Author: Steven Zuckerman, M.D.
The purpose of this article is to describe how I have been able to use “cloud technology” to simplify the process of getting useful clinical information from my patients. Since I am a neurologist, I have more than a passing interest in the management of patients with Parkinson’s disease. The successful management of this condition is highly dependent on the patient-physician communication regarding how their disease state is responding to their Parkinson regimen. Too much medication causes involuntary movements while inadequate dopamine stimulation results in the inability to move. Since there are several different Parkinson’s medications, all of which have different half-lives and durations of actions, the resultant clinical effectiveness is highly variable. Therefore, correlating clinical status with timing of medication ingestion is the only reliable means to make appropriate medication adjustments. Ideally, a patient log or journal should be completed at half hour intervals to capture this information. An analogous condition in Primary Care would be regulating a Diabetic. Insulin type and dosage need to be correlated with blood glucose determinations obtained throughout the day in order to optimize the Insulin regimen.
Clearly, a routine three month follow up visit would not suffice to obtain this information and respond in a timely fashion to improve disease control. I first thought of the notion of establishing an electronic Parkinson’s disease Journal about five years ago. The implementation of this system, unfortunately, was somewhat technically demanding. A program using a SQL database hosted on my office PC running an Apache server was the actual platform used. Since I was not sufficiently versed in using these programs, I never could manipulate the data to a point that I felt was adequate to help me manage the more difficult Parkinson patients.
In this era of cloud computing, the communication of the same information may be accomplished in a much more direct and controllable fashion. The exact platform to publish the Journal to the cloud does not make a huge difference, but I have found that Google Docs is best suited to this purpose. Therefore, I have created a PD Journal in a Google Doc Spreadsheet format. In addition, I have created a very simple Google Site webpage as a means of the patients accessing some instructional videos. These videos explain the physiology of Dopamine and the importance of tracking the clinical response to timing of taking their medication. All of this can be accomplished without any knowledge of programming and without spending any money at all.
The videos may be seen at:
There are several features of the Google Docs applications which make this approach easy to use. These include:
1. Security- each patient is emailed their own copy of the PD Journal Spreadsheet. No one else can access that particular file, so there is really no way identifiable patient information is at jeopardy.
2. Real time accessibility to Journal updates- since the file actually resides in the clouds, as soon as the patient fills in the Journal, access to that information is instantaneous. It is auto saved and patients do not have to hit a send or email button to transmit the information.
3. After the Journal is analyzed, I can delete all the data which resets the Spreadsheet back to its original empty state ready for the next time the patient needs to fill it out.
4. The information can be readily be transformed into a bar graph within the Google Spreadsheet program to rapidly visualize where their particular Parkinson regimen is inadequate.
To see the actual Journal itself, please click here.
A value is entered every hour, or, the form is expandable to accommodate every half hour entries. There are drop-down selections to choose the medication and dose at the appropriate times. Since there is only one form per patient (named with their initials), identification of the patient is readily accomplished without a HIPPA violation. Google records the time and date of any modification of the form so this information is also collected without requiring further user input.
Of course, collecting information regarding Parkinson’s disease is only one example of managing a clinical condition which can take advantage of this technology. Within the field of neurology, Journals recording headache or seizure frequency can easily be devised. Many chronic conditions including Hypertension, Diabetes and CHF may similarly find utility in employing this technology. A little thinking “outside of the box” in applying cloud computing could go a long way.
About the author:
Steven Zuckerman, M.D is a solo practitioner neurologist in Baton Rouge, LA. He is board certified in internal medicine and neurology. He trained at Parkland Hospital in Dallas and then Columbia Presbyterian in NY respectively. He has a longstanding interest in Medical Informatics and has a Masters Degree from the University of Edinburgh and Bath University. He was a judge for CCHIT in the original certification programs and he is actively involved in the Louisiana REC. He currently serves on the Practice Management and Technology Committee of the American Academy of Neurology and he is in charge of the annual course regarding EMRs.