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.