Mar 28, 2011
Eric J. Topol, M.D., Scripps Translational Science Institute Director, is quoted in the Wall Street Journal’s article, “Medicine on the move: Mobile devices help improve treatment.” The article on digital, or wireless, medicine, is part of the newspaper’s Innovations in Health Care series.
By Stephanie Simon
Eric Topol felt a twinge of nostalgia when he stopped carrying around his trusty stethoscope.
It didn’t last long.
Dr. Topol, a cardiologist in San Diego, carries with him instead a portable ultrasound device roughly the size of a cellphone. When he puts it to a patient’s chest, the device allows him to peer directly into the heart. The patient looks, too; together, they check out the muscle, the valves, the rhythm, the blood flow.
“Why would I listen to ‘lub dub’ when I can see everything?” Dr. Topol says.
The $8,000 device—called the Vscan, made by GE Healthcare, a unit of General Electric Co.—is just one entry in the booming field of mobile-health technology. In an era where many medical schools hand out iPods along with dissection kits, Dr. Topol, the chief academic officer for Scripps Health, a San Diego-based nonprofit health-care network, says smartphone apps, wireless sensors and other innovative tools hold “transformative potential.”
He and other physicians say the technology can not only improve diagnoses and treatment, but also revolutionize how doctors and patients think about health care. Mobile tools allow physicians to monitor vital signs, note changes in activity levels and verify that medications have been taken, without ever seeing a patient face to face.
That means fewer office visits—and fewer hospitalizations, since even very ill patients can be monitored from afar. For their part, patients can monitor their health in real time, gaining access to an unprecedented amount of data that will allow them to “take charge of their own health care,” Dr. Topol says.
Kelly Morris, a mother in Union Grove, Ala., sees the potential most clearly in a red plastic tag she clips to her daughter’s shirt each morning. One side of the tag reads: “In Case of Emergency.” The other instructs responders to text a unique PIN to the number 51020. Anyone who does so will receive a text offering detailed instructions for 13-year-old Michaela’s care. They’ll learn, for instance, that her particular form of epilepsy does not respond well to the most common seizure drugs and that certain medications make her manic.
“These are things I would like an emergency team to know,” Ms. Morris says. “It gives me the ability to say what I want to say, even if I’m not there.”
Another feature of the $10-a-year service allows trained medics, who are given special access codes, to pull up a preprogrammed list of the patient’s emergency contacts. The medic can swiftly notify them all—by automated text, email or phone call—that the patient is being taken to a specific hospital.
The technology, called “invisible bracelet,” was developed by Docvia LLC of Tulsa, Okla. In addition to the red plastic tags, the company sells key fobs and stickers that can be attached to ID cards and that carry the same instructions about texting a PIN in case of emergency.
The TransportAV system, which costs about $30,000, uses a small video camera, digital stethoscope and microphone mounted on a stretcher to transmit live images of the patient to the treatment team waiting in the hospital emergency room. Paramedics and nurses in the ambulance can send close-up images of wounds, real-time video of the patient’s response to various treatments, and audio of heartbeats and respiration.
Such monitoring isn’t all that crucial for short ambulance rides. But specialized facilities like Cincinnati Children’s Hospital Medical Center often pick up patients in other states, four or five hours away. Hamilton Schwartz, an ER physician at Cincinnati Children’s, says the system lets him see the patient for himself, instead of having to rely on an ambulance nurse to describe symptoms by cellphone. Dr. Schwartz can then order treatments en route, brief the ER team or prepare a surgical suite for the ambulance’s arrival.
Dr. Schwartz has been using the system on a trial basis for several months and says his “gut feeling is that it’s great.” He has launched a formal study to determine whether doctors who use this technology order different treatments from those who simply hear the patient’s symptoms described.
When the patient is in the hospital and the physician is on the road, a different type of long-distance monitoring is needed. The Mobile MIM system, approved last month by the Food and Drug Administration, lets doctors use their iPhones to view images from sophisticated hospital tests such as MRIs and CT scans. Developed by MIM Software Inc., of Cleveland, the program reproduces the scans with enough clarity and fidelity that physicians can make diagnoses via smartphone.
Nurses on the labor and delivery floor routinely use sensors to monitor the fetal heart rate and the mother’s contraction patterns and oxygen levels. In days past, Dr. D’Ambrosia would call the hospital every hour or two to ask a nurse to describe the data being spit out by the sensors.
“Everyone uses different terminology,” she says. “I would have to spend a few minutes trying to tease out what that heartbeat looks like.” If she wasn’t satisfied with the nurse’s description, she’d drive to the hospital to look at the graphs and charts in person.
Now, however, Dr. D’Ambrosia uses an application called AirStrip OB to pull up that information on her iPhone. With a couple of taps, she can view, in real-time, all the data from the sensors strapped to her patient’s belly. If she spots danger signs, she can order a Caesarian section by phone, so the patient will be prepped and ready for surgery by the time she gets to the hospital.
Hundreds of hospitals nationwide use the system, developed by Airstrip Technologies of San Antonio, Texas.
The California Hospital Medical Center in Los Angeles has adopted a more elaborate patient monitoring system, EverOn, for critically ill patients.
The system consists of a sensor-studded mat that is placed under a patient’s mattress. Nurses program the device to alert them if any of the patient’s vital signs drop to a level that they deem worrisome for that individual.
If that happens, the EverOn wirelessly transmits an alarm that goes off at the main nursing station on the floor, in the patient’s room, and on nurses’ smartphones or pagers.
“We’ve had a lot of saves on close calls,” says Jamie Terrence, the hospital’s director of risk management. “The nurse gets in there before we have to call code blue for cardiac arrest.”
The mat, made by EarlySense Ltd. of Dedham, Mass., can also be set to send nurses reminders at predetermined intervals, so they don’t forget, for instance, to turn a patient regularly to prevent bed sores. Installing the system throughout a typical 30-bed hospital unit costs about $230,000, with annual maintenance costs of about $50,000.
Other monitoring devices abound.
Sotera Wireless Inc. in San Diego is developing a wristband sensor that tracks vital signs—including blood pressure, cardiac rhythm, even activity level—and sends wireless alerts to the doctor at the first sign of trouble.
AT&T Inc. is developing “smart slippers” with pressure sensors to detect any changes in the wearer’s gait that may signal a health issue or increased risk of falling. If such changes are detected, a transmitter is supposed to notify the patient’s doctor.
And myriad smartphone applications promise to help patients do everything from monitoring their blood glucose to taking their pills on time.
So much information, so readily available, can have a downside. “We could create a whole culture of cyberchondriacs,” says Dr. Topol, the cardiologist in San Diego.
He acknowledges, too, that something will be lost when most face-to-face visits with physicians are replaced by wireless exchange of data. “We’re getting virtual touch, rather than actual touch,” he says.
But Dr. Topol says in his own practice, he’s found that many patients are more willing to make lifestyle changes that keep them healthy when they can monitor the consequences of their actions in real time. A doctor can talk “until he’s blue in the face,” he says, but it sometimes takes cold, hard data to motivate a patient.
Technology “can create anxiety,” Dr. Topol says, “but it’s also empowering.”