A diabetic shares his diary entry detailing his interaction with his healthcare provider – a day in the not too distant future …
What a Monday! I woke up this morning and didn’t feel well.
I had a mix of symptoms where I wasn’t sure if it was worth my time to see a doctor, or if my affliction was viral and therefore requiring only time and patience. My phone answered my question immediately with a recommendation to see the doctor. My wearable body temperature and pulse oxygen sensors, along with the blood glucose monitor I have as a diabetic, provided my personal health algorithm with enough data to predict that there a good chance my issues are bacterial and amenable to treatment. I have a single app on my phone that connects my personal health information, my diabetes treatment plans, my contacts and accounts with all my providers and emergency contacts and all my insurance and payment info. This data is stored securely, with strong controls that limit visibility into my data to only those people and processes that need it.
I agreed with my phone’s suggestion that I see a doctor.
One button press entered me into the scheduling function. Since the phone knows my preferences for who to see and understood that this is a time-sensitive but not critically urgent matter, it showed me the near term available appointments for my preferred providers, including an estimate of the wait time it predicted I might have to endure, based on its analysis of historical patterns, adjusted for the recent uptick in illness that, most likely, caught me this morning.
I scheduled the appointment and went about my morning.
My app knows I have a car, so it schedules reminders for me based on predicted traffic. If I didn’t have a car, it would advise me on appointments relative to bus schedules and Uber availability. Shortly before it’s time for me to leave, I get a new alert that my provider is running 15 minutes behind schedule. I have the option to immediately reschedule, but I choose instead to spend a few more minutes at home. I do have to sacrifice a couple of those extra minutes I got, as my app lets me know there’s an accident on my normal route. But the app and I agree on an alternate route, so I leave when recommended and arrive just before the time predicted for my doctor to be ready for me.
I arrived at the provider’s office.
Unfortunately, I still have to pay for my visit. But I have no other paperwork, except the occasional legal requirement to review my privacy settings and who is permitted to see what in my medical history. Of course, the doctor is already aware of my symptoms and the data reported by my connected devices. In fact, the only reason I had to come into the office today at all was the algorithm suggested, and the doctor agreed, that she needed to palpitate my neck and listen to my chest to confirm the diagnosis. This is the first time in a long time I’ve been into the office in person. For most items that don’t require physical presence, we have our appointments via video chat.
I saw my doctor.
After check-in, my wait is short since my app was just right in predicting when the doctor would be available. We have a relaxed conversation about my symptoms and other things going on in my life. The doctor comments on how much she appreciates getting to spend more time with patients, since nearly all the paperwork she’s been spending years enduring has finally gone away with the true integration of her EMR, Insurance, and Billing, Pharmacy, Scheduling, and Staffing applications, as well as the fact that she always knows if her patients are on time and can plan better for the unexpected.
As part of our conversation, she mentions that she noticed I filled one of my prescriptions a couple of weeks after it was prescribed. I explain that I have a backlog as I don’t always need to take as much as prescribed. We review the drug and my dosing and agree that I’m using it appropriately. Since this is maintenance medication for my diabetes and required to keep me alive, she notes the backlog and my actual usage so my health data can track how much I actually use but allowing me to continue to have extra in case I ever need it.
I appreciate her reviewing my pharmaceutical compliance, remembering the time I forgot to fill a prescription and required a follow-up visit as a result. She appreciates the fact that she can see, with every refill, whether I’m continuing to follow our agreed program correctly.
As she’s examining me, we review my exercise schedule, particularly my heart rate, EKG and pulse oxygen during exercise. I’ve never had heart disease, but as a diabetic, I’m at risk, so I’ve been on a program with a combination of medication, diet, and exercise. She notes the good news that the during-exercise data shows improved heart capacity and stamina over the last few months. But she also notices that my frequency of exercise is down slightly. The reduced frequency also is visible in the fact that I need more insulin for the carbohydrates I eat. This causes me to need more insulin and have higher blood sugars overall but with more insulin circulating in my body, exercise causes a larger drop in blood sugar and puts me at risk of hypoglycemia. This vicious cycle is all visible in the data we both have in front of us. As she reviews it monthly and I review it daily, we both get better at anticipating and predicting the effects of various foods and exercises and stresses. My app has access to all of this, as well as our inputs, and offers its own suggestions and recommendations, as a third opinion.
We discuss how much better I have been doing, with all my data integrated and evaluated in one place and with practical recommendations I try to follow on a daily basis. I explain that I believe this setback is temporary and due to issues at work. She supports me but reminds me of the importance of keeping to our program. We agree on tweaks to the reminder settings on my app to encourage me to step it back up just a bit.
She prescribes rest, lots of fluids, and medicine, and we review the dose and usage. The algorithm reminds us that this medicine can impact blood glucose levels, so we check to ensure that the closed-loop blood glucose sensor and insulin pump system I wear has downloaded the drug information from my data set and are ‘tweaking’ the insulin algorithm to account for it.
Check-out after my appointment was even easier than the check-in.
Before I leave my app offers me options for a video-chat follow-up appointment and I select one. As I walk out, I see the office is starting to make better use of all the waiting room space they no longer need, since wait times are so short. They’ve put in place kiosks and patient services reps to help patients with their wellness and eating plans and to provide a human check that the data and recommendations in the system are still accurate.
On the way home, I was lost in deep thought.
I’m thinking about the continual challenges of self-care, and I head toward home, forgetting the pharmacy. Fortunately, my watch reminds me that I should pick up my prescription and I do. The pharmacist has my prescription ready at the desk, as the doctor had communicated my intent to pick it up immediately, and I had received a notification that the script was ready and confirmed my payment information, and my location information had given the pharmacy an estimate of my arrival time. The QR code on my phone identified me and the medicine. The longest part of the transaction was the greetings I exchanged with the clerk.
And then, I was home.
When I arrived home, I of course immediately recycled all the paper involved. There’s no need to keep a receipt when it’s already been transmitted to the insurance company and the deductible has been sent to my FSA for reimbursement. Unfortunately, later that day when I go to take the medicine, I can’t remember if it should be taken with or without food. The algorithm and the phone are ahead of me though and as soon as I open the app it notes that I have a planned dose coming up and instructs me to be sure to take it with plenty of water.
Update from Monday: I’m feeling much better. So much so that I forget about my medicine. Fortunately, as a diabetic, my blood sugar sensor knows I’m eating a meal and reminds me to take the dose. And was I not diabetic it would have still known to alert me at the time I normally eat. The doctor and I have a quick chat at our video-conference follow-up. I took the medicine as directed and it worked. I even did well in managing my food intake and blood sugar while on the medication, with the help of all my devices, data, and doctor.
While some of the sensors and devices are still in development, all the data described above is available now. Most of the story above could be implemented today, including the overall algorithms, and the remaining hardware and data can be added as they become available. The challenge is in consolidating all the disparate data sources and integrating them with a consumer-friendly application and interface.
RCG Global Services is working with customers on many of these capabilities. RCG puts together strong business experience, a deep healthcare industry team, superior technical and data integration capabilities, and a world-class user interface and user experience team. Call us to find out how we can help you bring a modern digital consumer experience to your system.