Smart healthcare, it sounds like the future is here: AI-assisted diagnosis, remote consultation, smart wearable devices…… But when we actually walk into the hospital, open the app, and face the doctor, do these “wisdoms” really solve the core problem? Or is it just an old bottle of new wine in the cloak of technology? This article will take you to clear the fog of technology and re-examine the true face of smart healthcare: is it an accelerator for the medical system, or is it another illusion of “pseudo-intelligence”?
Recently, due to the illness of his family, he personally experienced the whole process of outpatient and emergency services and inpatient services in the new first-tier city. This experience has led me to develop a new and deeper understanding of the “Future Hospital” project and smart medical practices that I have participated in and am proud of.
First, analyze the user portrait:
The patient was a 59-year-old male. Previous smoking history and have successfully quit smoking; Had a long history of daily drinking and now occasional drinking. Diagnosed underlying diseases include: diabetes, hypertension, gout. The patient’s lifestyle is characterized by a preference for a high-fat diet and a significant lack of daily exercise.
Before the diagnosis
During the family’s visit to the hospital for acute abdominal pain, gout symptoms occurred at the same time. When faced with a sudden illness and need to clarify the direction of diagnosis and treatment, the first question that comes to mind is: “How to choose a specialist department for gout attacks?” “As a product designer who has been in the medical industry for nearly ten years, I subconsciously searched for hospital and department recommendations through social media platforms (such as “a sweet potato”), but realized a phenomenon worth pondering – including the medical products I participated in, no industry solution could become my first choice, which was deeply surprising.
At this moment, I am eagerly looking forward to oneAI-assisted decision-making system with medical logic and scenario insight capabilities。 It should be able to integratePatients’ past medical history (such as diabetes, hypertension, gout), regional medical resource distribution, and real-time outpatient information, provide pertinent suggestions after cross-dimensional analysis, such as accurately recommending matching hospitals, departments and doctors, and even planning the optimal treatment path.
In the diagnosis
The entire long “in-diagnosis” process can be divided into the following stages
1. First visit to Hospital A:
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After improving the relevant examinations and examinations, the family obtained information from the receiving doctor was kidney stones (later reviewed the written medical records and actually recorded hydronephrosis), and the doctor’s plan was to treat it conservatively with medication and provide infusion support.
2. Transfer to B hospital for the first consultation
The treatment lasted less than a week, and the abdominal pain worsened instead of relieving, so she was transferred to the emergency department of the tertiary hospital. On the basis of reviewing the examination results of Hospital A, the physician of Hospital B supplemented the necessary examinations, confirmed that it was a urinary tract stone co-infection, gave anti-inflammatory treatment, and clearly requested to go to the urology and nephrology clinic of the hospital the next day.
3. Specialist treatment in B hospital
The next day, the first doctor of the nephrology department believes that urological emergencies need to be prioritized, and it is recommended to refer them immediately; Finally, after urological evaluation, it was determined that the core cause was hydronephrosis secondary to urinary tract stones. Formulate a phased treatment plan: the first stage of outpatient indwelling ureteral stent tube to relieve urinary tract obstruction and promote creatinine level (creatinine reached about 350 at that time) to fall back to the safe range; In the second stage, stone removal should be performed electively (after the cough improves). In addition, urologists simultaneously recommend nephrology experts from our hospital to formulate adjuvant treatment plans for renal function recovery.
4. Wait for the surgical stage
- Gout diagnosis and treatment: In view of the family’s previous history of gout and current acute attacks, he went to the general outpatient clinic of the Department of Rheumatology and Immunology of Hospital B. Because the patient also has renal insufficiency and conventional anti-gout drugs are contraindicated, the treatment regimen is adjusted to glucocorticoids to control inflammation. Doctors particularly emphasize that if there is no attack after the symptoms of gout are relieved, the medication should be stopped. Previously, family members often bought drugs from pharmacies when they had gout attacks, and such drugs actually caused significant damage to kidney function.
- Cough treatment: During the same period, due to persistent cough symptoms in the family, in order to rule out the possibility of pneumonia, he was treated at the respiratory medicine specialist clinic at the same time. After improving the relevant auxiliary examinations, the diagnosis of pneumonia was ruled out, and the laboratory results showed that the creatinine level was significantly too high. After evaluation by a specialist, it is recommended to immediately refer to the emergency department for intravenous fluid therapy to lower creatinine.
- Follow-up treatment: After that, follow the doctor’s instructions to receive intravenous infusion treatment in the emergency department many times, and regularly follow up in the outpatient clinic, and issue test sheets to monitor relevant indicators (such as creatinine, etc.). Until the early stage of the operation, if there are doubts about the preoperative preparation, make another appointment for the chief surgeon’s outpatient consultation. After evaluation, the chief surgeon pointed out that the previous frequent emergency and outpatient procedures were not necessary, because a complete pre-hospital examination during hospitalization would cover all necessary evaluation items.
5. Inpatient surgery
The pre-hospitalization model has shown significant convenience in optimizing the diagnosis and treatment process. However, its information transparency still needs to be improved, mainly reflected in:
- We do not have access to key information such as the surgeon’s information, estimated start time of surgery, and estimated duration of surgery.
- On the day of the operation, near noon (about 11:30), the nursing staff notified that the originally scheduled morning surgery might be postponed to around 14:00 p.m. We went to eat first according to this arrangement, but as soon as we arrived at the restaurant, we received a text message notification to send it to the operating room, and then turned back to the hospital.
In addition, during the operation, the bedside information display system of the ward could not update the progress status of the operation in real time, and we could not confirm the end of the operation until the family returned to the ward.
During the “in-consultation” session, the following problems were found or encountered
1. Information is not transparent
Compared with other defects, the current information transparency problem is relatively easy to improve. Its core contradictions focus on two points:
First,Missing information on key diagnosis and treatment nodes(For example, the identity of the chief surgeon, surgical scheduling and other basic data are not open to the patient);
SecondThe intraoperative progress synchronization mechanism failed(Typical manifestation is that the point-of-care information system does not update the surgical status in real time).
From the perspective of feasibility, the former can be solved by expanding the data display content of the patient’s mobile terminal, while the latter needs to be optimized by troubleshooting system stability or faults.
2. The diagnosis is not comprehensive
During the first consultation of Hospital A, the receiving physician failed to improve the relevant examination for the high-risk indicator of significantly increased creatinine (detection value of nearly 200 μmol/L), resulting in the failure to identify the root cause of secondary hydronephrosis of urinary tract stones in time. According to the early warning rules for abnormal renal function, such scenarios should trigger the system to recommend supplementary imaging (such as ultrasound) and urinary tract infection screening and other key tests. The CDSS did not play the expected role in this diagnosis and treatment, and the specific reason for it is unknown to individuals.
3. Inefficient resource allocation
I fully understand that the original intention of government departments to regulate outpatient infusion behavior is to ensure the safety of patients’ medication. However, when the outpatient physician really needs to be treated with intravenous fluids after professional evaluation, the current process requires the patient to be transferred to the emergency department for treatment, and the emergency triage is rated as level 4 (non-emergency), and the infusion prescription can be obtained for almost 3 hours! It is recommended to refer to the “simple outpatient” service model to improve the medical experience of specific patients.
4. Process fragmentation
The author believes that this is the most critical problem exposed by this medical experience: when patients suffer from several diseases at the same time (such as gout, hydronephrosis, cough), the lack of efficient collaboration between various departments in the hospital leads to the fact that we are forced to independently switch between rheumatology and immunology, urology, nephrology and other specialties. It turns out that when the author designed the hospital system, he would include single-disciplinary consultation and multidisciplinary consultation, but it was not applied in the actual medical treatment. Of course, the author did not consult the doctor on the spot, so he could only search and query afterwards, and there are two possible reasons:
- The clinical assessment did not reach the emergency threshold for consultation;
- In the outpatient scenario, doctors’ spatio-temporal resource constraints make it difficult to coordinate immediately.
It is enough to see the importance of “online remote consultation”.
In addition, although the receiving physician has formulated a phased treatment plan, the delivery of the plan mainly relies on oral notification or fragmented records in the current medical record, and lacks systematicPatient-side path visualizationTool. In fact, many private medical institutions have applied the electronic outpatient clinical pathway system, so that patients can track the whole process nodes such as examination, medication, and follow-up consultation in real time. It’s just that it may be more difficult to implement public hospitals.
5. Lack of intelligent reminders
In this case, the author’s family repeatedly reused historical prescription drugs, resulting in a significantly increased risk of drug-induced kidney injury. This highlights the establishmentPersonal medication intelligent monitoring systemNecessity: Through the integration of medication records, medical history data and test indicators through digital tools, intelligent multiple protection can be realized, real-time risk warning, active intervention reminder, and closed-loop health management.
After diagnosis
After talking about “during the diagnosis”, let’s talk about “after the diagnosis”.
After completing the urological stone removal surgery in the “in-diagnosis” stage, the patient still needs to perform two key post-diagnosis arrangements: 1) return to the hospital for ureteral stent removal half a month after surgery; 2) Go to the nephrology department to evaluate the treatment plan for improved kidney function.
In order to avoid the inconvenience caused by multi-department travel, there is an urgent need for an auxiliary tool with intelligent reminder function – which can actively push doctors’ schedule update information, trigger registration reminders at the appropriate time, and eliminate the burden of personal recording and planning of follow-up procedures.
epilogue
Before experiencing the diagnosis and treatment process of his family, the author believed that the smart medical system of Hospital B had reached a high level – this understanding stemmed from his own experience as a young patient with no underlying disease, and his single registration or hospitalization could solve most problems. However, in the face of the complex conditions of elderly patients with multiple diseases, the existing system is obviously inadequate in interdisciplinary collaboration and continuous care. This reflects the lack of experience of smart medical designers in multiple clinical scenarios, and to achieve “intelligence” in the true sense, it is still necessary to continue to deepen the system adaptation ability.
This experience also warns that the health of family members requires daily active attention. To this end, the author has fully bound the existing health monitoring products with family information, and suggests that readers establish a family health management mechanism at the same time to strengthen the continuous tracking of the health status of relatives.
