Cardiac Patients will Benefit from Digital Health Technologies


Cardiovascular disease, specifically sudden cardiac death is the number one killer in the USA and most westernized countries. Many of the technologies which have been developed to address the problems of cardiac diseases have centered on expensive devices such as implantable pacemakers, defibrillators, stents and most recently percutaneous valves. As digital heath technologies become a greater part of the dialogue of healthcare reform and technologies have advanced, I thought it important to revisit their relevance to cardiac patients after a previous post. I will discuss technologies and concepts which have further developed in the relatively short (15 months) time since the prior article.

1.  Patient portals will, because of the implementation of the HITECH Act’s Stage 2 of Meaningful Use, become significant players in that overused phrase known as patient engagement.  There has been a movement afoot for cardiac patients to directly obtain data derived from their implantable defibrillators.  I naively wrote a year ago of implantable device data driving the adoption of patient portals.  This hasn’t yet happened; though the development of the connective technology is proceeding and will achieve that goal. Recent advancements have occurred in the realm of monitoring of these devices, specifically the development of hand-held transmitters and sharing of data wirelessly real-time among providers, which I hope will pave the way towards better patient access to data.  Portals can contain not only this type of data, but ECGs, images form diagnostic tests, and genetic data pertaining to medication susceptibility.

2.    Remote patient monitoring of the post-discharge patient has received much attention because of 30-day readmission penalties facing hospitals. Congestive heart failure and heart attack diagnoses are among the conditions on the radar with regards to readmissions. The monitoring might consist of a combination of blue-toothed weight scales, blood pressure cuffs, and heart monitors, or be as simple as a traditional scale.  An important aspect of remote monitoring lies in how the data is filtered so as not to become the equivalent of white noise (and more importantly a detested annoyance to the physician).  The data need to be delivered in an actionable alert mode only (ideally prompting algorithm-determined responses by providers), but stored and able to be reviewed if desired.  De-identified data should be open and able to be shared for the purpose of scientific research and other crowdsourcing projects. There must also be a human component checking symptoms and adding emotional support and encouragement. A simple SMS program coupled with human contact via telephone was utilized in a landmark study by the Geisinger Health System  which demonstrated a 44% decrease in readmissions. Examples of companies with comprehensive solutions are Independa and GrandCare.  The telecoms ATT and Verizon as well as many others are in the space as well.

3.    Mobile medical apps.  Much has been said about both the disappointment and promise of mobile medical apps. Two recently released apps I like here is the Alivecor ECG iPhone case which records cardiac rhythm strips which can be wirelessly transmitted to a provider, and the CMS ICD app which applies algorithms and determines which patients are at risk for sudden cardiac death and might require implantation of a defibrillator. Airstrip Technologies allows mobile device-based monitoring of hospitalized patients.  It is especially useful for the monitoring of vital signs and cardiac rhythms of intensive care patients. These technologies will eventually be used by EMTs transmitting data to ERs at the scene and during patient transport.

4.    Patient education tools are extremely important to patients with cardiac disease. There are many solutions now which are both PC and mobile based. Some offer prepackaged content and others allow for provider customized content.  Two examples are Emmi Solutions  and OrcaHealth.

The strategy of digital solutions being applied to cardiac patients is important because of the magnitude of the problem of cardiac disease (vis-a-vis its demographic as well as economic implications), potentially critical situations, and the shortage of cardiologists in many areas.  As a former cardiac electrophysiologist and patient advocate I can testify to the literally vital importance of these technologies.  I am proud to be part of the improvement of care of not only cardiac patients but all patients through the use of digital technologies.

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About davidleescher

David Lee Scher, MD is Director at DLS HEALTHCARE CONSULTING, LLC, which specializes in helping digital health technology companies, their partners and clients. As a former cardiac electrophysiologist and pioneer adopter of remote patient monitoring, he is uniquely qualified to address both clinical and operational concerns of clients. Scher was Chair of Happtique's Blue Ribbon Panel which established standards for certification of medical apps in the categories of safety, operability, privacy, and content. He is a well-respected expert in mobile and other digital health technologies and lectures worldwide on technology and its impact on patients and healthcare systems.
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4 Responses to Cardiac Patients will Benefit from Digital Health Technologies

  1. Carolyn Thomas says:

    Hello Dr. S and thanks for this interesting overview. I’m not a health care professional – merely a dull-witted heart patient – but I’d like to comment on two of these key concepts (mobile medical apps and patient education tools).

    I get a wee bit nervous when I observe companies, investors and developers busy high-fiving each other over mobile technology (like the CMS ICD app) – especially given the serious problems we already have with real-life cardiac technology. How, for example, would you reassure patients that the technology claiming to predict who needs an ICD implanted is any more trustworthy than the alarmingly flawed technology evident in the recalled St. Jude Riata leads that are already living inside real live patients (who are now being told the defective leads should not be removed?) “Don’t worry, be happy!” We’ve already seen enough recalls to make us leary of claims that sound a lot to us like: “This time, we’ve got it right.”

    And I’m also wondering how pre-packaged patient education tools differ from, for example, clicking on the Mayo Clinic’s excellent heart site? Or how does provider customized content help patients more than participating in the regularly scheduled Cleveland Clinic “Ask A Cardiologist” web chats, or (even more helpful for female heart patients) on the 24/7 Inspire.com’s WomenHeart online community of 7,000 other patients – who I can tell you from personal experience will get back to you pronto, often within minutes.

    Health info from patient forums not reliable? A BMJ study (Esquivel et al, BMJ 2006;332:939) found that only .22% of health info monitored in such online communities was considered inaccurate, and of that, almost all of the misinformation was self-corrected by other members.

    Compare that to the E.R. doc with an M.D. after his name who, despite my textbook MI symptoms (central chest pain, nausea, sweating, pain radiating down my left arm) sent me home with a misdiagnosis of GERD. If only he had bothered to Google my symptoms . . .

    Cardiology as a profession is besieged with controversy as it is: stent-happy docs doing clearly unnecessary procedures, “marketing-based medicine” as drug and device makers continue what Dr. Marcia Angell describes as their “pervasive influence” over practice decisions (think Multaq!), women being under-diagnosed (and then under-treated even when appropriately diagnosed compared to men), FDA class 1 recalls of implantable devices that our docs reassured us would help to save us – not hurt us, the list goes on in a frightening fashion if you happen to be a patient – not an investor in yet more technology.

    My concern is that is in our mad mHealth rush, it’s easy to forget that there are already diagnostic/treatment programs that are NOT working now – almost all of them ones that we trusted when they were first launched to the same kind of excitement we see in health care technology startups. When those cardiac issues are adequately addressed, maybe we can get more excited about The Next Big Thing.

    regards,
    C.

    • Thanks so much for those thoughtful and sincere comments, Carolyn. They certainly do not come from anyone dull-witted. Firstly,
      I would like to discuss your comments regarding mobile apps. Yes, there are problems that arise with existing technologies such as the problem with the St Jude ICD lead that you mention. However, there have been issues with all companies who make these type of devices. What I am saying is that technology is man-made and not guaranteed 100% to be infallible. What has arisen from problems in this realm as well as in other industries is that we learn from problems and design better technologies based on discoveries made. This applies to cars, planes, buildings, space technologies, and the list is endless. The CMS ICD app is one that helps physicians identify patients at risk of sudden death and recommended by current guidelines to receive an ICD. It also promotes scheduling ticklers for patients to be reevaluated if they are borderline indicated. Many of these types of patients have fallen through the crack and remain at risk or have died (I have heard of many of these stories). “Don’t worry be happy” is better than “Don’t worry, be dead.” I would of course never say either one to a patient. What our culture does NOT do is to prevent people from getting heart disease BEFORE they become at risk. Obesity, diabetes, and high blood pressure need addressed way before the life cycle of a patient needing an ICD. We need to start incentivizing providers and patients to focus on preventiv measures.

      Regarding the patient education tools, there certainly are tools other than the ones I mention. I was focusing on patient education apps with my examples. Certainly web-based sites such as Mayo Clinic, Cleveland Clinic and others offer excellent advice. Some of the app-based custom content might even come from these sites. One needs to be aware of site biases though. Be careful about hospitals saying “voted the best….” There are many different surveys and rating services now and one should read on. That’s an aside, and not referring specifically to those institutions.

      You say “My concern is that is in our mad mHealth rush, it’s easy to forget that there are already diagnostic/treatment programs that are NOT working now – almost all of them ones that we trusted when they were first launched to the same kind of excitement we see in health care technology startups. When those cardiac issues are adequately addressed, maybe we can get more excited about The Next Big Thing.” I agree fully that there is over-exuberance of any new technology or field. Nothing is as good as marketers say it is. EVER. I am the first to say that mHealth is not proven as a sector. I have been campaigning for efficacy studies and ROI investigations for a long time. I believe they will come as others like you and me are clamoring for the “Where’s the beef?” Activist patients like yourself should be supported and encouraged to raise the type of issues you do. But the difference between educating people of risks of technology and actively discouraging them from adopting it must be made. especially when dealing with life and death (referring specifically to the ICD issue). I wish you the best of luck, and thank you for your comments.

  2. There is a tremendous overuse of screening for cardiac disease in this country. The rule is: no symptoms no screening. I think the emphasis on apps and other cardiac awareness is very counterproductive. We should push apps for weight loss, proper diet and exercise and avoid apps that suggest you can find out if you have a heart problems creating a market for inappropriate testing and procedures.

    • I respectfully disagree about you concept of apps. I do think that there need to be efficacy studies of apps. There also needs to be a cost analysis of what the app does. Is it acceptable for 100 people to take a statin to avoid one person’s death? Same question.

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