I had the opportunity last week to participate in a day-long meeting sponsored by the Heart Rhythm Society. The goal was to help HRS develop recommendations for physicians and industry on providing patients access to information generated by wearable and implantable cardiac electronic devices. The organizers invited me to provide the viewpoint of an educated patient.
I can’t say how HRS will ultimately craft the guidance (and I am not involved in writing it), but the discussion was lively, and I came away with a number of impressions.
First, device manufacturers understand that they must move to afford patient access to the data their products are generating, but they are limited in how quickly they can do so by a number of factors, including the slow pace of technical iteration created by close regulatory oversight, the uncertainty of what data patients want and how to present it, and concerns about getting out ahead of electrophysiologists (their traditional customers) on this issue. Nevertheless, I was impressed that there seemed to be unanimity of opinion among the manufacturers that patients should have access to the same data that doctors see.
Continue reading Getting There
Dear readers –
You have the chance to amplify the conversation that we have been having (well, OK, so I have been having) on this blog. Please consider supporting a proposal for a panel on the “digital disruption” of health care at the 2019 South by Southwest Conference. I am proud to be a part of this, along with colleagues from Kaiser Permanente, GE Ventures, and USA Today. As you may know, SXSW is way more than a world famous music festival. It is also an ideas festival – a place to learn and teach and collaborate. Here’s a brief description of what we hope to address:
Peer into any medical bag and you may see a stethoscope, which came into use 150 years ago, and a blood pressure cuff – a 135-year-old technology. While these tools advanced the practice of medicine, today’s technologies hold enormous promise for improving the health and well-being of countless lives. But what about the patient-physician relationship? A computer in the exam room may provide the physician with integrated and actionable information, yet interfere with the patient-physician interaction. So how do we optimize innovations to sort hope from hype? This panel explores bridging the digital divide to improve the quality of health care, lower costs and make health care more human. Technologies we’ll discuss include:
– Predictive analytics
– Machine learning
– Precision medicine
The program is developed, in part, through online voting for the presentations that people want to see and hear. Please consider supporting our proposal by going to the “SXSW PanelPicker” at: http://panelpicker.sxsw.com/vote/86636 and “vote up.” If you don’t have a SXSW account, it only takes a minute to create one and vote.
Thanks, and see you in Austin!
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.
Continue reading Do It Yourself
Our most recent water bill was about 5 times higher than the one for the preceding quarter, so I called the local water authority to see if there had been a mistake. With a few keystrokes, the woman with whom I spoke was able to tell me exactly which days over the previous months appeared to have high usage, and asked if we had a leaky faucet or a running toilet. Well, yes, I explained, we did have a toilet that had been running (which I have since fixed), but I was surprised that it could lead to such an outsized bill. The response was more or less, “oh yeah, that can do it” and the more medically resonant “we see this.”
I was disappointed that the bill was real, but also sort of impressed that the water-works was able to pinpoint my usage, so I asked her about the metering. She explained that we have a smart-meter that transmits our usage on a daily basis to the central office. When I heard that, I asked why, if they could tell we had a problem, that they didn’t notify us or provide us with access to the data. Turns out they intend to make that information available to users in the near future. Cool.
Continue reading Heart Monitors and Running Toilets
When I was a cardiology fellow back in the 1980s, I learned about a variety of early tools for evaluating heart health that had been displaced by the modern standards of electrocardiography (ECG, or EKG for the Deutschephiles) and echocardiography. One such technique – ballistocardiography – stuck with me, and may be making a comeback.
Ballistocardiography is based on the observation that the mechanical action of the heart leads to subtle but reproducible movement of the whole body. It is the old “every action has an equal and opposite reaction” maxim in, well, action. We literally shudder a little bit each time the heart ejects blood. Back in the day, researchers compared patterns of that shudder to detect and quantify disorders of cardiac output. As someone who had studied biomedical engineering in college, I thought it was pretty cool that you could non-invasively estimate cardiac output by measuring how much somebody bounced up and down with each heartbeat, even though it had been eclipsed by more accurate and easier to use technology.
By the way, you can easily measure the effect yourself, if you have an analog bathroom scale. Just stand on it as still as you can, and you will notice the needle deflects slightly with each heart beat – as the blood goes “up” out of your heart, your body goes “down” and your weight appears to increase momentarily. More elaborate ways to measure and quantify the effect are, of course, available on YouTube.
Continue reading What Goes Around Comes Around