delivery” in Unwired Business Cases in Mobile Business pp. 187-2002 Eds. S. Barnes and E. Scornavacca IDEA Group Inc. Hershey.
3. Wickramasinghe, N. and S. Goldberg 2006 “A Framework for Delivering M-health excellence” For Web-mobile-based Applications for Healthcare Management”edited by Dr. Latif Al-Hakim and Dr. Khalid S. Soliman to be published in 2006.
4. Wickramasinghe, N. “Delivering M-health Excellence: The Wi-INET Model” with S. Goldberg forthcoming in Ed Encyclopaedia on wireless and Mobile Commerce Idea Group, Hershey.