September 11, 2023

Lily:  We (CHLA) are one of the few Cerner using centers so would not have access to the smart links/phrases. However, we have implemented changes in our documentation so that more of us are now charting in a Form with discrete fields for CGM matrix. I would estimate that we are capturing 60 to 70% of the CGM users, although the consistency of entering these data depends on whether we have a scribe that enters these parameters and the clinician involved. I believe that we can use the discrete fields to map to T1D exchange. It takes me less than 10 seconds to type in the 3 numbers (I typically just enter the <70, 70-180, >180), without having to build additional clickable fields.  

To accommodate different center that have different data collection process, I would propose that centers can either map the actual numbers to the desired parameters, or have clickable Yes/No fields, and then on the T1D Exchange data side, to then unify the reported output. This would minimize the number of builds the various centers need to have to map the data.  

Regarding digital integration of device data into EMR, we recently had a conversation with someone at Dexcom, who is interested in working with us so that the discrete fields of interest would be pulled into our notes/forms, and those fields would then by mappable. I am hoping that once the workflow is established with the major EMR platforms, it would be easier to adapt for the different centers. These conversations about integration seem to take a very long time and unfortunately do not always end up with a successful outcome. But I will hope for forward movement.  

I also agree with having pilot centers as part of this work group, to at least learn the barriers and successes of such an integration. 

Francesco: Can you tell more about charting with discrete fields for CGM matrix? I wonder how this is done in order to make it extractable. It may be an alternative to smart links. 

From Lily : Brian Miyazaki in our group has created Power Forms for diabetes related parameters. Most of us never completes all of the boxes. But if they are filled in, then those data can be extracted. The fields highlighted in yellow is required (can’t exit the form otherwise). I usually just complete the “CGM data” section. Then anything we have filled in, will pull into our Dyne Doc Diabetes Note type. Of course, if people don’t go to this field, then we have no data. We generally have scribes to help us document on our main campus, and they are much better about filling this in then the clinicians are…