Insulin, Diabetes

Build vs. Buy: Insulin Dosing Software

The evidence is clear: tight glycemic control contributes to positive patient outcomes and reduced cost of care. That’s why many hospitals are choosing to implement insulin dosing software

Insulin dosing software can solve many of the biggest glycemic management challenges. The best solutions provide benefits such as:

  • Moving providers away from outdated and dangerous methodologies such as sliding-scale insulin therapy
  • Providing dosing recommendations that are personalized to each patient
  • Alerting providers to patients at risk of hypoglycemia and hyperglycemia to support early intervention
  • Offering insights into glycemic management performance to track progress and set goals

Project leaders have a fundamental choice to make when beginning an insulin dosing software initiative: Build it themselves, or buy it from a third-party provider? 

As the leading software provider in this field, we obviously have an interest in hospitals choosing the latter — but we want to present the argument as objectively as possible to help you make the right choice for your organization. 

In this article, we’ll discuss a few key factors that should influence your decision when deciding on an insulin dosing software solution, as well as key differences between building and buying. 

Scope of Project

First things first: what kind of insulin dosing software do you need to build or buy? 

Unfortunately, there is no one-size-fits all approach to safe and effective insulin dosing in the hospital. Insulin can be delivered via intravenous (IV) and subcutaneous (SubQ) routes, each with its own dosing considerations that depend on a myriad of patient-specific factors. 

Hospitals with paper-based insulin protocols require multiple different methods and algorithms for cases such as type 1 diabetes, type 2 diabetes, stress hyperglycemia, surgical patients, DKA and hyperglycemic crisis, pediatric patients and patients receiving enteral nutrition. Each scenario presents its own unique considerations that impact a patient’s insulin needs.

Glytec’s insulin dosing software solution, Glucommander™, supports both IV and SubQ (basal-bolus) insulin dosing for adult and pediatric patients ages 2 and up. It guides providers through optimal ordering practices for different patient scenarios, as well as transitions of care within the hospital and from hospital to home.

Efficacy 

Hospital IT teams are certainly capable of building simple insulin dosing calculators within their EMR. But the question must be asked: are these basic calculators safe and effective in achieving glycemic goals?

Many homegrown insulin dosing calculators are simply digitized versions of basic paper protocols providers have used to dose insulin for decades. When these methods were first created they were intentionally oversimplified to minimize the level of effort, and error, associated with manual (human) calculations. 

Using the same outdated dosing protocols in electronic form may reduce human error, but are likely to yield the same poor clinical results.

One of these methods, used for IV insulin dosing, has been shown to result in rates of severe hypoglycemia five times higher than Glytec’s solution, Glucommander.

Glytec’s dosing algorithm is personalized, predictive and much more complex, and is supported by nearly 100 clinical studies and abstract publications. It’s not in the same category as simple dosing calculators, and the clinically-proven algorithms are supported by the seamless user workflows, safety guardrails, and analytics.

Safety

Insulin is a high-alert medication and can result in serious adverse effects when improperly administered. When hospitals build their own homegrown solutions, they may be introducing new patient safety risks. 

Insulin dosing software used by clinicians to calculate IV or SubQ insulin dosing is regulated by FDA as a class II medical device and is characterized as a Software-as-a-Medical-Device (SaMD) and the agency is charged with the evaluation of  the safety, efficacy, and security of these devices, typically through a 510(k) premarket notification. Glytec has gone through this process with FDA four times. Additionally, the company is required to maintain compliance to FDA regulations that govern, among other things, the development and distribution of its software to over 300 hospitals around the U.S.

Our solution also features a number of built-in safety guardrails, such as a glucose velocity warning, anion gap monitoring for premature discontinuation and alerts to switch to glucose-containing fluid when patients are at risk of experiencing hypoglycemia.

Even if your solution uses previously-published algorithms or established protocols, software bugs originating from the technology implementation or user error that’s not mitigated by safety measures can also lead to potentially disastrous outcomes.

Legal and compliance risk

In addition to posing a safety problem, using unproven software in a hospital setting could open your organization up to legal and compliance risks. 

Development and use of SaMD products, without FDA clearance, could result in FDA enforcement actions. 

Perhaps even more pressing, however, is the risk of malpractice lawsuits when using medical devices that have not been evaluated by the FDA. Are you willing to accept the risk of liability for causing patient harm due to dated, inadequate protocols, technology glitches or user error in your homegrown software? 

Features and workflow

Technology creates the potential for data integrations, streamlining complex workflows and standardizing processes while providing personalized care.

Many homegrown solutions, however, require providers and point of care staff to do nearly as much manual work as they were doing before — especially when it comes to subcutaneous insulin, where providers must manually titrate carb ratios after an initial calculated starting dose. 

In addition, every single feature, workflow and integration must be designed and built from scratch in a homegrown solution. 

Glytec’s eGlycemic Management System® (eGMS) goes beyond just insulin dosing to provide features that improve workflows, which saves doctors and nurses time and guides them to focus on higher-impact activities. 

eGMS features include:

  • SmartClick: This single sign-on technology integrates with your EMR and allows providers to interact with eGMS directly from a patient’s chart. Integrations with hospital’s ADT, LIS, Flowsheets and MAR databases allow the algorithm to leverage critical patient data points and real-time BGs without duplicative manual entry or introducing transcription errors.
  • GlucoView: This module provides a dashboard of primary glycemic status indicators for all patients in a unit, enabling timely BG checks with reminders and better communication over shift changes, promoting team nursing. 
  • GlucoSurveillance: eGMS interfaces with the laboratory information system to perform continuous real-time surveillance and analysis of blood glucose values for all patients in a unit. The dashboard highlights patients with hyperglycemia to trigger provider review and insulin dosing orders.

Software maintenance and support

Working with a third-party technology provider like Glytec means you get access to ongoing technical and clinical support from a team that specializes in glycemic management. We also have a dedicated development team that is continually updating and enhancing the software.

When you choose to build insulin dosing software in-house, on the other hand, these responsibilities fall to the hospital IT team, which is likely already overloaded. 

In our experience, homegrown software tends to become obsolete because the hospital IT team ceases to maintain it, or a change in leadership or priorities causes it to fall by the wayside.

Cost

We know that building an insulin dosing calculator on your EMR may initially seem much more cost-effective than purchasing a third-party solution, but it’s important to consider these hidden costs:

  • Cost of labor: How many hours will your IT team need to put in to build this solution? Do they have the capacity? Will you need to hire additional employees or a third-party implementation team? 
  • Expertise: Has your IT team ever developed new technology? Does your clinical team have the time to provide their expertise to ensure clinical efficacy? Is your team up-to-date on the latest glycemic management best practices?
  • Opportunity cost: What projects will be delayed as you dedicate resources to this one? Building new technology takes significantly longer than configuring an out-of-the-box solution.
  • Maintenance cost: How will you ensure the IT team consistently maintains the software? If resources are not dedicated to maintenance, the technology will quickly become obsolete and go out of use.
  • Risk and liability costs: Are you willing to put your patients and the organization at risk?

Building your own insulin dosing system comparable to what you can buy from Glytec would take years of development, which means delaying benefits for your patients. The cost of human resources required to build and maintain such a complex project would also quickly eclipse the cost of eGMS: a DIY solution’s cost would be hidden and hard to measure

You should also consider return on investment, which will only be realized if the solution you implement is clinically effective, guides practice change and is used by providers. 

One of Glytec’s clients realized over $7 million in savings in the first year after implementing Glucommander. This return on investment came from fewer hypoglycemic events and reducing patient length of stay. 

Conclusion

Overall, it’s crucial that your organization considers efficacy, safety, legal risk, software features, support and cost when pursuing a technology solution for glycemic management. 

All solutions are not created equally - and they certainly don’t all have the same impact.

We believe the choice is clear: Glytec’s clinically proven, FDA-cleared solution has 80+ studies showing how our customers reduce hypoglycemic events, readmissions and length of stay while saving providers’ time and saving organizations millions of dollars a year

Since 2006, we’ve been continuously improving our technology. Our eGMS solution is in use at over 300 hospitals, which means we’ve continuously improved its capabilities based on feedback and best practices from healthcare professionals across the country.

Glytec’s eGMS can be implemented in as little as 12 weeks and we’d be happy to help you calculate the potential ROI using your specific data.

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