1. The Organization and Display of Blood Glucose Measurement Information Matthew I. Kim, M.D. Johns Hopkins University Division of Endocrinology and Metabolism Division of Health Sciences Informatics

3. Data Management Issues Blood glucose measurements – Volume – Currency Insulin prescriptions – Flux – Decentralization Evaluation – Integration – Abstraction

4. BDLHS

5. 57 seconds

12. Design Clinical Operational Integrated Explanatory Flexible Vector graphics

14. 32 U5 R25 N11 H17 L

15. 32 U5 R25 N11 H17 L

16. 16 인슐린 5 Actrapid25 Protaphane 32 U5 R25 N11 H17 L

23. 1. Selection of test cases 2. Establishment of reference standards 3. Comparison study Evaluation

24. Test cases Queried IN-TOUCH ® Microsoft Access database –100 measurements within 90 days – Clustering within pre-meal time blocks – Identified 43 cases Reviewed medical records

25. Test cases 5 test cases B L D HSB L D B D B D B L D Type 1 Type 2 Gestational

26. Reference Standards Logbook views –100 contiguous blood glucose measurements Insulin prescriptions –Standard terminology 5 practicing endocrinologists Recommendations –Incremental changes in doses –Changes in frequency of measurement

27. Reference standards Accepted – 4 out of 5 reviewers 85% - all 5 –Direction of changes in doses –Timing of changes in frequency of measurement

28. Comparison study PGY2 and PGY3 Osler Medicine Residents n = 20 Session 1Session 2 Recommendations –Incremental changes in doses –Changes in frequency of measurement Completion times Subjects Logbook Display

29. Comparison study Responses –Direction of changes in doses –Timing of changes in frequency of measurement Data –Correct responses –Incorrect responses –Completion times Analysis –Paired t-test, 2-tailed

30. Correct Incorrect ** * = p < 0.05 = p < 0.01 Time

31. Correct Incorrect Time 3:47 HSB D ** * = p < 0.05 = p < 0.01

32. Correct Incorrect Time 3:471:32 HSB D ** * = p < 0.05 = p < 0.01 **

33. Correct Incorrect ** * = p < 0.05 = p < 0.01 Time

34. Correct Incorrect Time 3:31 B L D HS ** * = p < 0.05 = p < 0.01

35. Correct Incorrect Time 3:311:30 B L D HS * ** * = p < 0.05 = p < 0.01

36. Correct Incorrect ** * = p < 0.05 = p < 0.01 Time

37. Correct Incorrect 3:08 B D ** * = p < 0.05 = p < 0.01 Time

38. Correct Incorrect 3:081:19 B D ** * = p < 0.05 = p < 0.01 ** Time

39. Correct Incorrect ** * = p < 0.05 = p < 0.01 Time

40. Correct Incorrect Time 4:30 B L D ** * = p < 0.05 = p < 0.01

41. Correct Incorrect Time 4:301:32 B L D ** * = p < 0.05 = p < 0.01 **

42. Correct Incorrect ** * = p < 0.05 = p < 0.01 Time

43. Correct Incorrect Time 4:32 B L D ** * = p < 0.05 = p < 0.01

44. Correct Incorrect Time 4:323:11 B L D ** * = p < 0.05 = p < 0.01

45. www.mikim.net/development/bloodglucose.html

46. 135 Before After Breakfast Lunch Dinner Bedtime !!! 135 Before Breakfast !!! 135