Do It Yourself

In one of my earliest blog posts, I told the story of a patient of mine who asked if she could use an app on her smartphone to monitor her heart rate, and wrote: “Patients monitoring themselves! Cell phones transformed into medical devices! How cool is that?”

Since then, I have become more committed to the principle that patients should be the owners of their medical data and empowered to collect and manage it, and the technology to facilitate their ability to do so has improved remarkably. I recently purchased some of that new technology myself, and it goes well beyond what I was thinking was possible when I got excited 5 years ago at the prospect of self-monitoring heart rate.

This is a picture of my wrist with my new Apple watch, equipped with the Kardia band and yes, that is my ECG.

It requires an app on my phone, an Apple watch, and the band ($199 retail), but all it takes to record a single lead ECG is holding my other thumb over the metallic contact on the watch band. Once recorded, I can retrieve my tracing (30 secs of data) from my phone, annotate it, email it or archive it for future reference. I have taken tracings at the gym (sinus tach) and under a variety of conditions, and have been impressed by the quality of the tracing. Did I mention that it also provides a machine reading of the rhythm?

I have no financial interest in the company that sells this, but I am very impressed, and I am convinced that this kind of technology will only become better and more pervasive. In fact, we are in a moment of great transition. Diagnostic tools and the data they generate are no longer “doctors’ toys” – they are consumer products, and we as medical professionals must learn to adapt to this new reality by becoming better partners with our patients; we must learn to encourage,  advise and interpret instead of dictate, order and pontificate.

I think this will be better for us and our patients.

What do you think?

13 thoughts on “Do It Yourself

  1. Dr. Nash,

    Technology is amazing and fun, but when it helps patients it can also be lifesaving.This is what I believe, can be a very helpful tool for our patients and or providers.
    It is nice to know that the quality is impressive, because without the quality this would be beneficial to anyone. If ECG strip can not be read, there is no benefit to recording it.

    Thank you for the information and a view of the ECG app, I look forward to learning more.


  2. I agree Dr Nash, it’s a great, new world for patients. Our next goal needs to be making these diagnostic tools accessible to everyone. An iWatch ($300+) plus a Kardia band ($200) is expensive. The $100 a year additional fee Kardia charges to use the app is a bridge too far. After 3 years I will have paid $800 for this set up and the use of a single app.

    I still have a few days left on my free month of monitoring with the Kardia band. I’m not sure if I will continue with the annual subscription. I think it just costs too much.

  3. I agree that the financial barrier to accessing this technology is too high, but I am convinced that the cost will fall as the technology improves and the market becomes more competitive. We are paying a premium for being “early adopters”!

  4. Dr Nash
    As a Cardiac Cath/ELectrophysiology nurse and IT specialist I think this technology is vital. Wearables are a part of life for so many people and although the cost is high, the piece of mind it gives is worth it. We are an immediate gratification society now. The ability to record this data immediately, stamp it, and annotate your symptoms is a game changer. The provider has data to drive your care. So many newly diagnosed patients with arrhythmias can ease their minds knowing they have control of their information.
    Plus the geek in me thinks this is very cool!

  5. Amazing. I’ve been waiting for the band to be approved by the FDA. If you like this technology, look at Dexcom’s G6 CGM. Its incredible!

  6. I have been prescribing this device as a cell phone accessory for years. The Kardia watch application is for people who don’t have to ask what the monthly cost is. The original alive-cor phone case main drawback is because people upgrade their phones, lose them and replace them. Nonetheless I recommend it to any patient after their inaugural episode of atrial fibrillation and for my big population of worried healthy people. They email me pdf files via “my chart” and we can talk about what they are feeling with more intelligence. Also with the phone based program you can record up to five minutes. Anyone see the olympic athletes with their phones in their pockets? Helps with exercise induced arrhythmias too.

  7. Nothing particularly novel for us endos. We’ve had patients tracking their own glucose for about 30 years, using insulin pumps that collect historical data for about 20, and continuous glucose monitors are coming into their own. The Apple watch single tracing pales by comparison and costs a good deal more than a home glucose monitor, though far less than a pump or cgm device. But the purpose of having a patient collect and respond to their data seems very comparable.

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