The adaptation of a single institution diabetes care platform into a nationally available turnkey solution

Gloria Y K Kim^{1

2}, Rea Rostosky³, Franziska K Bishop⁴, Kelly Watson³, Priya Prahalad^{4

5}, Aishwari Vaidya³, Sharon Lee³, Alexander Diana³, Clint Beacock³, Brian Chu³, Ginny Yadav³, Kaylin Rochford⁶, Carissa Carter⁷, Johannes O Ferstad², Erica Pang⁴, Jamie Kurtzig⁴, Brandon Arbiter³, Howard Look³, Ramesh Johari², David M Maahs^{4

5}, David Scheinker^{8

9

10

11}

Affiliations

¹ Clinical Informatics Management, Stanford University School of Medicine, Stanford, CA, USA.
² Management Science and Engineering, Stanford University School of Engineering, Stanford, CA, USA.
³ Tidepool, Palo Alto, CA, USA.
⁴ Division of Pediatric Endocrinology, Stanford University School of Medicine, Stanford, CA, USA.
⁵ Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA.
⁶ Department of Mechanical Engineering, Stanford University School of Engineering, Stanford, CA, USA.
⁷ Hasso Plattner Institute of Design, Stanford University, Stanford, CA, USA.
⁸ Management Science and Engineering, Stanford University School of Engineering, Stanford, CA, USA. dscheink@stanford.edu.
⁹ Division of Pediatric Endocrinology, Stanford University School of Medicine, Stanford, CA, USA. dscheink@stanford.edu.
¹⁰ Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA. dscheink@stanford.edu.
¹¹ Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, USA. dscheink@stanford.edu.

PMID: 39506045
PMCID: PMC11542048
DOI: 10.1038/s41746-024-01319-x

The adaptation of a single institution diabetes care platform into a nationally available turnkey solution

Gloria Y K Kim et al. NPJ Digit Med. 2024.

. 2024 Nov 6;7(1):311.

doi: 10.1038/s41746-024-01319-x.

Authors

Affiliations

¹ Clinical Informatics Management, Stanford University School of Medicine, Stanford, CA, USA.
² Management Science and Engineering, Stanford University School of Engineering, Stanford, CA, USA.
³ Tidepool, Palo Alto, CA, USA.
⁴ Division of Pediatric Endocrinology, Stanford University School of Medicine, Stanford, CA, USA.
⁵ Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA.
⁶ Department of Mechanical Engineering, Stanford University School of Engineering, Stanford, CA, USA.
⁷ Hasso Plattner Institute of Design, Stanford University, Stanford, CA, USA.
⁸ Management Science and Engineering, Stanford University School of Engineering, Stanford, CA, USA. dscheink@stanford.edu.
⁹ Division of Pediatric Endocrinology, Stanford University School of Medicine, Stanford, CA, USA. dscheink@stanford.edu.
¹⁰ Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA. dscheink@stanford.edu.
¹¹ Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, USA. dscheink@stanford.edu.

PMID: 39506045
PMCID: PMC11542048
DOI: 10.1038/s41746-024-01319-x

Abstract

Digital decision support and remote patient monitoring may improve outcomes and efficiency, but rarely scale beyond a single institution. Over the last 5 years, the platform Timely Interventions for Diabetes Excellence (TIDE) has been associated with reduced care provider screen time and improved, equitable type 1 diabetes care and outcomes for 268 patients in a heterogeneous population as part of the Teamwork, Targets, Technology, and Tight Control (4T) Study (NCT03968055, NCT04336969). Previous efforts to deploy TIDE at other institutions continue to face delays. In partnership with the diabetes technology non-profit, Tidepool, we developed Tidepool-TIDE, a clinic-agnostic, turnkey solution available to any clinic in the United States. We present how we overcame common technical and operational barriers specific to scaling digital health technology from one site to many. The concepts described are broadly applicable for institutions interested in facilitating broader adoption of digital technology for population-level management of chronic health conditions.

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Conflict of interest statement

All contributors from Tidepool have an employment relationship with the manufacturer of Tidepool software. The remaining authors declare no competing financial or non-financial interests.

Figures

**Fig. 1. CDCES patient review flow.**
Fundamental components of a whole-population CDCES-led care model include triage, assessment, investigation, and intervention.

**Fig. 2. Tidepool-TIDE dashboard.**
Tidepool-TIDE dashboard with synthetic data. Risk stratification is by ATTD consensus glucose metrics and a personalized time-in-range metric. Of patients with sufficient CGM wear time, patients with excess severe hypoglycemic are assigned highest priority, followed by patients with clinically significant hypoglycemia, patients with a large drop in time-in-range compared to the prior week, patients with overall time-in-range below threshold, and patients meeting targets. Patients with insufficient CGM wear time are identified in a separate category.

**Fig. 3. Patient care flow and partial randomization.**
Opportunities for leveraging partial randomization (noted by “R”) before and after scaling through Tidepool.

**Fig. 4. TIDE accessibility beyond Stanford.**
Technical instrumentation and maintenance by institutional IT professionals are no longer necessary for adoption.

See this image and copyright information in PMC

References

1. Khairat, S., Marc, D., Crosby, W. & Al Sanousi, A. Reasons For Physicians Not Adopting Clinical Decision Support Systems: Critical Analysis. JMIR Med. Inform.6, e24 (2018). - PMC - PubMed
1. Sasangohar, F., Davis, E., Kash, B. A. & Shah, S. R. Remote Patient Monitoring and Telemedicine in Neonatal and Pediatric Settings: Scoping Literature Review. J. Med. Internet Res.20, e295 (2018). - PMC - PubMed
1. Cresswell, K. & Sheikh, A. Organizational issues in the implementation and adoption of health information technology innovations: An interpretative review. Int. J. Med. Inf.82, e73–e86 (2013). - PubMed
1. Borges Do Nascimento, I. J. et al. Barriers and facilitators to utilizing digital health technologies by healthcare professionals. Npj Digit. Med.6, 161 (2023). - PMC - PubMed
1. National Diabetes Statistics Report. https://www.cdc.gov/diabetes/php/data-research/index.html (2024).

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UL1 TR003142/TR/NCATS NIH HHS/United States

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The adaptation of a single institution diabetes care platform into a nationally available turnkey solution

Affiliations

The adaptation of a single institution diabetes care platform into a nationally available turnkey solution

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources