Hacking The Medical Care of Chronic Disease


The medical world has done an astounding job of treating and curing acute disease. Heart attacks, strokes, gun shot wounds, infections and broken bones can all threaten your life; yet, with our level of complex care and diagnosis, your chances of survival are very high. However, when it comes to treating chronic disease, medical care needs a makeover. Our one visit every 3-4 month model of medical care does not suffice for adequate management of obesity, diabetes, hypertension, smoking cessation, or any other intervention that requires patient follow up. 

Case in Point:

Let’s say a patient named Joe has high blood pressure and poorly controlled Type 1 diabetes. Controlling his hypertension and lowering his blood sugar are essential to his survival. Joe arrives for his appointment in January for his first check up of the year. You enter the room and look at his vital signs and selected labs:

Heart rate: 70

Blood pressure: 165 / 100

Hemoglobin A1c: 10%

Blood Sugar today: 145

His blood pressure is far too high (goal is under 140 / 90 ), and his Hemoglobin A1c, which is a measure of long term blood glucose control, is very elevated. A goal for A1c is less than 7%. Without significant intervention, Joe will more than likely develop kidney disease and nerve damage, and he will be at a dramatically increased risk of having a stroke or heart attack.

Joe will have his medications adjusted and insulin regimen improved. His physician will discuss how he can change his diet to improve his glucose control, and how exercising will help his overall health. A follow up visit is scheduled for Joe and he returns in three months with similar labs and vital signs. Now what do you do?

Despite the physician’s care and knowledge of Joe’s condition, there remains an enormous 3-month period of time in which he has absolutely no data. For the past three months he has almost no idea what Joe has eaten, when he takes his medications, or how many doses he has missed his medications. All the physician knows is what Joe remembers, which may or may not be accurate. 15 minutes every three months without any interval data is not sufficient to take care of such complicated conditions.

With three simple, currently available technologies, chronic disease management could be dramatically improved.

Recording dietary intake

Perhaps one of the most difficult problems is asking patients to record what they eat, yet this information is essential for a managing a disease like diabetes. High carbohydrate meals can be very dangerous, especially in patients with Type 1 diabetes, and having a detailed log of foods eaten correlated with blood sugars on that day would be immensely helpful to the physician. Enter PhotoCalorie (full disclosure: I am a co-founder). We developed PhotoCalorie to enable a physician to see what their patients are eating in real-time. A patient takes a picture of their food and types in a description. The nutrition information is displayed to the physician. The doctor can see your portion sizes, and make sure you are estimating them correctly. This sort of information allows for more accurate and improved follow up appointment.

Recording Blood Pressure

With the growth of the Quantified Self movement and mobile health, there are many ways to collect high quality health data. For a patient with high blood pressure, an essential tool for better care would be Withings Blood pressure cuff. It attaches to your iPhone and records your blood pressures automatically. This technology helps determine if medications are working properly or if the dose needs to be adjusted, and can provide the physician many readings per day.

Measuring Activity Level

Right now, our best way of determining a patient’s level of activity is by asking them. Of course this self-report is subject to embellishment or forgetfulness, and is not an objective measure. If patients had a Fitbit or other activity trackers, exercise and sleep statistics could be transmitted to their physician.

Now imagine Joe used these three tools and came to his next 3-month follow up visit. The doctor now has 3 months of eating behaviors, activity levels and daily blood pressure readings correlated with Joe’s report of how he is doing. Ongoing tracking would provide better management of these chronic diseases, save millions of lives and dollars each year, and bring the medical care of chronic disease into the 21st century.

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Larry Istrail is a medical student and entrepreneur that is passionate about the intersection between medicine, technology, and innovation. He is the co-founder of PhotoCalorie, a photographic food journal that allows you, your friends or your physician to literally see what you’ve been eating. He is also the founder of the Ancestral Weight Loss Registry, a crowdsourced weight loss research service with data from over 50 countries around the world. You can follow him on tumblr.


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