Baltimore-based WellDoc has announced the publication of a case study on the integration of it's mobile diabetes management offering with the electronic health record system Allscripts, implemented at George Washington University School of Medicine. Back in 2010, MobiHealthNews reported on the partnership, which was funded by the US Air Force.

WellDoc's diabetes management offering is FDA-cleared as a Class II medical device, and the study refers to it as a "mobile-integrated therapy" (MIT). It uses patient-entered data, data from sensors built into a smartphone, and data from connected sensors (like a continuous glucose monitor), to provide personalized coaching to the user. In integrating the MIT with the Allscripts EHR, patient data was shared bi-directionally, according to the paper.

For the study, which was published in the Journal of Diabetes Science and Technology, WellDoc conducted interviews with mobile development and testing teams, the EHR software consultants, the hospital IT team, patients, project managers, and business analysts. They collated that information into eight lessons learned from the integration.

1. The integration must take into account each user's day-to-day life and workflow, including patients, providers, IT staff, and additional caregivers. Some users will need access to a greater depth of information, while for others design and usability will be paramount.

2. The design should be interoperable and support the integration of multiple MITs into a single EHR. In particular, developers should make sure to eliminate redundancies between the systems, where app users and EHR users might enter the same data into different fields.

3. Multiple environments have to be secure, but their security can't keep them from interacting with each other. Stakeholders WellDoc interviewed reported problems with competing firewalls in implementing the integration.

4. Both halves of the integration, but especially the patient-facing app, should work natively on as many mobile devices as possible. Patients are most likely to use a system that allows them to continue using their device.

5. The mobile health offering is subject to a limitation already standard for EHR apps: it must be able to run even when network connectivity is sparse or intermittent, as is sometimes the case in large hospital complexes.

6. It's crucial to have a support team in place familiar with the technology  to help acquaint users with it.

7. Make sure the two systems adhere to common standards. Not only data interchange standards like HL7, but also making sure that measurements in both systems use the same units. If lab-collected blood glucose data in the EHR and patient-collected blood glucose data have the same unit, but one is potentially more accurate, the integrated system should easily identify and distinguish the two.

8. The team working on an integration should be ready for a more complex process than anticipated. A clear vision, good communication, and a steering committee are important for anyone attempting to integrate a mobile heath offering and an EHR.

The paper also indicates that a paper with results from a clinical trial with more quantitative data about the George Washington University School of Medicine trial is still to come.

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