History: The patient is an 85 year old lady who signed out of the hospital against medical advice to go home and be with her 96 year old husband for their 64th anniversary. Upon arrival at home the nurse practitioner from Call Doctor performed a non-invasive cardiac impedance test showing her cardiac output, stroke volume and ejection fraction had decreased by 30% probably due to the multiple new medications she was on, including Lopressor, a beta-blocker that impedes the force of contraction of the heart. The Lopressor was stopped but the home health nurse called two days later requesting an emergent physician visit, as she thought the patient was in heart failure, coughing all night and extremely weak.

The Housecall: The Call Doctor arrived after re-triage indicated no life-threatening immediacy. The patient did have some signs of failure, but was unable to give a history due to Alzheimer's disease. Using the BioZ machine from Cardiodynamics, connected through the Vectis electronic medical record of Call Doctor by the CDMA technology of a Qualcomm phone, the doctor created the medical record on line with the server ten miles away, printed the chart in the office for electronic billing and emailed an encrypted version of the data to a related physician. The test confirmed that the patient was not in failure and the cough was probably due to medication.

Qualcomm, Cardiodynamics, and Call Doctor are all San Diego companies backed by original institutional investors.

To our knowledge, this is the first time in history a human's cardiac output has been transmitted through wireless means in an encrypted medical record from the home. The cost of services under Medicare assignment for the 47 minute housecall was:

Physician Level 2 home visit:	$71
Cardiac Impedance study:	$40
Pulse Oximetry:	$8
Total cost:	$119

The Call Doctor Company
www.1800calldoc.com