Real-Time Healthcare Monitoring

WHETHER A PATIENT is being discharged from the hospital, living with a chronic disease or simply expecting a baby, the need for ongoing healthcare monitoring is real, potentially inconvenient and often costly. While providers have typically relied on the patient or caregiver to gather data and provide progress reports, asking a recovering patient or family member to take and accurately report vitals like blood pressure and heart rate is a less-than-optimal follow-up plan. Thankfully, emerging mobile health technology is now allowing doctors to see real-time data on individuals in their care, often without the patient or caregiver having to manually record or transmit it. The rapidly expanding market for these monitoring systems is showing promise for use with patients who span the treatment spectrum from physical therapy, cardiac and stroke to the elderly and homebound. Some applications are even making strides in the area of infectious disease.

“Telemedicine and mobile health will truly change and enhance healthcare delivery in the long run,” says George Tierney, co-founder of SnapMD, a virtual care management telemedicine software company. “These technologies are not a silver bullet for the many issues found with access and delivery of healthcare; however, they can play an enormous part in driving down costs and improving quality of care.”¹ SnapMD helps healthcare providers extend their reach of care by leveraging secure one-on-one live video, audio and text message consultations between ambulatory patients and their primary care and specialty care physicians. The company was named one of the top-10 telemedicine technology solutions for healthcare providers and their patients by Healthcare Tech Outlook.

Exploring Real-Time Advantages

Remote healthcare monitoring with real-time data offers many advantages to both patient and provider. Used correctly, it can spot health patterns or areas of concern, allowing healthcare professionals to intervene more quickly than if there was a reporting delay. Predictive analytics also allow physicians to compare real-time patient data from monitoring devices to medical baselines, helping them predict which patients are likely to develop complications and need further intervention.

This type of preventive, at-home monitoring could be extremely beneficial not just for patients, but also for the healthcare industry as a whole. According to a recent Goldman Sachs report summarized by Business Insider,² remote patient monitoring could save more than $305 billion in healthcare costs, largely attributed to monitoring of patients with chronic diseases such as heart disease, asthma and diabetes. The report also states that the healthcare community has been surprisingly open-minded when it comes to exploring this initial wave of digital health solutions that are poised to bridge “the digital and physical worlds to change physician and patient behavior.”

The report also addresses various obstacles to implementation of digital healthcare, patient and doctor acceptance, reimbursement concerns and U.S. Food and Drug Administration (FDA) regulations. “The FDA has laid out definitive guidelines surrounding regulation of digital health and pathways to approval,” the report states. “In general, the organization will intervene in cases where mobile applications make medical recommendations and affect the treatment of various illness. The FDA has already approved over 100 digital health applications to date.”²

Improving Quality of Care

Improving quality of care for patients is a significant benefit of real-time health monitoring. Flagstaff-based Northern Arizona Healthcare has pioneered a program called Care Beyond Walls and Wires that is expanding the reach of its healthcare services into underserved rural communities with outstanding results. The program monitors patients using a smartphone application and customized medical devices that vary by condition. Data from the devices is then captured in the app and automatically sent to the patient’s medical providers, who can then review it for warning signs or concerning patterns. A controlled study of the first 50 patients in the program showed an estimated $92,000 in savings per patient over a six-month period, as well as significant decreases in the rate of hospitalizations and days spent in the hospital.³ “This project launches a model of care that transcends traditional medicine, using state-of-the-art technology to care for patients beyond the walls of the hospital,” says William Bradel, Flagstaff Medical Center (FMC) president and CEO. “Working with these technology companies and national health agencies will extend FMC’s reach into outlying areas where healthcare is most needed.”⁴

The idea for the program originated with the National Institutes of Health Office of Public and Private Partnerships, which was looking for better ways to monitor patients with congestive heart failure (CHF) in rural areas. The goal was to provide better care while keeping the patients out of the hospital, thus reducing healthcare costs. San Diego telecommunications company Qualcomm was chosen to lead the project, with Maryland-based Zephyr Technology and Verizon providing software, smartphones and remote-monitoring hardware. “Our mission is to transform the health of the communities we serve,” says Bradel. “This program will dramatically extend the delivery of healthcare by giving our CHF patients the tools to stay connected to a nurse at FMC, regardless of how close they are to the hospital.”⁴

Real-time healthcare monitoring is also being used by researchers at the Scripps Translational Science Institute (STSI) in La Jolla, Calif. In 2015, the institute launched a home-based clinical trial that used wearable sensor technology to identify people with asymptomatic atrial fibrillation (AFib). According to the Centers for Disease Control and Prevention, as many as six million Americans live with AFib, an irregular heartbeat that can lead to a five-fold increased risk of stroke and other severe health-related complications. In fact, one in three people with AFib will have a stroke in their lifetime, making it a significant health burden worldwide. With as many as 30 percent of all cases of AFib undiagnosed, more effective methods of screening are needed to help reduce AFib-associated mortality, morbidity and costs.⁵

The purpose of the STSI study was to determine whether screening select individuals in their homes using wearable sensor technology could identify people with asymptomatic AFib more efficiently than routine care such as regular visits to a primary care physician to address general health issues. “This is a uniquely targeted and participant-centric trial that takes full advantage of digital technologies, including large medical data sets and wearable sensors,” says Steven Steinhubl, MD, director of digital medicine at STSI and principal investigator of the trial. “Once completed, it has the potential to truly change the practice of screening and markedly improve outcomes.”⁵

Researchers say this type of technology is especially promising since it can be customized not only for specific patient needs, but also for unique conditions and infectious diseases. STSI is currently testing monitoring technology that will help workers provide quality care to Ebola patients without putting themselves at risk of contracting the disease. The project will use a sensor similar to an adhesive bandage to take patients’ vital signs with two wireless monitors. Through this method, early signs of the disease can be detected while minimizing staff exposure to the virus.⁶

Big Data and the Changing Face of Healthcare

When it comes to healthcare, the increasingly popular term “big data” refers to a wide-ranging combination of clinical, genetic and genomic outcomes, claims, social and other data that are collected from multiple sources in an effort to give physicians a more comprehensive, detailed medical picture of their patient population. By most accounts, increased access to and use of big data is a decidedly big deal. According to an article published by Siemens Healthcare, “Big data will transform approaches in healthcare that have long defined the industry. No longer will we pool data from individuals to predict what happens at the population level. Instead, population data will be so comprehensive that it will accurately predict what happens to an individual patient.”⁷

As telemedicine becomes increasingly common, universal access to data will prove to be a crucial element in future healthcare delivery systems. In a pilot study of postcolorectal surgery cases, the Mayo Clinic cut complications by half, decreased patient stays and saved $10 million by using a program that identified best care practices, then measured and monitored those metrics in real time.⁷

Big data is also being captured and analyzed for bedside use in the hospital setting. In some cases, analytics can identify a patient’s risk of hospital readmission and divert staffing and resources to help prevent it. At SickKids Hospital in Toronto, Canada, infants in the neonatal intensive care unit wear biosensors that collect data thousands of times per second. These biosignals are uploaded and processed in real time for the fastest possible identification of hospital-acquired infections. This type of data access can help the hospital begin treatment as much as 24 hours sooner than if physicians waited until traditional biometrics indicated an infection.⁷

Smartwatches: The Future of Healthcare

The introduction several years ago of the smartwatch, a device that marries the practical advantages of a timepiece with the broad, app-centric benefits of a smartphone, initially limited its health-related content to wrist-based fitness tracking. Those capabilities have grown exponentially, with smartwatches now offering everything from fetal monitoring to the management of chronic conditions.

One device showing promise is the Oxitone watch, a wrist-worn, medical-grade pulse oximeter that continuously measures a person’s oxygen saturation, heart rate and respiratory rate. Portable pulse oximeters that provide continuous oxygen saturation readings are already available from a variety of manufacturers, including one that works with an iPhone, but unlike the Oxitone, they all rely on a sensor that clips onto a fingertip or earlobe, presenting a challenge for continuous all-day monitoring. “After investigating the current market situation, we found that while oxygen circulation was being monitored continuously in the hospital, it was an incredibly uncomfortable experience for the patient,” says Leon Eisen, PhD, founder and chief executive officer of Israel-based Oxitone Medical. “At home, people are only capable of having episodic measurements using spot-check monitoring, which doesn’t provide continuous measurement for oxygen circulation. People can’t wear the fingertip sensor all the time, it’s just impossible — it’s not comfortable and falls off your finger too easily. Nobody knew how to continuously measure blood circulation, so we decided it was time to move forward.”⁸

Dr. Eisen came up with the idea after experiencing a personal family tragedy: His father died from a heart attack just three hours after being released from the hospital. “Wearable devices are the future of monitoring health and will reduce the cost of healthcare,” says Dr. Eisen.⁹

The Airstrip App for Apple Watch is another example of smartwatch technology that allows doctors to read a patient’s heart rate and other acute health data. The app can also be used to view a patient’s health information on the go, and experts say its implications for the healthcare industry could be vast. The AirStrip company founders believe it could help doctors better monitor patients with chronic illnesses, including heart disease, diabetes and even chronic obstructive pulmonary disease, from home. It could also increase the line of communication between doctors and patients, without having patients make a trip to the hospital. In addressing privacy concerns, Cameron Powell, MD, AirStrip’s co-founder, says the app complies with HIPAA healthcare privacy laws by requiring users to authenticate themselves, similar to other doctor-to-patient messaging systems already in use.¹⁰

Another AirStrip app, the Sense4Baby, turns an average smartphone into a fetal monitoring tool for expectant mothers, enabling the mother to look at and hear her baby’s heartbeat, then transmit that information in real time to her doctor. This allows the doctor to immediately determine if the unborn baby is in distress or if the mother needs to come in for additional monitoring.¹¹

Companies like AirStrip are actively developing new uses for real-time healthcare technology, seeking to connect to a wider variety of medical devices such as blood pressure cuffs and glucose monitoring devices. According to AirStrip CEO Alan Portela, the ability to monitor this type of data in real time will not only help physicians better manage their patients with chronic diseases, but will empower the patients themselves to take control of their health. Next steps include connecting the sensors and smart devices to analytics, which would better enable both patients and physicians to monitor disease progress.¹²

Portela envisions the technology as a sort of go-between to allow doctors to monitor their patients on a more regular basis than the routine follow-ups that many patients with chronic illnesses currently follow. Instead, doctors could monitor patients in real time, and more quickly identify the individuals who are in need of immediate medical care. “It is not just about displaying [the information] in real time,” Portela says. “It is really about which clinical problem are we trying to solve.”¹²

Reinventing How Care IsDelivered Digital technologies have changed the way companies in every business sector innovate, interact and connect with customers. For the healthcare industry, adapting similar technologies has the potential to fundamentally reinvent how care is delivered. In a future where the healthcare delivery system is fully digitized, emerging trends such as telemedicine, portable data-recording devices and mobile apps will become the norm. Properly implemented, remote real-time healthcare monitoring can enhance patient-clinician communication, streamline coordination of care, promote self-management of chronic disease, reduce healthcare costs and improve patient outcomes.