Remote Monitoring of Patients Expands the Medical Frontier

This device, smaller than a AAA battery, monitors a subject's heart and sends readings over cellphone towers to University of Kansas Hospital doctors for analysis.

by Alan Bavley, McClatchy News Service / April 21, 2014

Friends have joked with Carol Spencer because this month a doctor implanted a microchip to monitor her, just as some extreme opponents of the Affordable Care Act had warned would happen when the law took effect.

But Spencer, 56, looked forward to getting the new gadget slipped under the skin in her chest.

Despite years of tests and treatments, doctors haven’t been able to figure out the heart rhythm problems that from time to time make her light-headed and dizzy. The device, smaller than a AAA battery, will monitor Spencer’s heart and send readings over cellphone towers so University of Kansas Hospital doctors can analyze what’s happening when she’s having those spells.

“I think this is going to be a big help” with the diagnosis, said the Emporia, Kan., woman. “Like anything, it’s not going to happen while you’re there at the hospital and the doctors are watching.”

It may not be long before many of us are being watched over by distant health care professionals as we go about our lives.

There’s a booming new market in remote patient monitoring technology that promises to change the way we diagnose perplexing conditions, like Spencer’s, manage recently hospitalized patients and care for the frail elderly.

Dozens of companies have entered the field, from startups to big players in the medical device industry such as Medtronic, which makes the device Spencer received.

The U.S. market for wireless patient monitoring systems already has gone from $3.9 billion in 2007 to $8.9 billion in 2011 and could double to $20 billion by 2016, according to one market research firm’s estimate.

Among the devices already available:

• A sleep apnea monitor that patients can apply to their forehead to collect data at home, rather than go for an overnight exam at a hospital sleep lab.

• A wireless, sensor-equipped mat placed under a patient’s mattress that can monitor sleep patterns, heart rate and breathing at home or in the hospital.

• A portable fetal heart-rate monitor with cellular technology that allows women with high-risk pregnancies to get frequent check-ups from home, rather than at a doctor’s office.

“In three to five years I think this technology is going to be pretty common,” said Gregory Ator, a physician and chief medical information officer at University of Kansas Hospital.

“It’s always been a big question for doctors: What does the patient do after leaving the office?” Ator said. “I can see the day where doctors prescribe (cellphone) apps.”

Several trends have been coalescing to make remote monitoring of patients a growth industry. Sensing devices have become cheaper and more sophisticated. Bluetooth and cellphone technology have made it easy to transmit the data.

And indeed, new government policies have made it more important for doctors and hospitals to make sure patients are doing well after they’re back home.

The Affordable Care Act is offering doctors and hospitals a share of the savings when they keep their Medicare patients healthy. But provisions of the ACA also impose financial penalties on hospitals when too many of their patients have to be readmitted soon after they’re discharged.

“We are increasingly going to be held accountable for people coming back,” Ator said. “It’s becoming more economically justified to invest in these technologies.”

For example, Rochester, Minn.-based Preventice teamed up with its neighbor, the Mayo Clinic, to develop a remote monitoring device specifically for heart patients who are home from the hospital.

BodyGuardian contains sensors that measure heart rate and rhythm, breathing rates, and how much and often a patient is active. It’s worn on the chest with an adhesive patch. The device transmits data to the patient’s cellphone, which sends it to an online site that their hospital can access.

Hospitals may monitor some patients 24/7, others when their vital signs trigger an alert, said Bryan Claseman, Preventice vice president for marketing. “There’s a lot of pressure on hospitals to monitor patients outside their (the hospital’s) four walls,” he said.

Other technology is now available for families to monitor frail parents who are living at home. Independa has a computerized system that lets families, home health agencies or hospice organizations fit a person’s home with a variety of sensors, including scales, thermometers, blood pressure cuffs and blood sugar meters that can be monitored remotely.

Independa worked with television manufacturer LG to develop a smart TV that allows family members to have video chats with the person they’re monitoring. They can also send the person reminders that appear as pop-ups on the TV screen when they have an appointment with the doctor or it’s time to take medications.

“If someone is lonely, they’re often sitting in front of their TV, and if they’re 80, they may not be able to use a computer, but they know how to use the remote control,” said Independa CEO Kian Saneii.

The Independa system even allows addition of motion detectors and toilet flushing sensors. But other than the camera on the TV set, the company decided against incorporating video monitoring into its system.

“No one wants to be patronized or Big Brothered,” Saneii said. “We’re not quite the NSA.”

New monitoring technology certainly will have some patients concerned about “constantly radiating data,” said Ator of KU Hospital. “But there are ways to work around that. It’s really a trust thing. We want patients to feel this is something they can use to help themselves, not that KU is monitoring them.”

And there’s another issue yet to be addressed as patients radiate more and more data, Ator said. “Just how much of this data can a physician absorb and incorporate into something important?”

©2014 The Kansas City Star (Kansas City, Mo.)