This is Part 2 of our ongoing series on the Internet Of Medical Things (IOMT).
There are many exciting devices that will help support the practice of medicine. Perhaps even more exciting (and challenging) for the emergency physician will be attempting to stay abreast of the rapidly growing number of devices that patients can purchase directly and will be calling upon us to interpret.
Most patients have already had the opportunity to explore the first wave of basic personal monitoring with wearables like Fitbit ($99–$150). Although these devices collect basic data about exercise and health, there has been a lot of conversation surrounding the validity and utility of the data. Can you imagine a conversation between a patient and a primary care physician or emergency physician regarding these data? “Doctor, I notice that Grandma’s steps per day have decreased by 50 percent over the past two weeks, which seems to be coinciding with some shortness of breath while exerting herself.” Although these are basic data, they can serve as additional objective pieces of information to support a diagnosis.
We can expect a large growth in data collection in health care that interfaces with the emergency department. Data will not only come from the home but also be pushed from third parties that are generating and monitoring data for our patients. I remember the first time I received a fax from a cardiac-monitoring device company regarding an event a patient had experienced while walking in a park. It was astounding that this small portable device had recorded an event and transmitted that data to the cloud, where it was interpreted. The patient was called and directed to call 911 to get transported directly to the emergency department. I received the data regarding the dysrhythmia prior to arrival of the patient. Truly astounding.
One example of this is connected inhalers from Propeller Health. By creating a connected inhaler, patients with asthma and chronic obstructive pulmonary disease have much better objective data regarding their usage. Prior to this, at best, patients would keep usage diaries to share with providers, but more commonly, it was just a vague estimation of use. Now, definitive data on frequency of use, time of day, and weather can be acquired and correlated. One may also be able to determine geographic areas that seem to trigger an increased use of medication. Not only do these data allow the user to be more actively involved in the management of the disease, but they also create a novel way in which the patient can engage with a health care provider. As emergency physicians, we can expect to be shown the app or printouts that summarize the data captured by a connected inhaler.
AliveCor’s Kardia (~$125) has been on the market now for a few years and provides a single-lead ECG when the user puts fingers from each hand on the back of an integrated mobile phone case. The Food and Drug Administration (FDA) approved machine learning algorithms that can help differentiate atrial fibrillation from normal sinus rhythm. Large data sets are available to be shared with emergency physicians upon arrival to the emergency department. Even more compelling is the Kardia wristband, which is pending FDA 510(k) clearance. This will take the technology one step further by providing passive, continuous cardiac rhythm monitoring. AliveCor claims that the device improves outcomes, reduces cost, increases workflow productivity, and deepens clinician-patient relationships. On Sept. 8, 2016, AliveCor announced a partnership with Omron that integrates blood pressure readings from Omron devices (~$65) with the Kardia app, creating a more robust data set.
Products like MedMinder have reported functionality that will take medication reconciliation to the next level, certainly something we may come across in the emergency department. There are alerts, texting functionality, and online reports that emergency physicians may be assessing.
Medication compliance is a huge issue in medicine. A number of entrepreneurs are attempting to tackle this by better controlling distribution of medications. There are a number of companies that have developed pill-dispensing systems, some of them attached to the pill bottle itself. Appropriate medication dosing can be accurately adhered to, ensuring that people take their medication and that people don’t overdose. Products like MedMinder have reported functionality that will take medication reconciliation to the next level, certainly something we may come across in the emergency department. There are alerts, texting functionality, and online reports that emergency physicians may be assessing. A step further are digestible digital medicines with sensors embedded in pills from the company Proteus Digital Health. It has developed an ingestible sensor the size of a grain of sand that, when ingested, sends a recordable signal to a patch that the patient wears on the torso. These data are transmitted to the patient’s mobile device and up to the cloud, where they sit in a portal that allows providers to access and review a patient’s medication administration history. This takes medication compliance from subjective data (self-reporting) to objective data (sensor reporting), thereby optimizing adherence and patient outcomes.
Part 3: In the next article, I will touch on devices that enhance communication within the hospital and remote-monitoring technologies that are changing the way our patients can be monitored in a variety of nontraditional settings.
Dr. Younggren is chief medical officer at Cue; medical advisor for Shift Labs and Blumio; medical mentor for the Highway1 hardware accelerator; and a practicing emergency physician and medical director for emergency preparedness and urgent care at Evergreen Health in Kirkland, Washington.