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Idea Mobile Follow Up App

By Abhijit Bhograj | 16 Dec, 2014

Submitted by: Dr Abhijit Bhograj

Most patients once started on a treatment are lost to follow up thanks to the complexity of our health system. The follow up app is a pre-set questionnaire follow up, texted to the patient few days/hours after the primary visit. This is very important because most condition symptomatology are often missed during the primary consult and the new symptoms can be brought to light easily without having to reschedule.

A Classic Example: chest pain, it could be acid reflux, angina, or an MI. A patient with an MI can present early with generalized discomfort with no changes biochemically or EKG changes, such patients are treated with a PPI and sent home. Over a few hours or a day, symptoms of these patients change, and, if not followed up can be missed altogether, leading to an untoward situation. On the other spectrum of the app, if all is ok, it's always good to boost the moral of a treating doctor to know that the treatment has worked and the patient is doing well.


Tara Narula Advisor Replied at 11:17 AM, 17 Dec 2014

Dear Dr. Bhograj,
Thank you so much for your idea on the mobile app. I think this is a wonderful way to begin to engage patients in taking ownership of their health and care as well as giving doctor's more information to correctly diagnose patients. Many times as you mentioned the more information we can get regarding history the easier it is to tease out the correct diagnosis and avoid missing more dangerous conditions. Giving patients the teaching to pay attention to their symptoms, document them and be in contact with their physician is empowering for them. Heart disease is a perfect example as you discussed of an arena that the mobile app might be used. What other disease processes do you think might benefit from this? Do you envision the mobile app as being used as well for follow up on medication tolerance or adherence?

Kedar Mate Keynote Speaker Replied at 3:49 PM, 17 Dec 2014

Dear Abhijit,

Very interesting idea. I like the fact that you are closing the loop with the patient and the doctor so the doctor can know whether they got the diagnosis and treatment right and the patient can know whether they should be taking any additional action to improve their outcomes. In an era when caregivers increasingly work on interdisciplinary teams, I wonder if your app can be made to include all of the members of the care team (nurses, doctors, etc) so that all can receive feedback and all can respond to patients who might appear to be deteriorating outside of the hospital. You might also consider adding on other feedback about not only outcomes of care, but the patient's experience of care as well so that providers can gain a richer and more real-time understanding of their bedside manner and their ability to help people understand their clinical circumstances. If the privacy and coordination barriers can be overcome, this seems like it could be a very useful app indeed.

Abhijit Bhograj Replied at 4:17 AM, 18 Dec 2014

Dear Dr Narula
The follow up and the history app go hand in hand kindly take a look at this link ( ideally that is what I hope these apps would do .
With regard to its application in other specialities ,eg in Endocrinolgy some of my challenges I face is with Insulin dose adjustment in diabetics. Once I start a fixed dose some time we over or under correct the dose depending on the case ,follow up questions with regard to hypoglycaemia is very important , the app will be pre programmed to send questions pertaining to hypoglycaemia and as you correctly mention medication adherence ( insulin technique and compliance )

Abhijit Bhograj Replied at 4:31 AM, 18 Dec 2014

Hello Dr Kedar I personally feel the patient should have the power to share information pertaining to their health . I am tring to get a work flow of both the history app and the follow up app going , will put it up once I have something of value

A/Prof. Terry HANNAN Advisor Replied at 4:43 AM, 18 Dec 2014

Abhijit, in response to your statement " I personally feel the patient should have the power to share information pertaining to their health" you have continued to make us focus upon the most important issue that we must concentrate our solutions upon (technical). To this end I have pasted below the "tale" provided to me by Professor Lawrie Weed who is one of the first forward looking health informaticians. His final 3 points are critical.

In the latter regard, I remember the day in a medical centre on a ward with a modern information system when they wanted to present a patient to me on rounds.
I said “ Do not present a new patient: tell me who is going home today”.
The nurse volunteered the name of a middle-aged woman who had Lupus for 10 years. I suggested that they give me 15 minutes with the patient and then they could return for discussion.
I asked the patient to tell me all about each of her problems. She knew very little about the medical problems.
“ Do you have a copy of your own medical record?”
“ Are all your medications in your bedside stand, and does the nurse come around at regular intervals to see if you are taking the right ones at the right time?”
“No. The nurse just comes with little paper cups with pills in them, and I swallow whatever is there.”
“ Do you know what a flow sheet is – what parameters we are trying to follow – what end points we are trying to reach?”
At this point I called the staff back together and told them what I had found. Their reactions were:
“ We never give patients their records.”
“ We do not have time to give the medicines that way.”
“ It would not be safe to leave them her with them unattended- she is on many powerful drugs.”
“ The patient is not very well educated and I do not think she could do all the things your questions imply.”
I then said:
“ But you said she is going home this afternoon. She lives alone. At 2 PM you will put her in a wheelchair, give her a paper bag full of drugs, and send her out the door. Are you going home with her?”
“ No. Is her management at home our problem?”
“ You just said she could not handle it – who will do it?”
“ The patient may not seem well educated or very bright to you, but what could be more unintelligent than what we are doing?”
We must think of the whole information system, and not just infinitely elaborate on the parts that interests us or fit into a given specialty. Patients do not specialize, and they or their families are in charge of all the relevant variables 24 hours a day, every day. They must be given the right tools to work with. They are the most neglected source of better quality and savings in the whole health care system. After all:
1. They are highly motivated, and if they are not, nothing works in the long run anyway.
2. They do not charge. They even pay to help.
3. There is one for every member of the population.”

Mark Ott Replied at 10:39 AM, 18 Dec 2014

Professor Hannan, That is a *great* story! I'm a huge fan of Dr. Weed. I fear the same issue he was tackling then is still all too pervasive today.

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