I recently came across MyCareTeam, a web-based diabetes management product. Based on the quicktour screenshots that they've posted online it certainly seems like an interesting product.
And as of today it's available from the American Diabetes Association for $12.99 per month, or $9.99 if you purchase a one-year subscription ($119.98). With the one-year subscription they'll also provide a free data cable for the meters that they support. Or you can buy the cable for $40. Based on the screenshot below, that's quite a long list of meters.
It certainly seems as if this product has some useful features. Here's another screenshot from the quick tour that shows the log screen from MyCareTeam.
As you can see, all my information about MyCareTeam is based on screenshots from their Quick Tour. That's one of the things that bothers me about this software. Why would I spend at least $12.99 to try it out and decide how useful it is?
For me, it makes more sense to have a 30-day free trial (with the option to purchase the download cable) and then see whether it's actually worth $100+ a year to me. After all there are already many free web-based diabetes tracking systems (Sugarstats.com, SweetSpot.dm, and others). And these are both useable and useful.
I see the benefit to both the ADA and MyCareTeam to charge for the product. It'll allow them to enhance the product and raise some funds for ADA. But I also understand web software a lot and I think that you need to let people try this software out first, before they'll commit to spending money to use it.
Do let me know what you think about this model. Have any of you used MyCareTeam? Did it seem like good value to you? Do you have any privacy concerns about using this or other web-based tracking software?
My aging Minimed 512 is due for replacement in September. This time, I'm planning to evaluate up to three models before deciding on the right one for me.
And tomorrow, I'm going to be fitted with a Cozmo 1800 insulin pump for a trial run. I'll be wearing it for a week or two with saline and testing it out.
What I've already heard about the Cozmo from friends is that it's a little bulky but very easy to customize.
I've also asked for the software that goes with it. And I'll blog about my impressions with both.
Because I don't see the software as an add-on for the insulin pump. It's an integral part. After all, what use would your iPod shuffle be if you didn't have iTunes? Probably you could use it as a door stop. Otherwise it wouldn't be worth all that much.
I'll post tomorrow about how the 'training' and first priming goes for me.
I was reading an interesting post today about the term 'user' and how it's become over-used in computer systems and software manuals.
Josh Bernoff does a good job of pointing out how that simple label affects how we think about people who use our systems and software.
I can't help thinking about the companies that make products we depend on. Glucose meters, syringes, insulin, insulin pumps, continuous glucose monitors.
Are the makers of these things thinking of us as diabetics, or patients, or something else? I hope that they remember we're also: children; moms; dads; people who are trying to live our lives despite the challenge of diabetes.
So I'm going to take his pledge here and now. I'll try and let it affect how I write this blog and my life as a software architect. I promise to avoid the word user whenever possible.
I will think of people who use technology as people, customers, and friends. I won't use them, and they won't use me.
During this week I've read more about the new Dexcom SEVEN continuous glucose monitor that was approved back in May.
I see some traffic on various mailing groups and I've spoken with Dexcom service/sales about the new device. So I now have a little additional information that I wanted to share (because there's so little out there in webland).
The new system appears to be available now. The person at Dexcom that I spoke with was ready to take my order on Friday.
The upgrade price for the system is $350. This includes new receiver, transmitter and software. You'll need to mail in the old transmitter and receiver. You'll receive a reconditioned receiver.
Warranty on the upgraded system is one year.
The price for a box (four) of new sensors is $175 when ordered with the upgrade. Future boxes are the full price. I think this is still $240 for a box of four.
The software is much improved. It can read data from the current Dexcom system as well as the Dexcom SEVEN. It includes statistics that can give you an hourly breakdown. I don't know whether it supports data export yet.
The receiver has not changed much. It still shows a graph of readings from 50 to 400 mg/dL. Major change is that it now shows you how long until the sensor expires.
I don't know how long the new sensors last beyond the official 7-day life span.
That's all the details that I have right now.
I hope to get the new system to try out for two weeks before purchasing. The software is the current Dexcom system was such a disappointment that I won't upgrade without trying the entire system out first (including software).
In the meantime, if you're already using the Dexcom SEVEN why not let us know what you think about it? Maybe you could post about it on the CGM Users group on TuDiabetes?
Adam Bosworth gave a speech at the 2007 American Medical Association of Informatics (AMIA) Congress.
In the speech he talked about three 'core principles' for future healthcare systems:
Discovery: we should be able find information that we care about
Action: We should have access to personalized services so we can get the excellent health support
Community: We should be able to form a community with those who have similar conditions and from their health practitioners.
His blog post provides the notes from the speech. When I read these, this comment early in the speech struck a note with me:
This vision for the future of health care starts with the premise that consumers should own their own total personal health and wellness data ... and that only consumers, not insurers, not government, not employers, and not even doctors, but only consumers, should have complete control over how it is used. [My emphasis]
As you may already know, I've tried to do a number of things so that I can get access to my data. Despite repeated attempts, Dexcom still does not let me get to the data behind their pretty graphs. And I can't export it to another program.
And for the other diabetes devices, I can see the results as the software maker intends, but I can't export it. The OneTouch software locks the database with a password, as does the AgaMatrix Zero-Click software. OneTouch does have an export facility, but it's the only one of four software packages I've tried that does this.
If I can't take my data out of their system, I can't combine it and manipulate it. I can't easily share it with my healthcare team. It's unusable except within the software package. It's basically trapped there.
Remember Adam Bosworth saw ownership of my data as the premise, or assumption, on which his vision is based. If I can't access it easily, I don't own it.
As a software architect I understand the importance of raw data. You can't build a software system unless you have data that can be shared by all the pieces. This is the main reason for my paper promising data format for blood glucose meters, and my creation of the Diabetes Data wiki.
If you'd like to get involved and help me, I'd love to hear from you.
Update: (August 19, 2007) I'm now using the latest Dexcom, the Dexcom SEVEN. The software that comes with the Dexcom SEVEN (Data Manager 2) has much better support for statistics and it allows you to export the readings in two different formats. This software also works with existing Dexcom 3 systems. Given this solves the problem for me, I'm not doing any more work in trying to understand their crazy data format!
Still no success getting data from my Dexcom STS CGMS. But my recent challenge post about decoding the Dexcom data format seems to have drawn a lot of attention.
Several people have jumped in to have a try at cracking the problem. I sent some e-mails to Dexcom technical support and customer support about this issue. So far, I've received no response. On June 5th I had a conversation with Dexcom which indicated they aren't about to open up the data even in their new version of the software.
I loaded up another Dexcom R2Downloads data file. From looking carefully at the graph in the Dexcom software it seems that there must be at least four types of records in the data stream. These are:
Start of use. With date (MM/DD/YY) and time (HH:MM:SS) values.
Gap in use. With time (HH:MM:SS) value.
Sensor reading. Glucose value, date (MM/DD/YY) and time (HH:MM) values.
Meter reading. Glucose value, date (MM/DD/YY) and time (HH:MM) values.
You can now find on my site two example data files, plus a hand-captured text file containing the values that are probably at the start of one of these data files.
How You Can Help
Maybe you know something about encoding or encryption. These skills may be enough to crack the problem.
If you can't do this, perhaps you can help in an indirect way. And I'll admit this is a little devious. :-)
If you search on Google for Dexcom my blog comes in around the 15th position in the results. I think I might get more attention from Dexcom if my blog came in as the number 1 search term for Dexcom on Google.
Impossible you say? Well, maybe not.
Here's where you come in. Can you post a blog entry on your blog which points to this blog post, and has Dexcom as the word in the link? Maybe write a note explaining that I'm trying to crack this problem for the Dexcom, highlight the Dexcom word and then add http://www.bernardfarrell.com/blog/2007/05/decoding-dexcom-data-format-update.htm as the hyperlink.
This way I'll get the word out about this challenge, plus Dexcom marketing may wake up and realize that this is important to many folks.
Can you tell I'm a little impatient to get to my data? How do you feel about a system that captures data that's important to you, but that doesn't let you get to it? Am I the only one who feels this strongly about this?
Update June 7th 2007: As of today, many people have linked to this post. When you Google search for Dexcom, this post is now about number 8 in the results, which puts me on the first page of Google results for Dexcom. I'm have still to write a letter to Jorge Valdes, VP Engineering, at Dexcom asking him to release the data format so that we can use it to access our data. First I want to hear what they say on the June 11th conference call.
If you'd like to help me, please post about this issue (setting our data free) and link to this blog entry using the word Dexcom, as I've just done here. Thanks.
Note: I currently own shares in Dexcom, I work not to let this ownership influence what I say about the company or its products.
Readers Challenge: Help me decode the Dexcom data format
I've been using a Dexcom STS continuous glucose monitor system for about a month now.
For day to day use, it's really wonderful. I can see highs before they happen and take the edge off them, and I can also watch much more easily for lows and reduce their impact.
But the software continues to be a major annoyance. Basically all it gives me is two very simplistic graphs of the blood glucose data collected by the Dexcom system.
The Glucose Trend graph shows up to one week of glucose readings from the system.
By choosing a smaller number of days, I can see the readings a little more spread out. For me, this makes it easier to look at the values.
However the software shows no summary statistics, and the only way I can actually see that values is by holding my mouse over them.
The other graph is the Modal Day one, which lets me see a number of days worth of data superimposed over a 24-hour period. This makes it a little easier to see patterns.
Again there is no summary data for the selected time period, and I can only look at one time segment at a time. So if I wanted to see what was happening for the last two weekends, I'd need to produce one report for each weekend and then look from one to the other.
OK. Now this is where I ask for your help. I've sent some e-mails to Dexcom asking for more information on how to get the data out of the system. So far, I've heard nothing back. Maybe one of you format hackers can help me in decoding the actual information itself.
Warning, it's fairly technical below this point. And I'm really hoping that someone can help with this problem.
Using some tools such as the wonderful FileMon from SysInternals, I've finally figured out where the receiver data is being stored on my PC. Trust me when I tell you that this is not easy.
For example, on my system, a lot of information is written by the software to various folders in this location: C:\Documents and Settings\Bernard Farrell\Local Settings\Apps\2.0\TO260ZDW.VE3\JGBRCCZA.X12
But the actual receiver data is written into a number of .R2Download files in this location: C:\Documents and Settings\All Users\Application Data\DexCom\DexCom DM - Consumer\ReceiverData\
For example one of them is named {2E6B7BE9-DA8F-42FA-8337-29404D84A829}.R2Download.
The files contain XML structured data, part of which is the readings themselves in some compressed form.
The data is contained in the DataBaseRecords object in this XML file. And from looking at the Signature object later in the file, it may be encoded using some sha1 approach.
I've uploaded the contents of one data file to my server. If you'd like to have a look at the file and see if you can figure out the data portion, then download the data file from here.
And if you can give me any suggestions as to how to decode this, I'd be thrilled.
Warning for those of you who are faint-hearted. This is not good software. So this is a very critical review
After some pestering, I finally received the download software for my Dexcom CGM system. I paid for the system on March 30th, and received the software today April 10th. It wasn't worth waiting for.
In a nutshell, this is extremely poor software. According to the Dexcom Help About screen, this is version 9.0.2.18. Why they would use a complicated numbering scheme is just an indication of how little they're thinking of the user.
To me this feels like beta software. There was no attempt made to give the user any level of control.
You can only do three slightly useful things with the software. Download the readings from the Dexcom receiver, view up to seven days worth of readings at a time, and print a report showing the readings over an extended period, with seven days of readings summarized on each page.
The screen to view the readings is shown below. You can see strong correlation between the Dexcom readings (blue circles) and the Ultra meter readings (red X marks). If you hold the mouse over a symbol you can see the summary value in mg/dL.
Later in the review, I show an example of the Modal Day view for the data. This is valuable for doctors and, with some help, patients.
I believe that software like this is unusable for the average patient. It doesn't provide information that they can readily act on. At the end of this review I've outlined some areas for improvement.
The rest of this article is a screen by screen description of what I found in the Dexcom software.
Dexcom Software Details
When I loaded the CD that the software arrived on, it immediately started installing. I was given no installation choices about where to put the software. This was the only screen that I saw.
The whole feeling I got during thw install was the lack of control I was given. Notice how the screen above only has a Cancel button? And there's no option to indicate where to install the software.
The next screen below warned me to remove any attached Dexcom receivers. Now this is written all over the box that contains the software and cable, but I understand the need to be cautious.
So after pressing OK, the next screen tells me to connect the Dexcom receiver using the supplied cable.
I connect the cable to a USB port on my computer and to the Dexcom receiver. After pressing OK, I get the obligatory legalese screen.
Now I'm ready to download data from my Dexcom receiver....but the software isn't.
First I've got to fill in some details to get the download going. On the screen below, I click the New button (picture is after I filled in my details).
Then I fill out this form. You could leave it blank. But then if you exported the data, it wouldn't have your name. I added the minimal amount of information.
Then I press the Start button to get the transfer going. I had data from March 23rd to April 10th, about 18 days worth. While the data is transferring I see the following screen. It takes about four minutes to transfer all the data across.
After that I can finally see the data, up to seven days at a time. Apart from the Glucose Trend view (shown at the start of my review), there is also a Modal Day view that shows up to seven days worth of data superimposed over a single 24-hour time period.
I think this is the most valuable aspect of the Dexcom software. You can select for example three days worth of data and then use the arrows to see successive days. That gives me some idea of the trends.
Minor Points
The Dexcom software was almost hidden on my PC. I had to use a special tool to find it buried under the following area:
C:\Documents and Settings\Bernard Farrell\Local Settings\Apps\2.0
After a good deal of investigation, I could not figure out which file in this area is holding the data itself. So for a technical person like me, I couldn't figure out how to extract my own data from their software so I could look at it in more detail.
Areas for Improvement
I could write several pages here. Let me just make a few points.
First. Make two versions of the software. One for patients and one for doctors. An individual doesn't need to track patients. This same criticism is true for software from OneTouch and Minimed. I think they're using the same group of consultants!
Second. Let us get at our data. Better yet, make it available in a standard format. That way we can build software to combine this with data about food, insulin, and other useful information.
Finally. Add some basic statistics. How about the average (mean) blood glucose value for the displayed time period? Or the percentage of time between a range of values. This could really help.
Other stuff. I'd like to compare what happens over different time periods. Show me the trend for a 14-day period. Give me the modal view for a selected set of weekends. Allow me to mark a range of readings with additional data to indicate sickness, menses, etc.
Your Assignment
Have you any experience with diabetes-related software? Are there things that you like or don't like? How about providing some comments that might help in the development of the next version of this software.
Have you used the Minimed software for this CGM? How about posting a review somewhere for that.
Diabetes: technology, devices, software, and other stuff.
About Me
Name: Bernard Farrell
Location: Massachusetts, United States
I was born in Ireland and now live in the US.
I have had Type 1 diabetes for over 35 years. I struggle with my blood sugar, the same as most people with diabetes.
I wear a Cozmo 1800 insulin pump and a Dexcom SEVEN CGM to track my blood glucose levels. I also take Symlin to help control my post-meal blood sugars.
I'm blessed by God, and every day brings the possibility of a cure.
