Digitizing the Human Being and Optimizing the Digital Ecosystem: The Automation of Remote Monitoring

In 2012, one of my mentors in the digital space, Dr. Eric Topol, said that monitoring “is the essence of digitizing a human being. For medical purposes, it’s getting all the essential data, and it will be the information to radically transform the future of medicine.”¹ His comments have now become a reality. Over the next 3 years, it is estimated that nearly 20 million patients will be connected to home monitoring devices. This will certainly generate hundreds of terabytes of data — much of which must be processed, interpreted, stored, and most importantly, acted on by a healthcare provider or team. The ability to track real-time information and monitor subtle fluctuations in measurable biologic indicators will likely allow physicians to respond to patient needs much more quickly — often resulting in better care and improved outcomes. 

Putting the Patient at the Center of the Digital Ecosystem

The digital space facilitates better patient care. Patients are more connected than ever before, and many engage daily via social media and Internet searches on healthcare topics. Now, through technological advancements, patients are also biologically connected while at home — monitors, watches, step counters, and implantable remote monitoring devices have created a new digital ecosystem for our patients. This ecosystem, when properly managed and when the data it generates is leveraged and used effectively, can transform the way in which healthcare is delivered and also how doctors and patients interact. When we are able to empower our patients and put them at the center of an advanced, user-friendly digital and highly connected ecosystem, we are able to create multiple “touch points” between visits, which can help patients in the following ways: (Figure 1)

1. Prepare for care: Patients can access information and better understand what questions to ask before their visit with a healthcare provider;
2. Understand care: Digital technologies can help patients better understand their disease process and their treatment plan both before and after an in-person interaction;
3. Find the right care: Patients can use digital tools to research and evaluate different healthcare systems, physicians, and procedures treatments, as well as to better understand the options that are best for them; 
4. Include family and friends in care: By utilizing digital tools — Internet sources, monitors, and other technologies — patients are able to engage their support system in their care as well. Including friends and family in a care plan can help patients stay on track.
5. Continue care: Remote monitoring technologies can assist patients in the management of their disease between in-person office visits. Data produced by remote/connected technologies allows patients to respond to changes in their symptoms in a more efficient and effective way.

Technologies for Monitoring

There are multiple technologies for monitoring and connecting patients that can enhance our ability to treat and engage. All of these different technologies have their particular advantages and shortcomings. There are many direct-to-consumer options such as FitBits, Apple Watches, and other “wearable” biometric devices. There are also smart tattoos, dermally implanted sensors, and subcutaneously implanted loop recorders. Cardiac implantable electronic devices (CIEDs), including pacemakers and ICDs, provide a wealth of data and biometric monitoring on a minute-to-minute basis. In addition, technologies such as the KardiaBand (AliveCor) allow for real-time data analysis and “consumer-driven” biometric feedback. The data generated through monitoring and connectedness allows patients to receive immediate feedback, and allows clinicians to more precisely manage disease. Patients are able to become more self-aware, and at the same time, feel more confident that their clinical needs are being met. Anxiety and worry are limited when patients are “connected” and they feel as though someone is watching over their medical needs.

Remote Monitoring and Data Management: A House that is Always on Fire 

Nearly 50 terabytes of data are generated by the healthcare space, and this number is growing every single day. In the EP space, CIED implants (particularly ILR implants) continue to expand, and these devices produce a constant stream of data. This data stream is akin to a house on fire — with flames shooting out of the widows and through the roof — with very little hope for us (as clinicians) to extinguish it before the entire structure burns to the ground. Many clinics and healthcare systems are simply overwhelmed by the never-ending data downloads. While many clinics have developed well-organized “systems” for managing remote monitoring, these systems rely on human beings to manage and interpret mountains of data. When the clinics are closed, such as on weekends and holidays, these data continue to accumulate. In many cases, actionable downloads that occur over a long holiday weekend are never even seen or managed until the office reopens. This lag in notification and action exposes patients to undue risk (e.g., stroke, arrhythmias, and other device-related complications), and can create risk management challenges for both clinicians and hospital systems. 

Transforming Workflow and Reaching Patients Through Automation

Remote monitoring can generate an enormous amount of data, and all of this data must be carefully analyzed and managed. False-positive transmissions, particularly from implantable loop recorders, are common and can unnecessarily burden clinical staff. Device nurses can sometimes spend hours sorting through transmissions in order to classify them into normal, false-positive, or clinically actionable events. These nurses and device technicians are experts at managing device patients, but can find themselves “pushing electronic paper” when dealing with remotes rather than spending quality time interaction with their patients — either in person or on the phone. If we are able to automate the remote follow-up process through the use of artificial intelligence (AI) and machine learning, we are better able to become far more efficient in the way in which we handle device-generated data. 

A new workflow — in which software would triage all transmissions and sort them into categories so that the interpreting clinician is able to quickly view the transmissions that are normal, ignore those that are false-positive, and act on those that have clinically relevant findings — could lead to better outcomes in the future. This type of software solution to automate remote monitoring is currently being developed by PaceMate. Ultimately, automation of the remote monitoring process could revolutionize our ability to treat device patients. For example, it could offer a streamlined process of early detection and intervention, improved time management for device nurses and techs, standardized reporting of devices, faster turnaround for device transmissions, prompter action for abnormal downloads, and personalized care without increased staffing. 

The Future of Remote Monitoring

Automation is key for handling the ever-increasing data burden that the healthcare space is generating. Software solutions to data management are the way in which patients will interact with doctors going forward. As more patients become connected, more solutions will be needed in order to put out the “house fires” that are sure to develop along the way. 

1. Winslow R. The Wireless Revolution Hits Medicine. The Wall Street Journal. Published Feb 14, 2013. Available online at http://on.wsj.com/2z7H73T. Accessed December 18, 2017.