Encryptions were used to ensure patient privacy and for data transmission. The Web connection between a user client and the server was encrypted using the hypertext transfer protocol secure (HTTPS) protocol, and data transmission between the glucometers and the server was enciphered with advanced encryption standard (AES) encryption. Asynchronous JavaScript and XML (Ajax) and JQuery JavaScript were used to validate the format of the data input and to cooperate with different browsers.
Asynchronous text messages were provided in the online diabetes self-management system; patients and caregivers could communicate through the online diabetes self-management system internal message service or short message service (SMS) text messaging. Application programming interfaces (API) from the Internet were used to send and retrieve information such as weather and pollution standard indexes. The online diabetes self-management system exchanged data with the hospital information system (HIS) using a service-oriented architecture (SOA) mechanism. The Health Level 7 (HL7) embedded Extensible Markup Language (XML) formatted data were used in the framework for data exchange. Patients were able to see their blood test results from the online diabetes self-management system.
The online diabetes self-management system included the monitoring items and the diabetes-related information, such as blood glucose, blood pressure, heart rate, body weight, insulin injection, daily diet, and daily physical activities. Information that was measured with equipment that did not have transmission networks required manual input. Dietary intake could be recorded through the use of either text or images. Additional information to enable self-management and goal setting for glucose control were generated (eg, the mean, median, standard deviation, and maximum and minimum daily blood glucose values). The variations in blood glucose and other parameters are presented together graphically to enable the user to observe the effect of each behavior. The frequency of self-monitoring of blood glucose (SMBG) was recorded and compared with the set goals to determine whether adjustments were needed. Body mass index (BMI) was calculated, and the suggested calorie intake and ingredient volume for each meal were displayed. An additional care-provider interface was designed so that caregivers could get a quick overview of patient status. Case managers were able to log in and view the data uploaded by the patients, identify abnormal events, and make phone calls. The online diabetes self-management system sent an SMS text message to care providers when the data exceeded the alerting range.
This study provided a teleconsultant service to support patients with diabetes self-management. The case managers for this study, including a nurse and a dietitian, were the care providers who interacted with the patients from a distance. They were responsible for monitoring patient status, answering questions about self-care activities, regularly keeping in touch with the patients through telephone calls or text messages, and encouraging them to perform self-management. The care plans and goal setting were formulated through a discussion with each patient during his or her enrollment. The case managers monitored the data uploaded by the patients. They gave advice and reminded the patients to perform self-care activities. In this study, the case managers were not involved in medication adjustments. They did, however, collate patient data and bring the information to the clinic when the patient returned for an appointment. They communicated with physicians to suggest adjustments when needed.
The assistance of the online diabetes self-management system and the teleconsultant service covered the 7 behaviors of self-management activities (shown in Multimedia Appendix 1). During the study period, the CDEs did not know whether the patient attended the telehealthcare program.
Encryptions were used to ensure patient privacy and for data transmission. The Web connection between a user client and the server was encrypted using the hypertext transfer protocol secure (HTTPS) protocol, and data transmission between the glucometers and the server was enciphered with advanced encryption standard (AES) encryption. Asynchronous JavaScript and XML (Ajax) and JQuery JavaScript were used to validate the format of the data input and to cooperate with different browsers.
Asynchronous text messages were provided in the online diabetes self-management system; patients and caregivers could communicate through the online diabetes self-management system internal message service or short message service (SMS) text messaging. Application programming interfaces (API) from the Internet were used to send and retrieve information such as weather and pollution standard indexes. The online diabetes self-management system exchanged data with the hospital information system (HIS) using a service-oriented architecture (SOA) mechanism. The Health Level 7 (HL7) embedded Extensible Markup Language (XML) formatted data were used in the framework for data exchange. Patients were able to see their blood test results from the online diabetes self-management system.
The online diabetes self-management system included the monitoring items and the diabetes-related information, such as blood glucose, blood pressure, heart rate, body weight, insulin injection, daily diet, and daily physical activities. Information that was measured with equipment that did not have transmission networks required manual input. Dietary intake could be recorded through the use of either text or images. Additional information to enable self-management and goal setting for glucose control were generated (eg, the mean, median, standard deviation, and maximum and minimum daily blood glucose values). The variations in blood glucose and other parameters are presented together graphically to enable the user to observe the effect of each behavior. The frequency of self-monitoring of blood glucose (SMBG) was recorded and compared with the set goals to determine whether adjustments were needed. Body mass index (BMI) was calculated, and the suggested calorie intake and ingredient volume for each meal were displayed. An additional care-provider interface was designed so that caregivers could get a quick overview of patient status. Case managers were able to log in and view the data uploaded by the patients, identify abnormal events, and make phone calls. The online diabetes self-management system sent an SMS text message to care providers when the data exceeded the alerting range.
This study provided a teleconsultant service to support patients with diabetes self-management. The case managers for this study, including a nurse and a dietitian, were the care providers who interacted with the patients from a distance. They were responsible for monitoring patient status, answering questions about self-care activities, regularly keeping in touch with the patients through telephone calls or text messages, and encouraging them to perform self-management. The care plans and goal setting were formulated through a discussion with each patient during his or her enrollment. The case managers monitored the data uploaded by the patients. They gave advice and reminded the patients to perform self-care activities. In this study, the case managers were not involved in medication adjustments. They did, however, collate patient data and bring the information to the clinic when the patient returned for an appointment. They communicated with physicians to suggest adjustments when needed.
The assistance of the online diabetes self-management system and the teleconsultant service covered the 7 behaviors of self-management activities (shown in Multimedia Appendix 1). During the study period, the CDEs did not know whether the patient attended the telehealthcare program.
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