Using web technology to support population-based diabetes care

Abstract

Background: Managed clinical networks have been used to coordinate chronic disease management across geographical regions in the United Kingdom. Our objective was to review how clinical networks and multidisciplinary team-working can be supported by Web-based information technology while clinical requirements continually change.

Methods: A Web-based population information system was developed and implemented in November 2000. The system incorporates local guidelines and shared clinical information based upon a national dataset for multispecialty use. Automated data linkages were developed to link to the master index database, biochemistry, eye screening, and general practice systems and hospital diabetes clinics. Web-based data collection forms were developed where computer systems did not exist. The experience over the first 10 years (to October 2010) was reviewed.

Results: The number of people with diabetes in Tayside increased from 9694 (2.5% prevalence) in 2001 to 18,355 (4.6%) in 2010. The user base remained stable (~400 users), showing a high level of clinical utility was maintained. Automated processes support a single point of data entry with 10,350 clinical messages containing 40,463 data items sent to external systems during year 10. The system supported quality improvement of diabetes care; for example, foot risk recording increased from 36% in 2007 to 73.3% in 2010.

Conclusions: Shared-care datasets can improve communication between health care service providers. Web-based technology can support clinical networks in providing comprehensive, seamless care across a geographical region for people with diabetes. While health care requirements evolve, technology can adapt, remain usable, and contribute significantly to quality improvement and working practice.

Figure 1

Structure of the MCN for diabetes in Tayside.

Figure 2

The Tayside Diabetes MCN information Website (http://www.diabetes-healthnet.ac.uk).

Figure 3

Example patient summary. Icons allow access to clinic correspondence, prescribing, data histories, and Web forms (anonymized data shown).

Figure 4

Example of practice list showing date and status of last foot screening with risk factors shown in red (anonymized data shown).

Figure 5

Example practice summary report for hemoglobin A1c. The practice is benchmarked against the whole region.

Figure 6

Annual system utilization.

Figure 7

Annual active users.

Figure 8

Number of logins by user.

Figure 9

Utilization by functional area.