August 21, 2025

 

Meeting attendees:
Hospital	Team members
Grady Memorial	Georgia Davis, LeChe’ Williams, Laya Chadalawada
Hassenfeld Children’s	N/A
Johns Hopkins	Nestoras Mathioudakis, Risa Wolf, Josephine Kolawole
Nationwide Children’s	Leanne Winslow, Juan Chaparro
Seattle Children’s	Meenal Gupta
SUNY	Ruth Weinstock, Rachel Hopkins, Jerusha Owusu-Barnie
T1D Exchange	Susan Thapa, Dhruvi Vora, Nicole Rioles, Trevon Wright
UT Southwestern	Abha Choudhary

 

Agenda 

1. Welcome
2. Participating Centers BPA Updates
3. Preliminary Data/ BPA Insight- JHU Team
4. Next Steps

JHU Updates 

• Deployment occurred on May 5th, and the data presented covers through August 5th. 

• 39% of the time, an acknowledgement button was selected. 

• 0.8% of the time, someone added the problem to the problem list. 

• 36% of the time, the advisory was dismissed. 

• 19% of the time, it was deferred. 

• 5% of people opened the smart set to add the device to the med list. 

• The most common acknowledgement reason was “patient declined or was not ready.” 

• Followed by “they’re already on an AID system. We’ll update the med list.” 

Differences Between Adult and Pediatric Data 

• Pediatrics seems to be engaging more with the OPA than adults. 

• Risa stated that in pediatrics, over 50% of people are acknowledging or addressing the OPA. 

• Cancellation rate is at 30% and some deferral. 

• Risa: “patient declines or is not ready” was 42% of the responses in pediatrics. 

• 20% was the patient is not appropriate. 

• 17-18% was the patient was already on an AID, just wasn’t updated on the med list. 

• 11% were in a pre-contemplative phase. 

Adult Data 

• 40% dismissed it, 30% had some acknowledgment, 22% deferred. 

• Very few are opening the smart set or adding the problem to the problem list. 

• The biggest acknowledgement reason was patient decline, followed by already on AID (will update med list). 

Free Text Comments 

• Common themes on the peds side: Newly diagnosed, in a honeymoon phase, on an NDI, doing well, don’t need a pump yet, Patient was incarcerated and couldn’t get access, Subpar patient compliance, Not yet on CGMs, newly diagnosed, not quite ready, needs more education. 

• Other comments: Patient considering, not interested, discussed without detail, Safety concerns (vision/cognitive impairment), Some people wrote insurance when they probably meant cost. 

Provider Feedback (Adult Side) 

• Alert fatigue is a big potential source. 

• Patients don’t have type 1 diabetes. 

• Patients are already on an AID. 

• Problem list reconciliation is a huge problem. 

• A provider reported the OPA fired inappropriately. 

• Training MAs to add devices to the med list at check-in since May. 

• Biggest feedback: right time in the workflow. 

• The main issues revolve around timing, workflow, and ensuring the right person (someone with type 1 diabetes not on an aid) is involved. 

Participating Center Updates 

Nationwide Children’s  

• The QI representative for ENDO will handle the data portion, while Leah focuses on slicer dicer sessions. 

• Leanne removed the cancel option to focus on actionable acknowledgement reasons. 

• Initial data showed many alerts per patient (8-10), which was scaled down. 

Acknowledgement Reasons and Comments 

• There was a wide variety of reasons for patient decline, such as parents not feeling the patient is ready, patients playing football, or families traveling. 

• Some initial feedback indicates that the acknowledgement reason buckets don’t necessarily fit the institution’s specific workflow. 

• Patients attend a pump class with a diabetes nurse educator as a next step in the process. 

• There’s some misuse of acknowledgement reasons, with practitioners sometimes selecting “patient declined” for practitioner-related reasons. 

• The organization is using SNOMED concepts to capture diagnoses. 

Note Templates and Smart Links 

• The organization uses Partners for Kids (PFK) to incorporate care coordination into patient-specific care, especially for long-term diagnoses. 

• A smart link is embedded into note templates to capture data and provide more specificity into the acknowledgement reason. 

• This smart link pulls information into the assessment and plan, offering more detailed descriptions that overlap with current acknowledgement reasons. 

• Smart data elements are associated with each acknowledgement reason to capture information, and an extension is used to pull in the comment. 

Alert Configuration and Feedback 

• The appointment trigger was removed from the note template to prevent the alert from firing during pre-charting, based on feedback. 

• The alert now only fires for office visit encounters, not video visits. 

• Instead of a 90-day lockout, a 72-day lockout was implemented to ensure the alert would fire at the next encounter if acknowledged in a way that it should. 

• There is a consideration to suppress the alert in pre-charting, but input from other groups is desired. 

• It may be necessary to reassess the decision in 8-12 months to see if patients want the alert removed entirely. 

Grady Update 

• Grady went live the first week of August. 

• The build looks like Johns Hopkins’ build, except Grady doesn’t have the order set. 

• Grady has the option to add the problem list. 

• All details match what JHU is doing. 

• Grady is a safety net hospital with historically high no-show rates. 

• The hospital is trying to improve continuity of providers. 

• There is a dedicated clinic for Type 1 diabetes in adults that is expanding. 

 

Feedback on the New System 

• Initial feedback from providers was that it was “too soon” and they needed more time to go through the chart. 

• There was a need for better education on what the buttons meant for accept, dismiss, and defer. 

• A faculty member suggested education around the “defer” button, specifically if it could pop back up after a certain time. 

• The IT team said there aren’t many trigger options outside of “open encounter.” 

• A suggestion was made for the storyboard to have the deferred item pop back up between 5 and 15 minutes later. 

Discussion on “Defer” Functionality 

• Some groups want the deferred item to pop back up because they are forgetting about it. 

• One suggestion was for it to pop back up 15 minutes later or right before closing the chart. 

• The current time frame for defer is set at 60 minutes. 

• There is no “close encounter” trigger yet, but there is talk of it. 

• A “sign note” or “mark note” trigger was suggested but not accepted. 

Technical Aspects and Alternative Solutions 

• The minimum time for an item to pop back up is unknown. 

• One group turned off pre-charging due to negative feedback. 

• The OPA trigger is “open chart,” which shows up when the MA rooms the patient, but the provider hasn’t spoken to the patient yet. 

• The storyboard and practice advisories tab are used to remind providers. 

• Other OPAs have alerts that come up and won’t let you sign the encounter if certain requirements aren’t met. 

• OPA customizations are limited in flexibility compared to others. 

• There are no override reasons. 

• Links and graphics cannot be added. 

• Currently, a user action is required to trigger the alert again. 

Validation and Re-triggering 

• The speaker asks about a validation process where placing a diagnosis code re-triggers the alert if it was snoozed or dismissed. 

• 30 minutes is a reasonable amount of time to lock out patient charts because patients are seen by multiple people (nutritionists, diabetes nurse educators, practitioners). 

• The goal is to capture data on patients using technology (pumps) that hasn’t been documented. 

Aid Use Reporting: T1DX-QI 

• Dhruvi asks about a consensus on a year to use as a cutoff date for when pump models became AID compatible. 

• The question is: If there isn’t discrete data to confirm AID use, can an assumption be made that if a patient has an insulin pump or CGM, they are likely using an AID? 

• Omnipod 5 was commercially released in May 2022, and Control IQ has been available since 2018. 

• Issue: Centers report general pump use but not specific pump variables or AID use. 

• Dr. Mathioudakis asks what percentage of patients with type 1 diabetes using pumps are in manual mode. 

• Concern: If the logic for defining an AID changes, it will affect the baseline for the project. 

• Suggestion: Combine pump and AID metrics in the T1D exchange portal. 

• Consensus: 2022 is a fair cutoff year. 

Ut Southwestern Updates 

• Deployed the intervention on 7/11/2025. 

• The AID fires in pre-charting and office visits. 

• Enhancement: A smart link to update AID information. 

• Educational efforts included division meetings and emails with educational material. 

• Targeted individuals who missed meetings or had low engagement. 

• Patient decline, not ready: More education is needed. 

• Several people got started on pump again. 

• Process: No button to start pump. 

Alerts Engagement 

• 181 BPAs fired for these 42 encounters. 

• 71% engagement. 

• One month data: 246 completed encounters with 187 acknowledgments. 

• No shows were being pulled up during the pre-charting and were being counted. 

• Removing no shows resulted in about 76% engagement this past month. 

• Some fellow visits were being counted twice. 

• Some people say discussing pumps is annoying. 

• “Once deferred, same thing, I forget about it. Can it pop up again after a certain time, 15 minutes or at encounter close?” 

• There should be a button to sign up for pumps as a part of the workflow. 

SUNY Upstate Update 

• Went live yesterday. 

• Training and overview meeting with providers on July 3rd. 

• BPA includes dismissed reasons, opening the order set, and adding problem. 

• Correct criteria in building the BPA: 

• Patient is type 1 diabetes. 

• No AID system listed on their medication list. 

• No diagnosis related to an insulin pump. 

• Patient must be older than 18 years. 

BPA Details 

• An order set lists pumps and CGMs used, with a referral to diabetes education for pump classes. 

• Dismissed reasons have been implemented, with an option to add more detail or a comment. 

• A BPA locks out a dismissed reason for 90 days, retriggering if the patient isn’t on an AID system after that period. 

• A defer button allows pre-charting providers to postpone the BPA, which will retrigger when the encounter is reopened. 

Potential Modifications 

• Turning off pre-charting. 

• Implementing a snooze function with a 30-minute lockout. 

• Adding a hyperlink for documentation within the smart form. 

• Implementing a validation system at the time of entering a visit diagnosis. 

Next Steps 

• Next meeting: September 18th. 

• The meeting will include feedback from SUNY upstate, Seattle, and Hassenfeld. 

• Hopkins will share the impact of any modifications made. 

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