By Stuart Long
Remote cardiac monitoring has come a long way since 1947.
That was our “Kitty Hawk”, when Dr. Ben Holter first donned a backpack with more than 80 pounds of vacuum tube-era monitoring equipment, hit the “record” button on a state-of-the-art reel-to-reel machine, got on a stationary bike and started pedaling. That was the first known broadcast of a radio electrocardiogram.
Dr. Holter didn’t stop there. He continued to develop the technology, collaborating with Bruce Del Mar of Del Mar Avionics. New solid-state technology, semiconductors and advances in electronics design enabled them to miniaturize the device. The revolution came when the monitor could be reduced to the size of a deck of cards – making it truly wearable and portable. The improvement was exponential – and their invention, for all its practical limitations, saved an untold number of lives.
The cardiac monitoring industry is now undergoing a technological revolution that is just as significant as the miniaturization revolution made possible by the semiconductor. Advances in telecommunications, data storage and management, SaaS (software-as-a-service) and artificial intelligence made in just the last few years are enabling us to make a quantum leap in cardiac diagnosis and intervention. We’re already seeing tremendous improvements for both patients and physicians as more doctors adopt the next generation of cardiac monitoring devices.
Limitations of Holter-like systems
Until now, Holter-style monitors and those developed with similar technology had serious limitations:
1. Patients vulnerable during the monitoring period.
First, patients had to wear legacy devices for 2 to 3 days or more, and then return them to the doctor’s office to get data uploaded. Then doctors had to rely on third-party independent diagnostic testing facilities (IDTFs) to get reams of data read to get a diagnosis. This adds days to the diagnostic process – and leaves patients vulnerable to fatal arrhythmias occurring during the monitoring period.
Today, ambulatory cardiac monitoring devices can send secure patient data directly to doctors’ electronic devices while making use of artificial intelligence to improve the process dramatically so physicians can get an intelligent up-to-the-minute feed throughout the monitoring period. They can set up alerts to give them instant notification of potentially dangerous arrhythmias. This alone can potentially allow for physicians to improve the time to intervention such that patients are treated faster.
2. Massive data blind spots.
When the patient returns the monitor for analysis, more than 99 percent of the data are discarded. The physician can only “see” perhaps 1 percent of the total data. Only a fraction of the individual’s arrhythmias is compiled into short “clips” of heartbeats.
Today’s advances in big data storage allow us to record continuously for days or weeks, if desired. We can then make all full-disclosure data available 24/7, on demand to the physician, eliminating data loss.
3. Analysis capacity limitations.
Even where data are not lost, previous limitations on our ability to process or analyze the data efficiently meant it was useless: Exceedingly large amounts of data – thousands and thousands of individual heartbeats – had to be compiled by clinicians. This was overly time consuming, added expense (when it was done at all), and either added days to the diagnostic process, or negatively impacted clinical decision-making.
The artificial intelligence revolution makes it possible to rapidly analyze massive amounts of data in seconds. The result is a more informed diagnostic process.
4. Loss of critical onset data.
Some devices required patients to manually activate devices when they weren’t feeling well – causing monitors to miss critical onset data in the minutes prior to an arrhythmia. These moments are critical for diagnosis, but too often lost to the physician with older devices.
Today’s advances in big data allow us to record continuously and store every single heartbeat. And advances in deep learning algorithms and artificial intelligence let doctors zero in on critical onset data in seconds.
5. Inability to switch modalities.
If a cardiologist wanted to switch modalities between Holter, Event or MCT, the patient had to get fitted with a whole different device. Again, this caused days or weeks of delay, added additional labor and expense for the physician or provider, and most importantly, leaves the patient vulnerable to fatal arrhythmias during the monitoring period.
Today, doctors can switch modalities remotely and instantly. The result is more complete, multi-faceted diagnostic data – in a fraction of the time.
Benefits for providers
The next generation of ambulatory cardiac monitoring devices is also having a tremendous effect on physicians and providers with ownership of the entire service line. Today, we’re eliminating the need for expensive third-party middlemen. This puts physicians in direct touch with their patients and provides on-demand, full disclosure of patient data.
Privacy and HIPAA considerations
Privacy is always a concern. But advances in secure telecommunications from huge players like Amazon Web Service, GE’s Azure, Apple and a growing number of smaller innovators have made it easier and more cost effective for vendors to employ strict standards of privacy.
Workflow is king
Any technology we come up with must be integrated into clinical practice, of course. But we’re able to automate the alert process, and streamlined enrollment by eliminating the third-party data firms. You can enroll, train and start monitoring in a single visit.
When you empower the hands-on healthcare provider, you have the opportunity to derive the best possible outcome for the patient. These exciting technology and information science developments are doing for healthcare what the jet engine did for air travel – and doing more to empower providers than anything we’ve seen in years.
About the Author: Stuart Long is the CEO of InfoBionic, the manufacturer of the MoMe® Kardia. Formerly the CEO of Monarch Medical Systems, Stuart, with over 20 years in the medical device industry, also holds dual registries in noninvasive diagnostic echocardiography, where he held management roles in both hospital-based radiology and noninvasive cardiology.