Personalized medicine for a care team — where everyone works from the same plan
iksa is the harness for n‑of‑1 medicine. Five of you can run one plan, with each change written once and the same number in your nurse’s hands and your patient’s answers.
A reading one of you takes can change the number another of you is working from
Your NP, nurse, coach and dietitian each hold part of the plan, so a trial of one here has a staff of five, and a change in one pair of hands has to reach the other four. A training zone is a heart rate borrowed from one test, on one machine and one list of medicines.
- Before any zone is writtenCardiopulmonary exercise test: The doctor sets the zones from the patient’s two ventilatory thresholds, since at the same percent of peak heart rate some people sit above a threshold and others below it (a Sports Medicine review). Watts hold steadier than heart rate through a long session, so give your coach both.
- Before the patient moves to another machineThe machine: Heart rate differs between cycling and running, at peak and below it, in a Sports Medicine review of triathletes, so your coach has to know the machine before taking these numbers on a run.
- The day a prescription changesMedicines that move the patient’s numbers: A beta-blocker lowers heart rate at any effort, so zones set before it mark a different effort. In twenty coronary patients in France, heart-rate targets ran easy even when set on the drug (European Journal of Cardiovascular Prevention and Rehabilitation). On an incretin, as on a diet, a quarter or more of weight lost was lean in pooled trials (Diabetes, Obesity and Metabolism), so your NP’s prescription changes what your coach and dietitian work from: resistance work, protein and DEXA lean mass on the incretin’s clock. Your nurse takes the patient’s questions with the plan and its reasons open.
- Each time the patient’s sessions or fueling changeEnergy for the training: The International Olympic Committee’s consensus on REDs defines low energy availability as intake too low for what training burns. Your dietitian holds one side of that sum and your coach the other, so a fourth session can undo a fueling plan neither of them got wrong.
- In six months, on the same cycleThe re-test: Repeated on a cycle within 30 days, oxygen uptake at the first threshold varied about 10% in a Utah series in Medicine & Science in Sports & Exercise. It didn’t report heart rate, so a threshold that moves a few beats may move nothing.
The doctor gave the patient’s coach heart rates from a bike test and wrote down what would make them wrong
These numbers hold on that cycle and on the medicines the patient takes today, so the note says so, in words their coach and their dietitian can act on without reading a CPET.
Pick a plan that has already changed hands twice, and we’ll trace what each person was working from.
Request a walkthroughRequest a walkthrough for a care teamFour other people carry this plan with you, and no study coordinator keeps you all in step
Your coach is paid for the session, your dietitian for the consult and your NP for the visit. Nobody pays for the minutes between them, and a study site hires a coordinator for those.
Delegation log
A study site signs a list of who may do what. Yours is in your head: a coach can change a session and not a meal plan, and a dietitian a meal plan and not a prescription.
Protocol amendments
When a study’s protocol changes, everyone on that list is told and signs for it. When your NP starts a beta-blocker on a Tuesday, the coach running Wednesday’s session is still counting the old heart rates until someone tells them.
Safety reporting
The patient tells their coach they felt faint on a long session. That could be the fueling, a new medicine or their heart, and the first to hear it isn’t licensed to weigh any of them.
Data reconciliation
The sum that says whether the patient is eating enough for the training takes your coach’s app and your dietitian’s side by side, and those two apps have never met, where a trial’s data manager would reconcile them.
The NP’s change and the doctor’s reason sit together, and the note names who tells the patient’s coach before the next session
The harness knows the patient through what each of you wrote, and nothing moves on their plan until one of you writes it down.
The doctor reads what the NP decided in the NP’s own words, with a name and a date on the note
Clinical Intelligence quotes the note behind each answer, with its author and date where the chart carries them. A next step either of you writes goes on the patient’s plan with a way back to that note, while an if-then stays in the note itself, where Clinical Intelligence and Patient AI can still read it.
Clinical Intelligence: clinical AI and lab trackingWhen the patient writes that they felt faint on a long session, a nurse can weigh what the coach can’t
After the safety questions, a card tells your nurse or you what the patient reported, and Clinical Intelligence lays out your NP’s last note and whatever your dietitian has charted, so whoever tells the coach about the next session has read them. Agentic CRM stays with a patient’s practice questions, so this goes to a person.
Agentic CRM: scheduling and follow-upThe patient’s wearable takes Zone 2 from a formula, the note takes it from their thresholds, and Patient AI goes by the note
Patient AI starts from that note, so the 128 to 146 they hear is the number their coach is working from, with the doctor’s reason for it.
Patient AI: the treatment companion
Resetting zones after a re-test or leaving them alone is still a judgment call, and your team’s notes say why each zone moved
Oxygen uptake at the threshold varied on re-test alone in that Utah series, so one result says little, while hundreds on one protocol could show how far training outside a lab moves it. That study would run with a research group, on de-identified records and each patient’s consent, from your team’s notes. How a study of thresholds would start →
The questions you’d ask with four people carrying your plan
What do my coach and my dietitian actually get?
Your note, and their own login if you choose.iksa has no screen built for either one, so what you send them is the note. We can set up a coach or dietitian inside your clinic with a login of their own, and it opens the whole chart, so hold it to the people you’d hand one.
Who can change what in this plan?
Whoever your state and you allow.An NP’s authority to prescribe depends on your state, a nurse works from your orders and a dietitian holds the nutrition plan. The National Board for Health & Wellness Coaching’s scope leaves out diagnosing, prescribing and even exercise prescription, so the coach writing the patient’s sessions needs an exercise credential too. iksa doesn’t police that: an item reaches this plan from a note, and that note shows whose it is.
I review my NPs’ charts. Can I see why they made each call?
As far as they wrote it.Each answer quotes the note it stands on, so you’re reading the reasoning your NP put down at the time. Nothing joins a plan item to the lab your NP was reading, so if the note doesn’t name it, the record won’t either.
Do my coach’s and dietitian’s apps have to go?
They stay where they are.iksa doesn’t connect to either and keeps no training log. What reaches the patient’s record is what someone files in the chart, so a dietitian’s assessment written up as a consultation note goes in.
Will iksa read the exercise test or work out the patient’s zones?
Your note carries them.iksa doesn’t interpret a CPET, so it carries forward the peak VO2, thresholds and zones you wrote in your note, which is where the machine and the norm belong too. It computes no percentile and no zone, so the heart rates your coach gets are the ones you set.
When my NP starts a beta-blocker, who tells the coach?
The person your note names.iksa has no channel that carries a change to a coach, so write who in the note, the way this one names your NP.
What is n‑of‑1 medicine?All practicesiksa beside your EHRProtocol management softwareWhat iksa adds
Put the zones your coach holds today beside the note you wrote them from, and we’ll look at whether they still agree
Bring a protocol you run. We’ll walk one patient through it.