With the many inadequacies in our medical care system, there are some encouraging signs that technology may offer the hope of improving our care. It’s an area ripe for disruption where there is now so much secrecy and confusion, and where insurance companies routinely come between our doctors and our well-being.
There’s a real need for better wellness care and personal responsibility that can identify medical issues before they’ve developed and making treatment more expensive and the prognosis more serious.
The first impact of technology have been the improvements in communications with our providers using online portals and apps where providers send us the results of our test results and examinations as they become available. A few years ago, we’d need to wait, often for days, for the doctor’s office to call back with the results, quickly scribbling down notes and then figuring out what they meant. Still, a lot more work is needed, as there is little compatibility of data and apps among the different providers. It encourages you to stay in the same network when selecting specialists, and often makes it very difficult to take your medical history and records to another entity.
Technology is also changing the face of primary care. One Medical, is using technology to provide immediate medical help to us, wherever we are in the world. They’ve opened 70 locations so far across the USA, offering same day appointments and provide tele-medicine from wherever you are – even in another country, as well as 24 hour access to medical advice, prescriptions or other non-urgent care. All for about $200 per year. Many companies are offering this as a benefit to their employees. Having traveled so often to Asia, it’s something I could have used numerous times.
An important area where technology is playing a more important role is in self-care. The Apple Watch has become one of the most important devices to allow self monitoring, including atrial fibrillation, and ECGs. The measurements are recorded on your phone and can be shared with your doctor.
A recent study in the Journal of New England Medicine reported just how effective it can be:
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Participants without atrial fibrillation (as reported by the participants themselves) used a smartphone (Apple iPhone) app to consent to monitoring. If a smartwatch-based irregular pulse notification algorithm identified possible atrial fibrillation, a telemedicine visit was initiated and an electrocardiography (ECG) patch was mailed to the participant, to be worn for up to 7 days. Surveys were administered 90 days after notification of the irregular pulse and at the end of the study. The main objectives were to estimate the proportion of notified participants with atrial fibrillation shown on an ECG patch and the positive predictive value of irregular pulse intervals with a targeted confidence interval width of 0.10.
RESULTS
We recruited 419,297 participants over 8 months. Over a median of 117 days of monitoring, 2161 participants (0.52%) received notifications of irregular pulse. Among the 450 participants who returned ECG patches containing data that could be analyzed — which had been applied, on average, 13 days after notification — atrial fibrillation was present in 34% (97.5% confidence interval [CI], 29 to 39) overall and in 35% (97.5% CI, 27 to 43) of participants 65 years of age or older. Among participants who were notified of an irregular pulse, the positive predictive value was 0.84 (95% CI, 0.76 to 0.92) for observing atrial fibrillation on the ECG simultaneously with a subsequent irregular pulse notification and 0.71 (97.5% CI, 0.69 to 0.74) for observing atrial fibrillation on the ECG simultaneously with a subsequent irregular tachogram. Of 1376 notified participants who returned a 90-day survey, 57% contacted health care providers outside the study. There were no reports of serious app-related adverse events.
CONCLUSIONS
The probability of receiving an irregular pulse notification was low. Among participants who received notification of an irregular pulse, 34% had atrial fibrillation on subsequent ECG patch readings and 84% of notifications were concordant with atrial fibrillation.
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What’s encouraging is that it’s now possible to study hundreds of thousands individuals, preferably with their consent (!), and draw important results. Remote monitoring, remote diagnosis, and telemedicine offers a promise of better care for all. With so much harm technology has been doing lately – this is an area where they may be able to redeem themselves. That is as long as there are no more scams such as Theranos,
We still need to be wary of tech companies, however. Google and Ascension disclosed the sharing of millions of our health records, ostensibly to improve diagnosis, but without our permission.
I’m looking forward to when I can strap on a few sensors and have my iPhone automatically transmit health data to my doctors office on demand from wherever I am in the world.
