Cardiac patients will benefit from digital health technologies
Cardiovascular disease - specifically, sudden cardiac death - is the number one killer in the U.S. and most westernized countries. Many of the technologies that have been developed to address this 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 these technologies have advanced, I thought it important to revisit their relevance to cardiac patients after a previous post.
I will discuss specific types of technologies and concepts that have 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 help in the achievement of that goal.
Recent advances 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 to better patient access to data. Portals can contain not only this type of data, but ECGs, images from diagnostic tests and genetic data pertaining to medication susceptibility.
2. Remote patient monitoring 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 regard to readmissions. The monitoring might consist of a combination of Bluetooth-capable 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).
Data needs 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 shared for the purpose of scientific research and crowdsourcing. 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 used in a landmark study by the Geisinger Health System, which demonstrated a 44 percent decrease in readmissions. Examples of companies with comprehensive solutions are Independa and GrandCare. The telecoms ATT and Verizon are in the space as well.