M THer - HISA

Innovative mobile technology to support the care of women with gestational diabetes mellitus

Dr Marlien Varnfield

M♡THer

CSIRO AEHRC

Dr Marlien Varnfield, AEHRC, Health & Biosecurity, CSIRO

BIOMEDICALINFORMATICS

Biostatistics, imaging and genomics based -

clinical workflows

HEALTHINFORMATICS

Improving health system performance & productivity from

electronic health data

HEALTHSERVICES

Improving access to services &

management of chronic diseases

CVD

‘Cardihab’

CKD

PD-Buddy

COPD

M-COPD

Diabetes

• M♥THER• Insulin Stab

Mental health

Health-e Minds

mHealth projects


GDM - What is the problem?

• GDM is one of the most common medical complications of pregnancy

• Usually occurs around the 24th to 28th week of pregnancy

• Associated with short and long term risks for both mother and baby, especially if blood

glucose levels are not well controlled

• Incidence of GDM is increasing

• New diagnostic criteria for GDM were introduced in 2014

• At Redland Hospital, 16% of women engaged in Maternity Services diagnosed with GDM


Challenges

Women with GDM

Midwife

Obstetrician

Endocrinologist

Diabetes Educator

Dietitian


Key problems

SuboptimalCo-ordination

of Care

Inconvenient

Ineffective

Women with GDM carry a paper based blood glucose level diary

Results not always available to the MDT team

in a timely manner


Our solution


Redland Feasibility Study (n=40)

Primary outcomes:

• User adoption and user satisfaction

Secondary outcomes:

• Number of BGL clinical reviews

• Frequency of antenatal contact

• Occasions of service related to GDM attended by women

• Time to commencement of therapy


Study Cohort

Inclusion criteria

• confirmed 1st OGTT diagnosis of GDM diagnosed between K24-28

• at least 16 years of age

• referred from general practitioner for antenatal care at Redland Hospital prior to K20

• owning and ability to use smart mobile phone (both Androids and Apple phones)

• ability (and willingness) to upload data either via WiFi or Mobile Data

• ability to speak and understand English

Exclusion criteria

• other types of diabetes

• other illnesses that would limit participation e.g. chronic kidney disease (stage3-4)

• a known history of major psychiatric illness


Recruitment


Study Outcomes

• Survey responses from the women showed the app is user friendly, convenient, and

continuation is highly recommended

• Treating clinicians reported improved communication with the women they treat and showed

an increase in multi-disciplinary co-ordination amongst themselves

• BGL clinical reviews were significantly higher with the introduction of M♡THer, as was frequency of ante-natal contact. Time to treatment and ante-natal clinic visits were comparable

• 8 women were identified with elevated readings in the first week of using the app enabling

early intervention

• Due to elevated fasting BGL’s 12 were commenced on Metformin, 8 were commenced on

insulin


Interest

• Health Round Table Winner, Category: “Improving self-care”, Brisbane, July 2017

• RN Breakfast Show interview, May 2018

• Media report, Essentialbaby, May 2018

• Presentation, Australian Diabetes Educators Association (ADEA) QLD State Conference, Gold Coast, May 2018

• 2018 iAwards Nominee, Queensland Awards, Brisbane, Jun 2018

• Show cased at the Australasian Diabetes in Pregnancy (ADIPS) Conference, Adelaide, Aug 2018

• Metro South Health Board Chair’s Award, Winner in Category: “Innovation Through Digital Technology”, Brisbane, Sep 2018

• International Hospital Federation, Gold Award Winner: “Excellence Award for Quality & Safety and Patient Centred Care” Brisbane, Oct 2018

• Invited presentation, Australasian Diabetes Advancements and Technology Summit. Sydney, Nov 2018

• Queensland Health Award of Excellence, Highly Recommended Dec 2018


• Funded for further implementation at all

MSH Antenatal Clinics

• Translating platform into different languages

• Offering MoTHer to all women diagnosed

with GDM

• FHIR enabled platform development

• Commencing July 2019

Implementation study MSH


Real world…

Adapted from https://www.kingsfund.org.uk/projects/nhs-65/alternative-guide-new-nhs-england-2013

NDIS

GPs

PIR

FDA

Marlien Varnfield, AEHRC, CSIRO

• Medical advances, emerging technologies, consumer choices and expectations

• Providing high assurance security measures to put patients' privacy and security first

• Managing digital security to reduce the risk of downtime and breaches

• Integration with clinical systems

• Lack of standardised terminology, system architecture, indexing and regulation

• Change management

Implementation challenges


Acknowledgments

Principal Investigator:Dr Wendy Dutton

Divisional Director of Women’s and Children’s Services, Metro South Health (MSH)

Co-Investigators:

Dr Joel Iedema, Director of Medicine, Redland Hospital;

Liesel Higgins, Redesign Manager, Transformation, Innovation, Collaborative Team, MSH

Georgia Hellen, A/Project Manager Redesign, Transformation & Innovation Collaborative

Planning Engagement Reform, MSH

Naomi Scolari, Project Officer and Dietitian, Redland Hospital;

Roisine Warwick, Diabetes Educator (Clinical nurse consultant), Redland Hospital;

Janet Knowles, Nurse Unit Manager, Women and Birthing, Redland Hospital;

Barbara Kleine, Senior Dietitian, Redland Hospital;

Denis Morton, Chronic Disease Team Leader, Redland Hospital;

Dr Rachel Stoney, Director Nutrition and Dietetics, Redland Hospital.


M THer - HISA

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