Housecall started the summer that my two daughters were away at the Kansas City Ballet Intensive. It was an idea that a doctor-dad had, as he viewed his two daughter’s ailing feet from 400 miles away. Ballerinas, for all their grace and precision, have notoriously terrible feet. They stuff them into pointe shoes and then try to balance on their toes for several hours a day. Young ballerinas learn to deal with the myriad ailments that come with dancing for hours at a time. That summer intensive was my two daughter’s first experience in dancing at a pre-professional level. Their feet were not used to the punishing schedule. So, they turned to their dad, a Cardiologist. I was giving them advice about foot care (not exactly my specialty) after viewing the various bumps, bruises, blisters, and sores that many hours of ballet had wrought. I found that FaceTime actually worked pretty darn well to get an up close, high definition view of a blistered toe or a swollen foot. A mobile phone could easily share a detailed view of what hurt. I thought about all the times I had a patient who had called in and gone into a detailed description of some bruise or swollen area. The call invariably resulted in telling them to “just come in and let me look at it.”
I researched FaceTime and Skype and discovered that neither were secure enough for a medical use. They could fairly easily be hacked. I looked around at the video conferencing apps and products that had been around for a decade or more to connect businesses remotely to their home office. I found that they too were not secure enough for medical use and that most companies that had tried to create a telemedicine product out of their video conferencing app had found that a medical appointment was a little different than a discussion of the latest product release. Several large communication companies had tried and failed at finding the right way to do telemedicine. I began to think that this was an idea whose time had come and I was in a unique position to do something different.
I also had spent years looking at lists of heart rates and blood pressures from patients. They came into my office with legal pads filled with their home readings over days, weeks and sometimes months. Many patients with hypertension have fairly good BP readings at home but very high readings in our offices. The dreaded “white coat hypertension” was reliant on accurate patient-derived data from home, but dismissed data derived by a trained medical professional in the office. I had noticed the trend of patient health tracking via Jawbone’s Up band, Fitbit, and the at the time soon to come Apple Watch. I saw that trend as transformative. The patient would collect their own health data and be able to share it with whomever they wanted. I wanted to give the patient the ability to be the collector (and owner) of their own health data but to put that data in a format that would make sense for a doctor reviewing it in a telemedicine conference. Adding that data information to a remote telemedicine visit would allow a doctor to actually treat a patient just like they did in the office. That formative idea was Housecall.
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