Medtech innovation is the effective application of new technology to improve healthcare. Stefano Di Lullo of Sorin Group looks at a crucial new example: the power of intelligent remote monitoring to break down barriers between the clinician and the patient's everyday life.
Healthcare was transformed in the first half of the 20th century by the invention of a number of medical devices that enabled physicians to collect data about diseases in a way that had not been possible before. Inventions such as the thermometer, stethoscope, microscope, ophthalmoscope, laryngoscope and X-ray enabled doctors to understand in far greater detail how various diseases change the human body and affect health. With an ever-expanding database, healthcare professionals were able to specialise and develop a detailed understanding of diseases.
Developments in medical technology and in healthcare delivery have always gone hand in hand. Now, remote monitoring - which promises to deliver more data than ever before for chronic diseases - has the potential to shape the future of patient care.
Keeping in touch
The role of telecommunications in medical technology has greatly increased in the last decade. It is now possible to collect patient information without the patient attending a hospital or doctor's surgery or office. This represents a breakthrough in terms of the amount of data that can be collected, and the number of people that can be treated by a healthcare delivery system. Current telemedicine systems range from patients self-reporting via telephone to implanted devices communicating data to healthcare professionals via secure servers.
Remote monitoring - the collection of patient data at a site where the patient is not present - is most valuable for chronic diseases such as diabetes and heart disease: these conditions require frequent monitoring to control symptoms and ensure the patient's well-being while the patient gets on with life outside of the clinical setting.
In the treatment of diabetes, remote monitoring enables physicians and patients to track blood sugar levels and changes in activity, diet and medication, providing the healthcare professional with a clear picture of the condition and its impact on the patient. The data can also help patients to self-administer appropriate amounts of medication in response to dietary and activity changes. In the treatment of heart disease, remote monitoring has the capability to assist the 1.7 million people in the UK diagnosed with arrhythmia - a condition that can have fatal consequences if not managed properly.
Basic remote monitoring systems involve the patient reporting self-assessments of symptoms over the telephone and then receiving verbal advice and education. While this form of remote monitoring certainly has benefits for healthcare delivery, its usefulness is constrained by the fact that the patient needs to support the process actively and input the information. If the patient is away from home, loses interest or becomes confused by the equipment, then the system may break down.
A more sophisticated alternative is remote monitoring based on information from a medical device - for example, an implantable cardiac rhythm management device. In this model, the physician is able to collect data from the device and establish its functional effectiveness in a completely non-invasive way. This works by the implanted device 'communicating' with a piece of hardware in the patient's home, typically the bedroom. However, this type of remote monitoring presents healthcare professionals with a new challenge: how do they identify the data that are most relevant to patient management?
Handling the data
For remote monitoring of implantable cardiac rhythm management devices, marrying the device to a state-of-the-art data management system will be a key future requirement.
Some recent implantable cardiac rhythm management devices adjust automatically and continually to changes in arrhythmia. This is possible because the devices use algorithms that accurately predict the course of cardiac diseases such as atrial arrhythmia and heart failure. These intelligent implantable devices are a natural candidate for incorporation into a remote monitoring system, as they have the potential to empower healthcare professionals to understand the individual patient's disease experience without the patient leaving their home. In addition, such technology goes beyond providing warning alerts about potential disease deterioration, and can be termed an 'intelligent remote monitoring system.'
Sorin Group is currently developing a system of this kind. The data will be transferred securely from the implanted device to a Sorin Group data hosting system using technology from Orange. The implanted devices will draw on highly specific algorithms that adapt to the natural functions of the heart, measuring vibrations generated by heart contraction. Data provided by the algorithms could enable physicians to monitor the development of acute cardiac decompensation based on patient activity and breathing, as well as predict the course of the disease. It is believed that this technology will benefit the medical community through time savings and early intervention. Being able to undertake preemptive action could save healthcare delivery systems money, since complex surgical procedures and long hospital stays (as well as readmissions) may be avoided.
Intelligent remote monitoring promises a system that is better for the patient on two levels. Firstly, the patient will not be required to attend routine appointments to check on the state of the implanted device: instead, face-to-face consultations with their doctor can be spent discussing their condition in detail. Secondly, the patient will benefit from reassurance that they are being continually supported and their health is being proactively monitored.
From the healthcare professional's perspective, remote monitoring provides time benefits. Research has shown that with the assistance of remote monitoring, in-office visits can be scheduled at yearly intervals without compromising patient safety; indeed, patient safety is generally enhanced by the use of remote monitoring. The literature also reports that existing telemonitoring solutions reduce physician time per patient by approximately 40% - so imagine what could be achieved with intelligent remote monitoring systems!
The remote monitoring paradigm
Building an intelligent NHS
Professor John Morgan of Southampton University, a key opinion leader in remote monitoring technology, has pointed out that for the past decade there has been a high level of expectation about the use of new technology to manage chronic diseases - an excitement sparked when telemedicine was first introduced. However, the excitement has not necessarily led to changes in clinical practice.
The main sticking point has been the requirement for clinical evidence in a real-world setting. NHS decision makers need to see that embracing new technology will offer benefits to patients, physicians and the healthcare system, and that such technology can be effectively integrated into clinical practice.
To this end, Professor Morgan is currently working on developing a multi-centre study of remote disease management processes to evaluate this approach. He is focusing on remote monitoring in cardiology, as this is the most developed area, but he also believes that remote monitoring could offer benefits for the management of renal, neurological and skeletal conditions.
Outside the UK, research is under way in Europe to solidify the database for remote monitoring, and randomised clinical trials are being conducted to build a robust case for its health benefits.
The next steps
As technology evolves, people and institutions reform their behaviour and practices to incorporate it. The management of health has, until now, been based on face-to-face encounters between a patient and a doctor where information is conveyed and examinations are conducted. Remote monitoring allows the patient to be managed via the monitoring of data and further assessment during consultations. Intelligent systems will provide an array of detailed data that enhance the patient consultation instead of replacing it. This technology has the potential for smooth integration within our healthcare system.
The medtech community continues to innovate and provide new tools for managing patients. Intelligent remote monitoring will propel the patient into an environment in which their cardiac health, and other aspects of their wellbeing, can be cared for continuously. Healthcare professionals, helped by intelligent algorithms, will be armed with a powerful tool to develop tailored treatment approaches that are more effective for the patient and for the NHS.
Implemented within our healthcare system, this technology could represent a true example of innovation. It has the potential to help specialists further understand chronic diseases, save resources, see more patients, and deliver the best possible standards of care.
Stefano Di Lullo is President of the CRM Business Unit of Sorin Group. Sorin Group and Orange Business Solutions are developing an intelligent remote monitoring solution for patients implanted with cardiac rhythm management (CRM) devices. For more details, visit www.sorin-crm.com.
Healthcare professionals will be armed with a powerful tool to develop tailored treatment approaches that are more effective for the patient and for the NHS.