Sending reminder messages focused on provider accountability increased patients’ use of electronic blood glucose flow sheets.

What was the challenge?

The Office of the National Coordinator for Health Information Technology (ONC) has identified patient-generated health data as an important area for advancing provider-patient engagement. Electronic sharing of patient-generated health data between visits is a potentially valuable tool for patients with diabetes performing self-monitoring of blood glucose, who can share their glucose levels with their providers via electronic blood glucose flow sheets.

What was the program change?

ONC, Inova Health System, and OES designed an intervention to examine the effect of different reminder messages on both patient use of flow sheets and on consequent downstream health outcomes.

How did the evaluation work?

ONC, Inova, and OES assigned 2,182 patients at medical practices whose doctors placed orders for electronic blood glucose flow sheet to one of four groups based on the first letter of their last name: No Reminder, a Basic reminder signed by Inova, a Physician Accountability reminder signed by the patient’s physician stating that the patient-entered data will be discussed at the patient’s next office, and a basic reminder with a chance to win a $50 Gift Card. Data from Inova electronic health records were used to compare (1) flow sheet use, (2) number of prescriptions ordered, and (3) A1c test frequency (a lab test measuring average blood glucose control over the last 3 months), across the four groups.


What was the impact?

After 14 weeks, patients sent the Physician Accountability reminder were more likely to use flow sheets, had fewer prescriptions overall and few diabetes-related prescriptions ordered, and were less likely to receive an A1c test compared to patients who were not sent a reminder. Patients receiving the Basic or Gift Card reminders did not have significantly different values for these outcomes relative to the No Reminder group.


Allyson Root, Christopher Connolly, Season Majors, Hassan Ahmed, and Mattie Toma. “Electronic blood glucose monitoring impacts on provider and patient behavior.” Journal of the American Medical Informatics Association, ocac069 (2022).

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Project Type

Program Change and Evaluation


Health and Human Services




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