Kim Goodsell demonstrates the power of consumers who are enabled by knowledge and connected technology to manage personal health and their interaction with the health care system. In this example, the use of a $199 medical device, a $12 e-consult and a brief conversation with a cardiologist with a copy of the ECG results avoided an emergency room visit and workup, thus saving thousands of dollars, hours of time and the risks of exposure to infectious diseases. All of this was done with existing communications and information technology – it was not dependent on fully interoperable HIT systems. Can anyone doubt the present value of Connected Health?
Rob McCray, WLSA
Pioneering Connected Health Care From the Front Lines
Perhaps the best way to get a glimpse of the future of medicine is through the lens of a patient.
Last year I sought out Dr. Eric Topol, the foremost expert in the exploding field of wireless medicine after watching an interview of Dr. Eric Topol on NBC’s Rock Center, “iDoctor: Could the smartphone be the future of medicine.” I have a heart rhythm disorder that predisposes me to Sudden Cardiac Death. I thought that the AliveCor Heart Monitor, the first FDA approved smartphone electrocardiogram (ECG) app, demonstrated by Dr. Topol, could be a valuable tool for detection of a potentially life-threatening arrhythmia in “real time.” This capability could help me avoid a violent shock from my internal cardio-defibrillator. Dr. Topol kindly granted me a consultation and prescribed the app to me.
Using the app for other purposes was not anticipated, but recently my 81 year old mother presented a cardiac episode that I captured on my smartphone ECG. It detected an unusually slow heart rate and an abnormal rhythm. I sent from my mom’s home to Dr. Topol, who confirmed it was a matter of concern. He referred us to a electrophysiologist for a pacemaker consult. The first available appointment would not be until 3 weeks in the future.
At first I did not consider the wait to be a problem. My mother requires time to move on health issues. By choice she has avoided cardiac evaluation due to a troublesome patient/doctor interface that precipitates white coat syndrome. This inevitably results in the prescribing of a hypertensive medication that in turn amplifies her anxiety because she has had a very poor tolerance to all hypertensive medications. Mom does not welcome the inevitable subjugation to a pharmaceutical hypertensive treatment plan. Being “non-compliant” further exasperates her anxiety-ridden relationship with her physician. She did acknowledge however, that her quality of life appeared to be slipping away and reluctantly agreed to be evaluated for a possible pacemaker.
Meanwhile, she presented a particularly alarming set of symptoms. Using the AliveCor ECG, I was able to capture an irregular heart rhythm and an unusually slow heart rate of 36 bpm. With another mobile app I recorded her blood pressure at 187/96. I suspected that she was at high risk for a life-threatening cardiac event. It was Sunday morning and I tried to convince my mother that we should go to the ER. She was exhausted and apathetic and fearful of the ER. She just wanted to be left quietly undisturbed in her home. She was adamant that she felt it was not an emergency, and preferred to wait until she would see the physician that was referred by Dr. Topol. Navigating through the emotional risks and the medical risks was proving difficult.
Using the AliveCor app’s analysis service, I sent the reading in for expert review by a U.S. board certified cardiologist. It’s recommendation: “Serious / SINUS BRADYCARDIA IMMEDIATE physician evaluation is strongly advised”. This provided the evidence I needed to present her case to the physician on call (by-passing the ER), and to present my case for immediate intervention to my mother. The smartphone electrocardiogram (ECG) app had eliminated from the equation the confounding variables of my subjective assessment and my mother’s denial that were in sharp contrast.
I was able to contact the cardiologist who was on call for the physician recommended by Dr. Topol. I gave him her “real time” vitals and ECG results. He was incredulous that I would have such information and asked if I could send it to him. I emailed him the reports while we were on the telephone. He immediately confirmed that she was at risk and should come to the hospital right away.
Utilizing the AliveCor mobile app and computer algorithms to interpret the data, the diagnosis could be made remotely. The delicate negotiation process with my mother was a success. Consensus was achieved by all stakeholders. My mother willingly complied with the physician recommendation. The physician pre-admitted her, consulted with the pacemaker surgeon, and surgery was tentatively scheduled for the following day pending in-house evaluation. Before we left the house for the hospital my mother was fully informed of the actionable plan. Upon arrival she gained direct entry to the ward, by-passing the ER completely. This attenuated not only her stress but the stress on the medical system.
This story is a representation of where unplugged but connected health care can take us. For the first time, the consumer/patient and doctors are able to get “real world” medical information at the point of need. Rather than calling an ambulance or going to an emergency room, a medical situation it can triaged effectively, efficiently and inexpensively from the home. Of course, the accuracy and validation of all such technology has to be assured before it is made available to the public. It’s hard to imagine the effect the digital revolution will have on the future of medicine. But the rosy dawn can already be seen on the horizon as this new model of having critical data and information when and where it’s needed is rising.
Kim Goodsell is a ‘Digital Patient Revolution’ activist, co-founder ProAbility WalKArt L3c, inventor of ROVA (Realtime Operational/Virtual Assistant)