Event-Driven Medicine Holds Great Promise - InformationWeek

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Healthcare // Mobile & Wireless
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12/16/2014
09:06 AM
Paul Cerrato
Paul Cerrato
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Event-Driven Medicine Holds Great Promise

Research shows that wearables and biosensors can help clinicians collect enough data to pinpoint the abnormalities in a patient's biomarkers that require attention.

John Halamka, MD and CIO of Beth Israel Deaconess Medical Center, predicts that the hospital of the future will have software to collect the tens of thousands of data points -- blood pressure, urinalysis readings, and the like -- generated by the typical patient. That data will then get fed into an algorithm that will pull out abnormalities, or "events," from the mountain of data, events that alert clinicians about impending danger. "Today, unfortunately, we don't have event-driven medicine," Halamka said in an interview at this year's HIMSS convention.

Lacking such critical data, clinicians often arrive too late to prevent complications. In fact, what often occurs is the intern shows up the next morning, looks at the patient's chart, and declares, "Oh, I see. Yesterday, his urine stopped flowing."

BIDMC has made strides to solve such problems. It does have algorithms in place to spot triggering events that clinicians need to address, eliminating the need for them to review all the unimportant monitor readings. This new capability is made possible by connecting smart infusion pumps and similar devices to a network that also feeds information into a patient's electronic medical record or similar centralized repository that bedside clinicians can review.

[Contextual inquiry helps app developers better understand the needs of the user. Read Healthcare Software: Put Development In Context.]

Elsewhere, Sensiotec has developed a wireless monitoring device called a Virtual Medical Assistant that's inserted under a patient's mattress to measure heart rate and respiratory rate, bed occupancy, and patient movements, without the need to hook the patient up to any wires, chest patches, or wearable vests.

(Image: Sensiotec)
(Image: Sensiotec)

Biosensors are becoming more commonplace in the outpatient setting, too -- Internet-connected body weight scales, glucose meters, and blood pressure cuffs keep track of home-bound patients. A device from Safeheart USA, for example, lets patients measure the amount of oxygen in their blood (oxygen saturation) and pulse rate. This ioximeter, which clips onto a patient's fingertip, plugs into a mobile phone app that keeps track of the readings. Measuring oxygen saturation helps clinicians and patients detect early signs of hypoxia, or oxygen starvation, which helps those with chronic obstructive pulmonary disease manage their disorder.

The critical issue that all these wearables and biosensors must address: Can they stand up to vigorous testing in a clinical trial that demonstrates they improve patient outcomes?

Clinical research suggests that a wearable device that measures fetal heart rate and other important physiologic parameters can help physicians estimate if a pregnant woman is ready to deliver. The device is synched to a mobile phone app.

Similarly, research on Sensiotec's Virtual Medical Assistant suggests it can improve patient care. During a recent tour of Technology Square in Atlanta, I spoke with Sensiotec medical director Jiten Chhabra, MD, who described that research. To obtain FDA approval, the company had to submit data to verify the accuracy of the device compared to more conventional approaches to collecting vital signs. That evaluation was followed by a productivity study in which Sensiotec demonstrated that its VMA shaved hours off the time nurses need to collect vital signs. The company has yet to present evidence to show that the device reduces hospital readmissions or medical errors, however. Chhabra says those studies are in progress.

On the subject of clinical evidence, there's solid support for home telemonitoring of patients with congestive heart failure using devices that measure weight, heart rate, blood pressure, and the like. One analysis that looked at 25 peer-reviewed studies involving more than 8,000 patients found significant "reductions in mortality... and heart failure hospitalizations."

Biosensors will never replace clinicians at the bedside, but the research indicates they save time and money, while catching problems that overworked healthcare workers can easily miss.

The owners of electronic health records aren't necessarily the patients. How much control should they have? Get the new Who Owns Patient Data? issue of InformationWeek Healthcare today.

Paul Cerrato has worked as a healthcare editor and writer for 30 years, including for InformationWeek Healthcare, Contemporary OBGYN, RN magazine and Advancing OBGYN, published by the Yale University School of Medicine. He has been extensively published in business and ... View Full Bio
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Ariella
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Ariella,
User Rank: Author
12/16/2014 | 9:43:16 PM
Re: Don't Forget the Patient
@jastroff I agree that is a problem, but I hope that will be changing as those who handle healthcare technology learn to listen to the patient user experience. Progress is rather slow, but there's some cause from optimism based on the interviews I've had with representatives of hospitals that have adopted technology designed for the patient rather than the provider. There's also some interest in taking a more empathetic approach, though that will likely take years to realize.
nomii
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nomii,
User Rank: Ninja
12/16/2014 | 9:27:00 PM
Re: Don't Forget the Patient
@Ariella right. I have also heard and read about it as well. But one question which I wanted to know is the range between the doctor and patient is very important in that case. Thier must be some kind of distance involved within which the data is automatically updated with the doctor. What will be the case if the distance is more than required.
nomii
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nomii,
User Rank: Ninja
12/16/2014 | 9:20:47 PM
Re: Don't Forget the Patient
@Jastroff I agree with you that wearable and biosensors will bring a pleasant change  kind of medical care that is known to us. I must add here that the work on collection of data remotely from the patient with sensors placed in its wearables like watches, spectacles, chains etc will give you a constant data update to the doctor who once feel that patient needs a check up will get intouch with him and ask to get himself checked. I believe whatever the mechanism is selected this tech will definitely help the patient doctor relationship
jastroff
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jastroff,
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12/16/2014 | 6:43:12 PM
Re: Don't Forget the Patient
Given the way computing has developed, I have little faith that the patient will be be considered as they should, but rather, as technologists SEE them, not as they should be seen.

Systems today are for the most part user-hostile, predicated on the technolgists strange idea of what makes up a good "interface"

 

Sorry...but maybe I'm wrong!

 

 
Ariella
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Ariella,
User Rank: Author
12/16/2014 | 4:06:08 PM
Re: Don't Forget the Patient
@tjgkg there are already wearables that give reads as accurate as an ECG in a doctor's office that can be worn at all times, thanks to sensors woven into the fabrice of a (washable) shirt.

See personal-healthwatch.com/hwear-health-sensing-garments.aspx
tjgkg
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tjgkg,
User Rank: Ninja
12/16/2014 | 3:16:56 PM
Re: Don't Forget the Patient
And i am sure this capability will really improve going forward. The devices will be much less expensive and much more powerful.
tjgkg
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tjgkg,
User Rank: Ninja
12/16/2014 | 3:14:05 PM
Re: Don't Forget the Patient
Right now we are in the infancy of this kind of medical care. With the advent of the wearable fitness devices, I think we will see a lot more communications and feedback with medical professionals. This type of biofeedback has been available with computers for quite some time. Now the wrist devices will enable a more personalized type of consultation and fitness regimine.
Ariella
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Ariella,
User Rank: Author
12/16/2014 | 2:11:30 PM
Re: Don't Forget the Patient
@jastroff I looked into a few of those types of wearables. When an alert is sent, the doctor or whichever health care provider gets the data would either call or text the the person. And for some systems, the wearer is alerted directly. 
jastroff
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jastroff,
User Rank: Ninja
12/16/2014 | 10:08:04 AM
Don't Forget the Patient
Health treatment from wearables and other remote devices will bring all the changes we can imagine.

What I don't see addressed is how doctors, etc. communicate back to the patient, if we assume the patient is remote, i.e., not sitting in the doctor's office or in a medical facility. Always missing from the celebration of these devices, the big data they produce, and what the doctor can now know, is how to complete the loop to communicate back to the patient or caregiver. Do they call on the phone? Send a message? How long is the communication? What's the follow-up loop look like? And what is the patient told about the data?
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