About one in three adults has prediabetes, while 90% of people are unaware they have this condition. To help identify patients at risk for type 2 diabetes, physicians and their health care teams should be using their electronic health record. By optimizing your EHR, it can help diagnose patients with prediabetes and further prevent type 2 diabetes.
The AMA’s Diabetes Prevention Guide supports physicians and health care organizations in defining and implementing evidence-based diabetes prevention strategies. This comprehensive and customized approach helps clinical practices and health care organizations identify patients with prediabetes and manage the risk of developing type 2 diabetes, including referring patients at risk to a National Diabetes Prevention Program (National DPP) lifestyle change program based on their individual needs.
Through the AMA’s tools and resources, here is how you can use your EHR and technology to improve the care you provide patients with prediabetes.
Population health tools
It is important to create reports to share with physicians and care teams to track patients who are due for an abnormal glucose screening. Use evidence-based guidelines or screening protocol to generate these reports. Your institution or practice can create its own protocol or use an established clinical practice guideline.
You should also put together reports that identify patients who are eligible for prediabetes management. For example, referral to an organization recognized by the Centers for Disease Control and Prevention (CDC) that offers the National DPP lifestyle change program. These reports can be based on available laboratory testing results and can be used to monitor individuals who require follow up of laboratory testing or monitoring of medications.
A registry to track patients with prediabetes and related health factors can also be used to identify patients who require specific interventions. These might include referral to a CDC-recognized National DPP lifestyle change program, follow-up to verify enrollment and participation, or laboratory monitoring.
And if your organization uses a dashboard for quality measures or population health initiatives, consider incorporating metrics for abnormal glucose screening and prediabetes management.
Clinical decision support
To be notified if a patient is eligible for abnormal glucose screening or prediabetes management during an office visit, develop point-of-care advisories. The advisory should link to a relevant order set. Consider incorporating abnormal glucose screening recommendations into the health maintenance or prevention feature of the EHR.
Another option is to develop order sets for abnormal glucose screening and prediabetes management. Depending on your EHR, your order set might include other relevant activities or documentation, such as patient education and documentation templates. For prediabetes management, some example orders to include are:
- Referral to a CDC-recognized lifestyle change program.
- Metformin medication order.
- Referral to medical nutrition therapy.
- Future laboratory order for monitoring in 6-12 months.
Physicians should also consider incorporating questions that assess risk and eligibility for prediabetes management into standard rooming questionnaires. These can be linked to alerts and order sets that prompt physicians and the care team to take the appropriate action, such as follow up on a patient’s progress on lifestyle changes.
To remind patients that they are due for abnormal glucose screening develop standardized portal messages. These messages can also prompt patients to obtain laboratory testing prior to their appointment.
Incorporate the “Do I have prediabetes” risk screener questionnaire into the patient portal to engage patients in determining their risk for prediabetes and undiagnosed type 2 diabetes. It is also important to create and include standard patient education materials and instructions to obtain laboratory testing to use in after visit summaries.
Don’t forget to also develop patient portal messages to educate patients about their prediabetes diagnosis and for outreach to patients to discuss possible management options. This can include automatic reminder follow up messages to patients after a preventive service has been ordered.
Functionalities will vary depending on which EHR system you use. However, you can share this information with others in your health care organization to determine how to best use your EHR for diabetes prevention.