As nurse practitioners in maternal fetal medicine, our role involves managing pregestational and gestational diabetics throughout their pregnancy.  After working providing this care for a period of time, we recognized the need for improved communication with these patients.  Discussions with our patients made it clear that we were going to have to develop a more convenient route of communication.  Therefore, we felt communication via the internet would be a reasonable approach.           

Patients in our health system have the option to enroll in MyGeisinger, a secure website that gives patient the opportunity to review their health information as well as communicate with their providers through a secure messaging system.  We were able to lead a process of meeting with the MyGeisinger team to create a patient-entered flowsheet that our diabetic patients could access.  The flowsheet we ultimately created allows patients to record their glucose readings for fasting blood sugar, two hours after breakfast, lunch, and dinner, and one additional reading, if needed.  They are also able to provide comments for each reading and identify if they are on medications and if their medications changed in the previous 24 hours.  Glucoses are then sent to the provider through epic, our electronic medical record system, and the provider can review the blood sugars and respond to the patient through MyGeisinger.  Patients always receive a response whether or not changes in their plan of care are necessary.

We began enrolling patients in this process in January 2008.  Patients have been very receptive to the process, and, at any given time, we have anywhere from 25 to 40 patients enrolled.  Feedback from patients has been positive with comments identifying the ease of use, convenience, and quick response from the provider as contributors to patient satisfaction. 

We have also allowed patients to continue contacting us via telephone if they do not have access to the internet, and we are in the process of comparing patient compliance and maternal and fetal outcomes for telephone versus MyGeisinger management.  We have tracked all of patients from the start of diabetic care through delivery and recording information regarding maternal compliance, gestational age at delivery, pregnancy/delivery complications, fetal weight, number of days spent in the neonatal intensive care unit, whether patient utilized MyGeisinger process or not, and whether or not patient received follow-up at six week postpartum. 

In conclusion, a need for increasing patient compliance with reporting blood sugars during pregnancy was recognized, and an innovative approach to addressing this issue via a patient-entered flowsheet was developed. This flowsheet not only provides convenience for the patients, but allows the provider to review blood sugars and provide patients with a timely, yet confidential response.  Studies comparing the pregnancy and maternal and fetal outcomes between telephone managed and MyGeisinger managed patients are in process.  The response to this patient-entered flowsheet has been positive and rewarding, and we are now moving towards increasing the versatility of this patient-entered flowsheet to enable to us to monitor our hypertensive patients through a very similar process.