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Mimics and Testing: The Road to Diabetes Telehealth

By David Forbes From Western Australia

Posted On: March 4, 2010

One February summer morning my daughter was awakened by what she thought was her cell phone alarm call. She had not to her knowledge set that alarm call. It was barely daylight and a while before she planned to rise. Recalling this later prompted me to remind her that it is quite common in our part of the world, north of Perth, to hear sounds that at first seem electronically generated, but turn out to be birds that are apparently mimicking non-bird sounds. In a limited area of Australia, more than 2000 miles away in the east of the country, lives the Lyrebird, renowned for its remarkable ability to mimic sounds. Lyrebirds have their own unique calls, but can often be heard mimicking loud clear sounds made by other birds and mammals, even humans. Many reports confirm that they successfully mimic the sounds of chainsaws, horns, alarms, and even trains. As for our mysterious alarm call source, that’s an intriguing thought because we have no Lyrebirds in the west – but many, many colourful birds with a range of calls, from the exquisite song to the jarring shriek, live around here. Several species of parrot are also in abundance, as is the ubiquitous magpie. So we have yet to identify the culprit; then just before writing this, I heard what sounded like one of the earlier version cell phone ringing tones – coming from high up in the trees.
 
It set me wondering – how long does a bird mimic keep the same repertoire? With cell ringtone upload choices and technology changing so fast, how do they decide which to ‘copy’? That’s a similar but of course more significant challenge for the diabetic patient considering the purchase of home testing devices and adoption of telehealth services. In a subtle way, mimicking becomes a friend to the patient – for that is what artificial intelligence systems effectively can do when processing and flagging up health condition data in the abstract logic world.

‘Australia Facts: The Kangaroo
There are several species of Kangaroo. I commonly encounter Western Gray Kangaroos while walking the family dog in the nearby bush parkland.
 
The word kangaroo stems from an Aboriginal language (Guugu Yimidhirr). The Aboriginal word gangurru described the Grey Kangaroo.
 
A group of kangaroos is called a mob.
A baby kangaroo -- commonly named a ‘Joey’ -- at the time of its birth measures 2 centimetres.
Kangaroos need very little water to survive and are capable of going for months without drinking at all. When they do need water, they dig 'wells' for themselves, frequently going as deep as three or four feet. These 'kangaroo pits' are a common source of water for other animals living in the kangaroo's environment.
Emus and kangaroos cannot walk backwards, and are on the Australian coat of arms for that reason.
The Australian kangaroo industry estimates that it exports kangaroo meat to more than 55 countries. Kangaroo meat is increasingly popular and export markets are expected to increase since kangaroo is considered one of the finest game meats. Its growing appeal stems from its well-flavored, slightly gamey taste. Kangaroo meat contains very little saturated fat relative to other meats and is high in protein, zinc, and iron.’

Point of Care Testing (PoCT)
An explanation of the generic description ‘telehealth’ can come from several permutations, but for my purposes here, I am talking about the ability to self-manage diabetes by conducting self-tests using approved electronic digital devices capable of sharing information from the tests with ‘health care practitioners’ regardless of the physical distance between the patient and the practitioner. Collectively these devices may be called ‘Point of Care Testing’ (PoCT) devices. I need here to qualify my use of that term ‘practitioner’. It can include a doctor, a specialist, a nurse, or related health professional, but increasingly it will also mean a ‘virtual’ practitioner, in which computer systems with reasoning power – artificial intelligence on shared server systems – will fill a specific task role that supports intervention protocols. This should not be interpreted as a full service substitute, i.e. it augments and does not replace human professional care systems.
 
Digital devices, especially when linked to secure health specialist servers can share, merge, and help to analyse relevant data to deliver better patient health outcomes, while offering more efficient – and ultimately affordable – use of the finite time available to health professionals. On that subject of affordability, perhaps a useful analogy that shows the road ahead is the history of the multi-functional integrated desktop printer/copier/fax/scanner market. Who would have thought a decade ago that such home office capabilities could be obtained in a small single machine at such affordable prices? (Notwithstanding the ink cartridge cost – an example of the ‘hidden cost’ syndrome to be wary of when budgeting).
 
The tests may be completed at the patient’s home or in a local clinic that has protected connectivity with regional or central servers. The availability of devices such as glucose meter, blood pressure cuff, weigh scales, cholesterol test kit, pulse oximeter, etc., and their communications connectivity options, offers great promise. Reputable companies that have managed to produce integrated all-in-one telehealth capable device systems are continuing to pioneer developments that will make self-management much more of a reality for those who have yet to take advantage of these opportunities. For many there is a daunting aspect to face – how do I make the right choices? What can I afford? Are there any hidden costs? Does my health insurance carrier cover system costs? Who is my best choice to hook up with as my affordable efficient telehealth service provider? What equipment and connectivity support – broadband services, wireless, and other communications options are accessible and affordable? Before you throw your hands up – and maybe give up thinking about it – be assured there is plenty of free help available to make this exercise a more pleasant journey than you might at first imagine.
 
The Patient – Practitioner - Device Dialogue
This particular article does not attempt to answer the questions I have described. More will be explained in future articles. It is a very big topic. This third article is the beginning of a dialogue – and that usually means a two-way exchange. Bi-directional dialogue is what some like to call it; and it is key to the future success of health care for people with diabetes. It means that the patient must have a voice; and must be heard – individually and collectively. I have read many academic study reports in which patients appear to be reduced to the status of laboratory specimens; or components within statistical data sets. All are valuable studies, but I favor those that discover and develop new knowledge through free-flowing dialogue in which patients are the main contributors. Unfortunately academic rigour can mean that somewhat rigid questionnaires that fit nicely into a representational structure are the more common tools employed; and these risk very valuable patient experiential information escaping attention and justifiable further study. So – once again I urge you as a visitor to this site, to contribute to the diabetes care dialogue, recognizing that if you have diabetes or care for someone with diabetes, you are a veritable mine of valuable information that we can pass on to those who can put it to the most positive use –researchers, clinicians, other healthcare practitioners, and industry technologists.
 
Final words follow, but first here is another very important point about PoCT and Telehealth. Feedback information should become your knowledge, which is is vital for successful self-management. User friendly press button features aside, you want to know – directly from the PoCT device “What does this mean?” and you should not have to be educated to a rarefied level or become a computer whiz to grasp what you should be learning from the tests. Those who are fortunate enough to have a primary care physician with good communication skills will recognize the difference when encountering a doctor of a different less enquiring and informative disposition. So it will be with technology. Quality, versatility and usefulness of feedback will set the best apart from the rest.
 
Is there a choice? Can I expect to do without self-managed PoCTs? Can’t I stay with what I have done for years and rely upon my primary care physicians and nurses? Read the following, think about the average time and conversation you have with your doctor and then decide. The Cochrane Library website here includes the following statement:
 

To take research as just one example of information overload: over 2 million articles are published annually in some 20,000 biomedical journals – equivalent to a pile of paper 500m high (or nearly two Eiffel Towers)! It’s estimated that the average general practitioner needs to read 19 articles a day just to keep up-to-date with major developments. Yet we know that most health practitioners are only able to spend up to an hour a week reading the professional literature. Clearly, keeping up-to-date with all the evidence is not a task we can expect clinicians to do on their own.


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