M♡THer – Support for Women with Gestational Diabetes Mellitus

M♡THer is a novel interactive system designed to support women throughout diagnosis of gestational diabetes to the birth of their baby. It also improves multidisciplinary care co-ordination by providing shared access to the women’s clinical information. Clinicians saw an opportunity to improve service delivery to patients, and improve care provision, particularly as referrals to GDM services dramatically increase. No other technology like this could be found, at the time of development.

Innovation Summary

Innovation Overview

Gestational diabetes mellitus (GDM) is an increasing problem among pregnant women worldwide. Estimates of its prevalence vary widely because of varying threshold values. The increasing number of pregnant women being diagnosed with GDM is leading to snowballing healthcare costs. The condition has adverse effects on pregnancy outcomes and implications for the long term well-being of mother and infant. The risks GDM imposes are largely related to uncontrolled high blood glucose levels and its consequences. Treatment resulting in better control of these levels can reduce risks of adverse pregnancy outcomes considerably. It is important for women with GDM to carefully monitor their blood glucose levels and daily monitoring appears to be superior to intermittent clinic monitoring. In Australia, after a confirmed diagnosis of GDM, women are required to monitor their blood glucose levels up to 4 times a day, as per current clinical guidelines. It is general practice that women are provided a paper-based blood glucose levels diary at diagnosis. These paper-based results are brought to regular clinic check-ups, to be reviewed by a multidisciplinary team. There are several logistical problems associated with this system. To address these, an innovative information communication technology enabled solution, called M♡THer, was developed through a collaboration between Metro South Hospital and Health Service, and the Commonwealth Scientific and Industrial Research Organisation.
M♡THer is a novel interactive system designed to support women throughout diagnosis of GDM to child birth. It also improves multidisciplinary care co-ordination by providing shared access to the women’s clinical information. The M♡THer platform was developed from a clinically validated home-care delivery model developed by Commonwealth Scientific and Industrial Research Organisation, to manage cardiovascular disease. The care delivery model integrated in M♡THer was designed in alignment with existing clinical work flows, making it feasible for wide pre-natal services adoption. Development was guided through very close alliance with clinicians, involved in all levels of pre-natal care, but also with iterative consultation sessions with pregnant women, with a diagnosis of GDM.
The main goal of the platform was to support not only the pregnant women diagnosed with diabetes mellitus, but also practitioners providing healthcare to them, thereby offering several benefits to the provision of GDM services.
The M♡THer solution utilises technologies which integrate a smartphone app, the Internet, measurement devices and multimedia content to support the management of women with GDM. The smartphone is carried by the woman throughout the day to allow for capture of blood glucose levels and other clinical measures such as weight, stress, sleep and symptoms. It also provides educational multimedia content, and links to educational materials regarding diet and exercise in GDM. A secure web based clinical portal enables healthcare practitioners from different specialised disciplines to assess the women’s weekly progress and to provide early care intervention dependent on the review. Data can similarly be reviewed by the healthcare practitioners during clinic appointments to aid in discussions with the women. Each woman has her own profile compiled through the clinician portal, to ensure that the app is tailored and individualised according to specific needs.
M♡THer was tested in a feasibility study with 40 participating women at Redland hospital, Metro South Hospital and Health Service, Queensland, Australia from August 2017 to April 2018. The app was well received by the women as an alternative to the paper-based blood glucose levels recordings. All respondents agreed that the app was user friendly, convenient and helpful in managing their GDM, making them feel confident in the management of their condition. Treating clinicians reported improved communication with the women in their care and experienced an increase in multi-disciplinary co-ordination amongst themselves. The platform enabled early intervention for a number of women identified with elevated blood glucose levels readings in the first week of using the app, and due to elevated fasting blood glucose levels , a number of women were timely commenced on Metformin or insulin treatment.
M♡THer has further implications. It can expand access to, and improve, the quality of healthcare for women in regional and rural areas and those reluctant to attend clinic appointments for a number of personal situations. It reduces burdens for these women in receiving access to speciality care, and can improve monitoring, timeliness, and communications within their care teams. It has been identified to be a suitable solution to continue monitoring of the women after the birth of their babies for early intervention should their blood glucose intolerance not improve. There are many solutions aimed at diabetes management but few cover GDM. Most are developed without patient input, clinical input, evidence-based practices, adherence or citation of recognised medical guidelines. The pilot trial has proven the potential for widespread adoption of this technology.

Innovation Description

What Makes Your Project Innovative?

To the project team’s knowledge, the M♡THer platform is the first solution of its kind in Australia. Due to the increasing number of women engaged with maternity services at Redland Hospital, a search was undertaken to find potential solutions already on the market. A myriad of mobile technologies purport to help individuals living with diabetes, albeit a lesser number specifically for Gestational diabetes mellitus. However, majority of these technologies have not been created around evidence-based practices. M♡THer offers a comprehensive care model with health measure monitoring and sharing capability between pregnant women with Gestational diabetes mellitus and their treating clinicians and was developed based on a mature clinically validated home-care delivery model developed by Commonwealth Scientific and Industrial Research Organisation, to manage cardiovascular disease. Data input received from the M♡THer app include physiological measuring outputs and supports decisions on patient management that can impact clinical outcomes and patient care.

What is the current status of your innovation?

Our feasibility study at Redland Hospital concluded in April 2018. Study outcomes were evaluated through compiling data from quantitative surveys, logs from the M♡THer server and information collected from Redland hospital in terms of services utilisation.
The study has generated national and international interest and successes. The platform won a 2017 Health Round Table innovation award, a Metro South Hospital and Health Service Board Chair's Award and is a finalist in the International Hospital Federation Awards (winner to be announced 10th Oct 2018). Negotiations are currently underway to conduct implementation studies in a number of Australian hospitals and to further use the platform to detect early risk of Gestational diabetes mellitus and provide support to women diagnosed with Gestational diabetes mellitus in the US (part of Central Georgia Health System). Both Metro South Hospital and Health Service and Commonwealth Scientific and Industrial Research Organisation are keen to see the app and portal develop into a commercialised product so that it can be available to any Gestational diabetes mellitus service users. Negotiations are currently underway to make this happen.

Innovation Development

Collaborations & Partnerships

Metro South Hospital and Health Service provided the clinical setting, clinical teams, and patients. Additionally, they provided access to historical data sets for evaluation, co-funding to support the initial development of the platform, and project management. Commonwealth Scientific and Industrial Research Organisation provided the engineering and research skills. Commonwealth Scientific and Industrial Research Organisation engineers developed the app and portal and provided maintenance and technical support. The research team developed the research protocol, evaluation of the historical and current data, and the evaluation report.

Users, Stakeholders & Beneficiaries

Forty women who consented to the study utilised the app. Results from user satisfaction surveys indicated benefits from increased efficiency, ease of automatic upload of blood glucose levels to the app and not having to carry the paper diary around. Also, there was a feeling of assurance knowing the clinical team could access their data and follow their progress at the hospital. The multi-disciplinary staff identified benefits through increased team collaboration and improved care provision.

Innovation Reflections

Results, Outcomes & Impacts

Results from patient and clinician satisfaction surveys were:
Majority of women agreed that the app was helpful and supportive throughout their pregnancies.
• Benefits identified: ease of use, convenience, and accessibility
• 100% of clinicians agreed that the platform improved the efficiency of care
• 90% of clinicians agreed that the app was preferred over the paper-based diary
Other results from historical data comparison:
• Pre-pregnancy BMI and time of diagnosis were similar
• Time to treatment and ante-natal clinic visits were comparable
• blood glucose levels clinical reviews were significantly higher with the introduction of M♡THer
All involved are keen to see widespread availability of the app and portal. It is expected that over time, evidence of a decrease in clinic visits will emerge. It is also anticipated that this technology will integrate with electronic medical records for further integrated and efficient patient monitoring.

Challenges and Failures

Contract negotiations between Commonwealth Scientific and Industrial Research Organisation and MHS were initially challenging as this was the first time this type of innovation and collaboration had occurred. Legal and business teams from both organisations supported each to problem solve effectively.
There was a technical failure of the system over the Christmas period and while technical staff were on compulsory leave during the Commonwealth Scientific and Industrial Research Organisation's annual Christmas Shutdown. This caused a few days of system shut down which was stressful for all stakeholders. It was quickly resolved by Commonwealth Scientific and Industrial Research Organisation and due to the back up of results to the cloud, no data was lost.

Conditions for Success

Effective team work: the project team were a proactive group of professionals willing to help in any way possible. This proactive team work style was the foundation of the success of this project.
• Executive level support from both organisations provided decision making capability and leadership.
• Overall project management was necessary to drive the project and to not take away from the clinician’s patient hours.
• Onsite project officer support was invaluable in the smooth implementation and running of the pilot.
• Administration support was crucial in achieving meeting targets, documentation targets, and survey completions.
• Clear research protocols to guide and contain the research
• Uptake by patients and clinicians to utilise the technology
• Financial support to develop the technology
• The availability and willingness of the research governance officers to answer questions and help.
Technical reliability and support

Replication

Running beside this project was the development of the PD-Buddy platform, also collaborative between Commonwealth Scientific and Industrial Research Organisation and Metro South Hospital and Health Service. PD-Buddy is based on a similar concept but designed to assist in the management of patients requiring peritoneal dialysis. Additionally, both projects stemmed from the Commonwealth Scientific and Industrial Research Organisation's original work in cardiac rehab utilising a similar clinically validated platform. This technology alone could extend to private practice, GP share care models, and midwifery models of care. The service offered through M♡THer is clinically equivalent to the Gestational diabetes mellitus services offered in usual care. This warrants the integrity of the platform for potential future commercialisation, once it is validated through rigorous trialling. Future planned implementation studies will further inform improvement and advancement and provide a mature solution which, with little modification, can be adapt to continue monitoring of the women after the birth of their babies for early intervention if necessary.

Lessons Learned

• Securing survey responses was time consuming and challenging. It required a great deal of follow up to achieve results
• Bluetooth connectivity can be problematic and make an impact on what people think of the technology, even when the technology is not the actual problem
• More time was required, than originally planned, for contract negotiations
• What is promoted to the patients is what will be used. E.g. the blood glucose level recording was promoted heavily to patients and they predominantly used this function only. Other aspects, such as food recording, were not utilised but also were not strongly promoted by clinicians
• Ideally regular training needs to be implemented to account for staff turnover due to clinical rotations through wards
• Partnering with external organisations is challenging but can be a fruitful experience for professionals and create highly desired outcomes and improvements for patients.

Anything Else?

The M♡THer app is available for Android and iOS operating systems and available from Google Play and Apple Store, respectively. However, the app requires a Username and Password that is only available through registration to the clinician web-portal. The mobile web app and clinical portal are compatible with all Internet browsers in both smartphones and PCs. The clinical portal is integrated with a communication interface for patient’s data exchange to other clinical information systems to enable patient progress update to GPs and other external care teams. Commonwealth Scientific and Industrial Research Organisation implements process evaluation as an activity that is conducted with rigour and clinical guidance during platform design and development to verify effectiveness, performance and interoperability. The multi-disciplinary engineering staff operate in a highly connected-interactive socio-technical environment, adopting international standards for healthcare data electronic management.