I spoke with Dr. Jay Patel last Saturday at the #ENDO2013 poster sessions. I was interested in the Diabetes Doctor app, which according to his abstract meets HIPAA standards by providing end-to-end encryption between the patient (on his mobile phone) and the doctor. The app allows the patient to send glucose readings and for the doctor to suggest insulin dose changes.
I raised the following issues:
- MD-patient relationship. I think it would have to follow that the patient should be under the care of the MD who will be reading and interpreting the glucose values. I think it is vital that this app be used only in between actual clinic visits.
- Liability. Sometimes there may be reasons why blood glucose levels become low or high and that information may not be captured by the app. I would surmise that the MD using the app who makes errors in insulin dose titration will be liable.
- Reimbursement. I am not sure if there is a model for reimbursement for the kind of service the MD provides using an app like this.
- MD work load. While the app may spare clinic visits from the patient's end, it does not spare the MD from added work (maybe post clinic hours, yikes!) to study patients' glucose values.
I understand that Dr. Patel is hoping to run a clinical trial to test this app soon. I look forward to seeing the results which will also hopefully address the issues I have raised. Nice chatting with you Jay!