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Advances In Technology Are Improving Chronic Disease Management Through Real Time Patient Monitoring

I had the pleasure of interviewing Dustyn Williams, MD. Dr. Williams is the founder and chief medical officer of DoseDr, a telemedicine…


I had the pleasure of interviewing Dustyn Williams, MD. Dr. Williams is the founder and chief medical officer of DoseDr, a telemedicine tool that helps patients with diabetes manage the chronic disease and improve their overall health. He is also the founder and lead educator of OnlineMedEd, a digital learning platform for healthcare students and professionals, which, in four years, has grown to generate more than $5 million annually.

Thank you so much for doing this with us! What is your “backstory”?

I went to med school and completed my residency in post-Katrina New Orleans. Louisiana has the highest medical costs in the U.S. per capita with and the worst outcomes. There is no one problem, no one diagnosis that is the culprit. But the one that most stood out to me was diabetes. Diabetes is at the root of heart disease, stroke, kidney disease, and amputation. When blood sugar is high, people lose their eyes, their limbs, or their life. When the sugar is controlled, those health problems can be totally spared.

The hardest diabetic patients to treat are insulin-dependent. It’s hard because a patient must prick their finger to draw their blood, then stab themselves with a needle to inject insulin. Multiple times per day. And each dose is different during the day, and different on each day. The difficulty, fear, and complexity of the disease makes it catastrophically difficult for a patient to manage. Knowing how much insulin is needed, however, is incredibly challenging, because the dosage can change based on blood sugar, amount of exercise, a patient’s mood and sleep patterns.

There’s this idea that some people hold that Louisiana is full of lazy people that don’t want to help themselves and that’s simply not true. The fact is the healthcare system has failed them. Rural patients distant from healthcare, an education system that is one of the worst in the country, and not enough doctors staying in the state to help the population we have. I wanted to prove that it wasn’t the people of Louisiana that failed, it was the system that failed the people of Louisiana, and only with a powerful disruptive switch in the way healthcare is delivered, only with the right tools designed to empower patients, could this ever be done.

While in residency, I had a clinic in the Lord and Taylor building in downtown New Orleans. The department store, abandoned after the hurricane, had been retrofitted to be the MCLNO Clinic — the free clinic for people without insurance. There Tulane and LSU residents alike cared for the people the rest of the country forgot. The sickest patients with the least resources, desperate to get help. It was there I treated a patient newly diagnosed with insulin-dependent diabetes. The nature of the clinic where I was present in that clinic for a week, every five weeks. I wrote simple, personalized instructions for him to follow. Five weeks later he returned to clinic having successfully titrated himself.

If a patient could do this, on his own, with my hand-written instructions, surely this could be done with any patient with the right tool. After successfully helping that patient, I started doing it with others. It was time-intensive and exhausting. But then patterns developed, and I got the idea to create a tool — a mobile app — that everyone can use on their own at home, to connect the doctor to the patient and help the hardest, most difficult, most out-of-control diabetics control their condition. That’s when I went to work building DoseDr.

DoseDr is a mobile app that improves diabetes management by providing patients with medication reminders and simplified physician-reviewed instructions in real-time. They enter their blood sugar and the app tells them how much insulin to take. The fear, anxiety, difficulty and complexity are removed, and the patients are instilled with the confidence that what they’re doing is the right thing. At the same time this data is communicated to the cloud where either their own provider, or a DoseDr provider, can review the data. By making small, frequent titrations between clinic visits, the patient gets the right dose in a fraction of the time it would take with traditional techniques. And, unlike other disruptive technologies, it does so easily, without adding to already-overburdened clinical workflows, and without the need to add or learn new technology.

Can you share the funniest or most interesting story that happened to you since you began leading your company?

The first patient to use the DoseDr app was a woman with multiple chronic conditions and was extremely obese who was hospitalized for hyperglycemia and a skin infection. It was clear to me that she was struggling with her diabetes, so we enrolled her in DoseDr. She had been stable for a full month after she left the hospital, her blood sugar was well controlled using the app to dose herself. Using the DoseDr portal, I noticed her sugars started trending up despite using the stable insulin dosing. I contacted her and found that she was still using the app, the insulin was used properly, and that the insulin was good. This told me something else was wrong and we needed to take a closer look at the problem. After a brief conversation I found out that she was having loose stool. Having been recently hospitalized and on antibiotics, I suspected C. Diff Colitis. She was brought into the clinic, confirmed the diagnosis with C. Diff Colitis, and was treated with a liter of IV fluids in clinic and sent home on oral antibiotics. Had we not seen the change in her sugars through the app, she would have ended up hospitalized for days in the ICU. We saved her a trip to the hospital, possibly her life, and the healthcare system saved roughly $10,000 dollars.

What do you think makes your company stand out? Can you share a story?

No one has had as much success in diabetes as we have. Our two pilot studies, one at Christus Cabrini Hospital and another across Louisiana proves how effective the DoseDr app is. We moved patients’ A1c levels, the marker for someone’s glucose level over 90 days, from an average of 9.3, which is wildly out of control, to a well-under-goal of 6.4. Moving a patient’s A1c by three points can take up to seven years with conventional treatment methods. It took us 3 months. And we replicated that in two pilots.

What really makes DoseDr stand out is that it’s a full-stack solution. For patients, DoseDr is like having a team of doctors in their pocket when they need them the most. Patients have the safety and security of knowing what to do in real time. They check their blood sugar, enter it into the DoseDr app, and the app tells them how much insulin to take. An integrated physician-reviewed dose card enables the app to correctly dose the insulin and sends patients easy-to-follow instructions, so they can be confident they are getting the right dose every time. DoseDr’s real-time feedback increases medication adherence and reduces adverse medication events.

For doctors, DoseDr Physicians do the medicine between clinic visits, essentially working as part of the patient’s treatment team. The data entered by the patient on the app is sent to the Portal. DoseDr physicians regularly review blood glucose levels and insulin doses, allowing them to make informed decisions. Dose adjustments happen only after data is reviewed and discussed with the patient, keeping them informed and engaged in the management of their care. Small frequent titrations in the insulin dose between clinic visits allows for rapid control of the A1c without causing hypoglycemic events. As a result, this eases the burden many primary care physicians experience when attempting to manage care with limited resources.

Are you working on any new or exciting projects now?

After proving the efficacy of the diabetes module in the two pilot studies, we’ve expanded the platform to other chronic illness. We released a hypertension module in February and we’re now moving on to treat heart disease, such as congestive heart failure, and lung disease, such as chronic obstructive pulmonary disease.

It isn’t going to be just “enter glucose, get insulin.” Each disease has a thing that needs to be tracked, a sign that things are getting worse, and DoseDr both knows it’s happening and can give the patient some interventions — a medication or an action — to restore the balance. Where patients would wait five days unaware their disease was out of control and end up in the hospital, now DoseDr knows something is wrong before the patient realizes and intervenes before the patient feels ill.

What advice would you give to other CEOs or founders to help their employees to thrive in the tech space?

While incentivizing employees with company benefits has its advantages, providing a work environment that allows employees to achieve true fulfillment and engagement starts with building a culture that inspires and nurtures passion. This approach stands true whether you’re a CEO leading a large, more established business or the founder of a startup. If your employees are just coming into work to earn a paycheck, you’re doing it wrong. The goal is to have your employees excited about their projects, engaged with their teams and striving to achieve your overall goal.

At DoseDr, we look to instill in every employee the passion of putting the patient first. First the patient, second the team, third the self. Building a solution that dramatically improves the lives of the sickest patients while helping to solve the health care crisis in America — better outcomes with lower costs — is something that’s worth working on. When it’s a cool, slick technology, it’s an even better reason to come into the office.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are?

Michael Siebel, CEO of Y Combinator, and Justin Kan, a former partner. They gave us a chance by letting us in to Y Combinator. They gave us the tools, the skills, and the knowledge to make our vision for DoseDr a reality. Without their advice, without them taking a chance on us, we wouldn’t be here today.

How have you used your success to bring goodness to the world?

We’re rewriting the healthcare narrative. For decades, poor, uneducated patients with this severe disease essentially heard the healthcare system tell them, “this is the best we can do with the tools we have available.” That wasn’t something I could accept, so I decided to make a new tool. Every patient that has used the DoseDr application and titration services went from being confused, lost, and sick to being informed, in control, and healthier. With our tool and our service these patients who once were unable to comprehend or control their disease were finally doing it right.

Diabetes is no less scary when you have the right dose and sticking yourself with a needle multiple times per day is no less painful when you know exactly how much insulin to give, but when blood sugar is under control, the mind clears, vision improves, and the risk of death, stroke, and amputation is sufficiently less.

The diabetes we treat cannot be reversed nor cured, but by giving give patients control over their disease, preventing the severe medical disease and complications that can arise, and taking people from visiting the hospital every month to never needing the hospital in a year, we’re helping them live healthier lives.

Can you share the top ways that technology is changing the experience of going to the doctor? (Please share a story or example for each.)

The American College of Cardiology and American Hospital Association’s (ACC/AHA) recommendations on hypertension suggest with strong evidence that using self-monitored blood pressure readings is the gold standard for making medical decisions on changes to blood pressure medications. They still recommend the patient come in for physical visit, but technology is changing that need. I see technology expanding beyond just one disease. Chronic disease requires chronic vigilance and chronic assessments. And most of that information can be obtained from the patient where they are, not dragging them into clinic where they sit and wait for their turn.

Most treatment decisions for chronic disease are based on simple readings — blood sugar, weight, blood pressure, or a short list of symptoms — and focus on titration of chronic illness while preventing or responding to exacerbations early. Using technology, the information can be acquired multiple times per day. Parameters can be set. Patients can respond to changes in their readings with predefined, easy-to-understand instructions, which allows doctors to spend less time educating on how to do it themselves. Availability and ease-of-access removes the uncertainty providers have of their patients’ wellbeing, reducing the need to go to the doctor as often and when they do go in, the information is already waiting for the provider and does not need to be extracted.

Can you please give us your favorite “Life Lesson Quote”?

In his book “Start with Why,” Simon Sinek writes, “People don’t buy what you do, they buy why you do it.” I love this quote because it truly speaks to our company’s mission and story. Our primary focus has always been treating the most vulnerable patients in desperate need of help for one reason alone — because it’s the right thing to do. Simon Sinek uses it to illustrate how great leaders inspire action. I use it to mean doing the right thing is always the best thing to do. We gave away DoseDr services for free to the people who needed it most. The reason why people use DoseDr, the reason why they want to work with us, the reason we do anything is because doing good and being good at it is why we do what we do. We aren’t out to just make a profit (we want to be successful, of course) or to capitalize on a loophole. We’re out to change how healthcare is delivered and how patients interact with their own disease. We simultaneously empower patients to control their disease and give them the responsibility for their own care. Who wouldn’t want to work with a company that makes money and actually does good?

Some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why? He or she might just see this 🙂

Elon Musk. He’s a visionary and a futurist who’s obsessed with improving the world through innovation. I find the work Tesla is doing in automation with self-driving cars particularly fascinating. It’s completely disrupting what a “car” is and defying concrete concepts in what a car should be and do. The inside of the new Teslas looks like, feels, and works like nothing we’ve seen before. It’s that type of thinking that the healthcare industry desperately needs. It’d be fascinating to discuss his ideas and work in automation and figure out how to transform healthcare the same way. If done right, it would completely revolutionize the way we receive and deliver care.


Jilea Hemmings CEO & Co-Founder of Best Tyme. She is running a series on how technology is impacting healthcare.

Originally published at medium.com

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