Diabetes Research Paper
Abstract
With the advances in technology over the past 10 years, medical monitoring has advanced from wired monitors, such as with diabetes patients, who must manually input their glucose levels into an insulin pump attached to the belt to the wireless NUVANT Mobile Cardiac Telemetry System for patients with cardiac arrhythmia. This device allows the patient to record his heart rhythms and upload them to a wireless transmitter, which then send the data to the doctor. Other advances in medical monitoring involve the use of a patient’s smartphone to monitor the patient’s medical conditions and transmit directly to the cloud or email the results directly to the doctor for interpretation. This paper discusses the advances made in medical monitoring …show more content…
using smartphone applications (apps) and the future of wireless medical technology.
The Present and Future of Smartphones as Aids in Medical Monitoring
In today’s world, technology is advancing at an accelerating rate. Computers, home entertainment and cellular phone technology are just a few examples of how far technology has advanced over the last few years alone, permeating all walks and facets of life. Medicine is no exception to this rule. Over the last thirty years alone we have witnessed medical technology advance from the invention of the World Wide Web in 1989, to Telesurgery in 2001, to the advent of wireless and patient-managed technology for medical monitoring in the 2010s. New technologies are granting patients with chronic medical problems the ability to gain control of their conditions without compromising their mobility. It has become important to have an automated real-time system for checking important values such as weight, blood pressure, heart rate, daily activity, symptom responses, and so forth.
Home monitoring devices are now available to patients with direct access to patient information to the doctor’s office and its staff. As stated in the journal Biomedical Engineering Online, “medication adherence is a major problem amongst patients with chronic conditions and…that technology can play an important role” (Boulos, Wheeler, Tavares, & Jones, 2011). At the forefront of this patient-managed technology is the smartphone. A smartphone is a device that combines a cellular phone with a handheld computer, typically offering Internet access, data storage, e-mail capability, etc.(Dictionary.com). With the rapid developments in wireless technology, medicine has now become one of the leading industries to utilize these new developments. Eric Topol, a leading cardiologist who has embraced the study of genomic and the latest advances in technology to treat chronic disease, has stated, “We 'll soon use our smartphone to monitor our vital signs and chronic conditions” (TED, 2010). Among the features that smartphones possess is the ability to run third-party applications, better known as apps.
Smartphones have changed the world of medicine with apps for fitness, nutrition, health and wellness. Patients with congestive heart failure, diabetes, high blood pressure and other conditions now have smartphone apps designed to monitor their vital signs in order to better keep those medical conditions under control. Patients with diabetes can find apps for carbohydrate counting. There are ringtone reminders for when it 's time to check glucose levels. Patients with congestive heart failure (CHF) now have available to them a system which is programmed to collect patient data in order to track their weight (weight changes quickly with fluid load), blood oxygenation, medication adherence, and activities of daily living ( New Media Medicine, 2011), and transmit it to a website where it is reviewed by a physician. The system also can transmit data from a scale and blood pressure cuff.
Smartphone technology was designed not just for patients: doctors are now able to use their smartphones for diagnoses, reference and for keeping electronic medical records. An app called Medscape is an example of how this technology is assisting doctors in diagnosing and treating illnesses. Medscape offers such functionalities as drug reference, diagnostic reference and medical news. For cardiologists whose patients suffer from cardiac arrhythmia they now have access to patients’ ECG (electrocardiogram) readings from anywhere via their smartphone app. Applications allowing physicians to zoom in and out will allow doctors the ability to view near-real-time ECG data and the ability to review previous ECGs so that physicians can make accurate diagnoses. Diabetes is a condition where the body fails to utilize the ingested glucose properly.
This could be due to lack of the hormone insulin, or because the insulin that is available is not working effectively (Mandal). According to the 2011 Data National Fact Sheet 8.3% people in the United States have diabetes. Patients who suffer from IDDM (insulin dependent diabetes mellitus) suffer from their pancreas not creating enough insulin or their body ignoring the insulin altogether. Uncontrolled diabetes can result in amputation, blindness, heart disease and stroke, kidney failure and high blood pressure. More diabetics have found that using an insulin therapy pump is much easier than having to carry around insulin that has to be measured for the appropriate dosage amount and oftentimes kept refrigerated. People with diabetes must check their glucose levels up to 4 times a day or more often if they are experiencing high sugar levels by using a glucose monitor. Using the glucose monitor, patients will lance their fingers and take a small sample of their blood and place it onto a test strip that will be inserted into the monitor; within seconds patients will have their glucose levels reported back. Currently, patients must manually enter the glucose levels into an insulin pump where the appropriate amount of insulin will be dispensed into the body via a needle that is inserted into the body subcutaneously, and the insulin will travel through tubing connected from the insulin pump …show more content…
to the body. The most common complaint of patients who are using insulin pump therapy is that the tubing often becomes tangled. To make this process simpler, wireless technology has evolved and the OmniPod System provides patients with the first ever tubing free insulin pump system. Patients will simply apply the pod anywhere on their body they can inject themselves. The PDM (Personal Diabetes Manager) will wirelessly program a patient 's personalized insulin delivery, suggested doses, and also has a built in blood glucose meter. The device will dispense a small amount of insulin on a continuous basis day and night to cover a patient’s baseline insulin. Additional insulin is dispensed in order to cover meals and snacks or to help bring down high blood glucose levels. Using devices such as the OmniPod System for IDDM will be beneficial to patients to help prevent complications due to diabetes. As stated in the Diabetes Research and Clinical Practice, self-management is an important and evidence-based component of treatment and care for patients with Type 2 diabetes and there is an increasing demand for interventions to support and enhance self-management. With over 85% of Americans whose mobile phones have internet access, managing diabetes has become much more effective. The goal of using smartphone applications is to effectively manage diabetes by improving glycemic control, and ultimately preventing or delaying further complications of diabetes. (Tran 2012) There are several applications available to individuals with diabetes. Selecting the right app is based on personal preference and what the patient 's short- and long-term goals are. Apple iTunes offers apps such as iDiabetes, a blood glucose tracker, and Trac3-Diabetes, a dietary planner and carbohydrate counter. Many of these applications also allow a patient 's physician direct access to their test results. If any adjustments have to be made in the insulin dosage, or if a patient 's glucose levels are reading too high or too low, doctors and their staff will have immediate access to this information and the appropriate medical attention can take place to prevent further complications, hospitalization or even death.
Heart arrhythmias occur when the electrical impulses in your heart that coordinate your heartbeats don 't work properly, causing your heart to beat too fast, too slow or irregularly (Mayo Clinic Staff, 2013). In a normal heart, the electric signal that governs the rate and rhythm of the heartbeat follows a precise path through the heart. An arrhythmia can occur when those electric signals become interrupted in any way. While some occurrences of cardiac arrhythmia can be symptom-free, others can be fatal if not closely monitored.
Today the predominant method of monitoring an arrhythmic patient 's heartbeat is via a Holter monitor. A Holter monitor is a machine that continuously records the heart 's rhythms. The monitor is usually worn for 24 - 48 hours during normal activity (Medicine Plus, 2012). The test is performed using multiple electrodes placed on the patient 's chest and attached to a recording monitor for 24-48 hours. Then the doctor evaluates the readings, taking into account the patient 's recorded activities, in order to determine whether any abnormal heart rhythms have been detected.
Holter monitors will soon become an obsolete device. In January 2010, Corventis announced the Food and Drug Administration 's clearance of the NUVANT Mobile Cardiac Telemetry System. This device was designed as a patient-friendly solution for comprehensive detection and analysis of cardiac arrhythmia symptoms such as atrial fibrillation, which is the abnormal and irregular heart rhythm in which electrical signals are generated chaotically throughout the upper chambers of the heart. This device is an unobtrusive, water-resistant, wearable device designed for patient compliance and comfort. Automatic triggers capture ECGs for asymptomatic arrhythmia, while symptomatic patients can activate the device manually to record an ECG. When either an arrhythmia is detected or when a patient manually drives ECG collection, the device automatically transmits the information via a wireless data transmitter device called zLink® to a monitoring center. The device will provide up to thirty days of continuous surveillance of symptomatic and asymptomatic cardiac abnormalities to help physicians diagnose and treat cardiac arrhythmia. For patients who wish to maintain an active lifestyle, the convenience of having no wires on the Nuvant wearable device - thus enabling patient mobility and comfort - as well as the added benefit of automatic data collection and transmission, should minimize interfering with daily activities. For the physicians, the NUVANT MCT System is designed to support increased compliance by patients (without placing restrictions on patient activities) to ensure effective arrhythmic detection, data collection and transmission for physician review, automatic ECG collection for asymptomatic arrhythmias and patient-activated ECG collection to document symptomatic episodes and access to clinical information during the monitoring period to provide awareness of monitoring progress and to enable early intervention, when necessary.
Heart failure, also known as congestive heart failure (CHF), is a medical condition by which the patient 's heart can 't pump enough blood to meet the body 's needs. Over time, conditions such as narrowed arteries in your heart (coronary artery disease) or high blood pressure gradually leave the heart too weak or stiff to fill and pump efficiently (Heart Failure, 2011). For patients who suffer from heart failure or fluid management problems, Corventis provides the AVIVO MPM system. The AVIVO Mobile Patient Management (MPM) System was designed to provide continuous insight into the health status of ambulatory patients, such as those living with heart failure or fluid management problems, so healthcare providers can proactively identify concerning trends and intervene before problems progress (Corventis, 2012). This is a patient-friendly design that offers continuous monitoring to identify signs of heart failure and transmit them to the physician. The AVIVO MPM monitors fluid status, heart rate, heart rate variability, respiration rate, activity and posture. Physicians can also access the clinical information via fax, email or through the Corventis website. While medical monitoring for the various conditions listed above has made it easier for patients to monitor their vital signs and for doctors to evaluate those readings and intervene if necessary, Medical technology is always advancing, thus making these procedures obsolete over time.
While diabetes sufferers simply have apps to record glucose test results, soon diabetes patients will be able to wirelessly connect their iPhone to their glucose tester via Bluetooth. LifeScan received FDA approval in March 2013 for their OneTouch Reveal Diabetes app. This app works with their OneTouch Verio Sync Meter, which connects to the iPhone via Bluetooth. Once connected, it sends blood glucose test results directly to the Apple device, which can then store 2500 results and events or a maximum of one year’s worth of results and events. The app can alert users of high or low blood glucose patterns as well as the following features: time synchronization between the glucometer and Apple device, meal tagging, alerts when patterns are detected in test results, manual entry of carb intake/physical activities/medications/glucose readings and the ability to share results via email or SMS (The North Carolina Translational and Clinical Sciences Institute, 2013).
Patients with cardiac arrhythmia will soon have access to an iPhone app called AliveCor Monitoring App, which takes wireless ECG monitoring a step further. Approved by the FDA in 2013, this Class II medical device snaps onto your iPhone 4 or 4S like a case and wirelessly communicates with the app on your phone. No pairing between your iPhone and the Heart Monitor is required (AliveCor, 2013). On this device are two electrodes onto which the patient either rests his fingertips or alternatively, places onto his chest for 10 seconds. The app uses the input to record and encrypt the ECG and transmit wirelessly to the Cloud. Once the data are there, doctors can view, interpret and act upon the app’s findings from any internet browser.
For patients with Congestive Heart Failure, however, a smartphone app may be further away. Currently in development is an as yet unnamed app that is awaiting FDA approval. This app measures heart rate, heart rhythm, respiration rate and, with the help of an external pulse oximeter, blood oxygen saturation, by scanning the patient’s index finger for about a minute in front of the phone’s video camera. A color bar on the screen turns red if the heartbeat is irregular, indicating possible atrial fibrillation (Versel, 2012). The reason that an app for this medical condition is still on the horizon is because the signs of congestive heart failure are difficult to detect without large and expensive equipment and its symptoms are virtually nonexistent.
The dominant question in the world of wireless medical monitoring, especially in the realm of smartphone apps, is whether advances in smartphone apps for medical monitoring are feasible beyond what has already been achieved.
Have we reached the limits of our ability to monitor these medical conditions, or is the sky really the limit? In truth, the answer to that question is mixed. Speaking strictly regarding whether the technology will exist to accommodate the need for more advanced and less restrictive monitoring methods, there is no reason to assume that such advancements could not be achieved. However, in light of laws and regulations such as HIPAA, the ongoing issues of tort and the potential for lawsuits that these technological advancements could pave the way toward, it is impossible to determine whether or not our legal reach will exceed our technological
grasp.
Before five years ago, monitoring and reporting medical conditions such as diabetes, cardiac arrhythmia and congestive heart failure was limited to wired devices, requiring a doctor’s visit in order to use these machines, and then another visit to the doctor in order to address any anomalous findings. Then came the wireless monitoring machines: the OmniPod System for diabetics, the NUVANT MCT System for patients with cardiac arrhythmia and the AVIVO Mobile Patient Management (MPM) System for patients with congestive heart failure all began allowing patients the freedom to continue to monitor their conditions outside of the doctor’s office and then either having those results transmit wirelessly to the doctor’s office or else having the patients upload the data to the doctor over the world wide web or via an office visit. Now patients can gather data with their smartphones using, if necessary, various attachments for gathering the necessary information, and then emailing the results, without any office visits at all. In the next five years, smartphone apps will render obsolete wired (and some wireless) medical monitoring equipment. The Holter monitor is already experiencing such a status change in favor of more advanced and more efficient methods of monitoring. Patents are already being filed. FDA approvals are being made one by one. The future of wireless medical monitoring is now.
References
New Media Medicine. (2011). Congestive Heart Failure Management App. Retrieved from New Media Medicine: http://newmed.media.mit.edu/health-and-wellness-innovation-2013/congestive-heart-failure-management-app
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2011). National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Retrieved April 1, 2013, from Centers for Disease Control and Prevention: http://www.cdc.gov/diabetes/pubs/factsheet11.htm
Heart Failure. (2011, December 23). Retrieved from Mayo Clinic: http://www.mayoclinic.com/health/heart-failure/DS00061
AliveCor. (2013). AliveCor 's Heart Monitor. Retrieved from AliveCor: http://www.alivecor.com/
American Heart Association. (2009). Heart Disease & Stroke Statistics 2009. American Heart Association.
Boulos, M. N., Wheeler, S., Tavares, C., & Jones, R. (2011). How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX. BioMedical Engineering OnLine, 10-24.
Corventis. (2012). AVIVO® Mobile Patient Management (MPM) System. Retrieved from Corventis: http://www.corventis.com/us/avivo.asp
Dictionary.com. (n.d.). Smartphone. Retrieved from Dictionary.com: http://dictionary.reference.com/browse/smartphone
Joseph Kim, M. M. (2011). Medigus Announces World 's Smallest Video Camera for Medical Endoscopic Procedures. Retrieved from Medicine And Technology.com: http://www.medicineandtechnology.com/2011/05/medigus-announces-worlds-smallest-video.html
Mandal, A. (n.d.). What is Diabetes? Retrieved from News Medical: http://www.news-medical.net/health/What-is-Diabetes.aspx
Mayo Clinic Staff. (2013, February 27). Heart Arrhythmias. Retrieved from Mayo Clinic: http://www.mayoclinic.com/health/heart-arrhythmias/DS00290
Medicine Plus. (2012, June 22). Holter monitor (24h). Retrieved from Medicine Plus: http://www.nlm.nih.gov/medlineplus/ency/article/003877.htm
Mosa, A. S., Yoo, I., & Sheets, L. (2012). A Systematic Review of Healthcare Applications for Smartphones. BMC Medical Informatics and Decision Making, 12-67.
Nes, A. A., van Dulmen, S., Eide, E., Finset, A., Kristijansdottir, O. B., Steen, I. S., et al. (2012). The development and feasibility of a web-based intervention with diaries and situational feedback via smartphone to support self-management in patients with diabetes type 2. Diabetes Research and Clinical Practice, 385-93.
Stross, R. (2011, September 3). Tracking Vital Signs, Without the Wires. Retrieved March 15, 2013, from The New York Times: http://www.nytimes.com/2011/09/04/technology/wireless-medical-monitoring-might-untether-patients.html?_r=0
TED. (2010). Eric Topol: The wireless future of medicine. Retrieved from TED Talks: http://www.ted.com/talks/eric_topol_the_wireless_future_of_medicine.html
The North Carolina Translational and Clinical Sciences Institute. (2013, March 13). Access with Technology Blog. Retrieved from UNC Center for Diabetes Translation Research to Reduce Health Disparities: http://cdtr.unc.edu/index.php/cores/access-with-technology/access-with-technology-blog/89-onetouch-reveal-diabetes-application
Tran, J., Tran, R., & White Jr., J. R. (2012). Smartphone-Based Glucose Monitors and Applications in the Management of Diabetes: An Overview of 10 Salient “Apps” and a Novel Smartphone-Connected Blood Glucose Monitor. Clinical Diabetes, 173-178.
Versel, N. (2012). Smartphone app for AFib detection awaits FDA clearance. Retrieved from MobiHealth News: http://mobihealthnews.com/17638/smartphone-app-for-afib-detection-awaits-fda-clearance/
With the advances in technology over the past 10 years, medical monitoring has advanced from wired monitors, such as with diabetes patients, who must manually input their glucose levels into an insulin pump attached to the belt to the wireless NUVANT Mobile Cardiac Telemetry System for patients with cardiac arrhythmia. This device allows the patient to record his heart rhythms and upload them to a wireless transmitter, which then send the data to the doctor. Other advances in medical monitoring involve the use of a patient’s smartphone to monitor the patient’s medical conditions and transmit directly to the cloud or email the results directly to the doctor for interpretation. This paper discusses the advances made in medical monitoring …show more content…
using smartphone applications (apps) and the future of wireless medical technology.
The Present and Future of Smartphones as Aids in Medical Monitoring
In today’s world, technology is advancing at an accelerating rate. Computers, home entertainment and cellular phone technology are just a few examples of how far technology has advanced over the last few years alone, permeating all walks and facets of life. Medicine is no exception to this rule. Over the last thirty years alone we have witnessed medical technology advance from the invention of the World Wide Web in 1989, to Telesurgery in 2001, to the advent of wireless and patient-managed technology for medical monitoring in the 2010s. New technologies are granting patients with chronic medical problems the ability to gain control of their conditions without compromising their mobility. It has become important to have an automated real-time system for checking important values such as weight, blood pressure, heart rate, daily activity, symptom responses, and so forth.
Home monitoring devices are now available to patients with direct access to patient information to the doctor’s office and its staff. As stated in the journal Biomedical Engineering Online, “medication adherence is a major problem amongst patients with chronic conditions and…that technology can play an important role” (Boulos, Wheeler, Tavares, & Jones, 2011). At the forefront of this patient-managed technology is the smartphone. A smartphone is a device that combines a cellular phone with a handheld computer, typically offering Internet access, data storage, e-mail capability, etc.(Dictionary.com). With the rapid developments in wireless technology, medicine has now become one of the leading industries to utilize these new developments. Eric Topol, a leading cardiologist who has embraced the study of genomic and the latest advances in technology to treat chronic disease, has stated, “We 'll soon use our smartphone to monitor our vital signs and chronic conditions” (TED, 2010). Among the features that smartphones possess is the ability to run third-party applications, better known as apps.
Smartphones have changed the world of medicine with apps for fitness, nutrition, health and wellness. Patients with congestive heart failure, diabetes, high blood pressure and other conditions now have smartphone apps designed to monitor their vital signs in order to better keep those medical conditions under control. Patients with diabetes can find apps for carbohydrate counting. There are ringtone reminders for when it 's time to check glucose levels. Patients with congestive heart failure (CHF) now have available to them a system which is programmed to collect patient data in order to track their weight (weight changes quickly with fluid load), blood oxygenation, medication adherence, and activities of daily living ( New Media Medicine, 2011), and transmit it to a website where it is reviewed by a physician. The system also can transmit data from a scale and blood pressure cuff.
Smartphone technology was designed not just for patients: doctors are now able to use their smartphones for diagnoses, reference and for keeping electronic medical records. An app called Medscape is an example of how this technology is assisting doctors in diagnosing and treating illnesses. Medscape offers such functionalities as drug reference, diagnostic reference and medical news. For cardiologists whose patients suffer from cardiac arrhythmia they now have access to patients’ ECG (electrocardiogram) readings from anywhere via their smartphone app. Applications allowing physicians to zoom in and out will allow doctors the ability to view near-real-time ECG data and the ability to review previous ECGs so that physicians can make accurate diagnoses. Diabetes is a condition where the body fails to utilize the ingested glucose properly.
This could be due to lack of the hormone insulin, or because the insulin that is available is not working effectively (Mandal). According to the 2011 Data National Fact Sheet 8.3% people in the United States have diabetes. Patients who suffer from IDDM (insulin dependent diabetes mellitus) suffer from their pancreas not creating enough insulin or their body ignoring the insulin altogether. Uncontrolled diabetes can result in amputation, blindness, heart disease and stroke, kidney failure and high blood pressure. More diabetics have found that using an insulin therapy pump is much easier than having to carry around insulin that has to be measured for the appropriate dosage amount and oftentimes kept refrigerated. People with diabetes must check their glucose levels up to 4 times a day or more often if they are experiencing high sugar levels by using a glucose monitor. Using the glucose monitor, patients will lance their fingers and take a small sample of their blood and place it onto a test strip that will be inserted into the monitor; within seconds patients will have their glucose levels reported back. Currently, patients must manually enter the glucose levels into an insulin pump where the appropriate amount of insulin will be dispensed into the body via a needle that is inserted into the body subcutaneously, and the insulin will travel through tubing connected from the insulin pump …show more content…
to the body. The most common complaint of patients who are using insulin pump therapy is that the tubing often becomes tangled. To make this process simpler, wireless technology has evolved and the OmniPod System provides patients with the first ever tubing free insulin pump system. Patients will simply apply the pod anywhere on their body they can inject themselves. The PDM (Personal Diabetes Manager) will wirelessly program a patient 's personalized insulin delivery, suggested doses, and also has a built in blood glucose meter. The device will dispense a small amount of insulin on a continuous basis day and night to cover a patient’s baseline insulin. Additional insulin is dispensed in order to cover meals and snacks or to help bring down high blood glucose levels. Using devices such as the OmniPod System for IDDM will be beneficial to patients to help prevent complications due to diabetes. As stated in the Diabetes Research and Clinical Practice, self-management is an important and evidence-based component of treatment and care for patients with Type 2 diabetes and there is an increasing demand for interventions to support and enhance self-management. With over 85% of Americans whose mobile phones have internet access, managing diabetes has become much more effective. The goal of using smartphone applications is to effectively manage diabetes by improving glycemic control, and ultimately preventing or delaying further complications of diabetes. (Tran 2012) There are several applications available to individuals with diabetes. Selecting the right app is based on personal preference and what the patient 's short- and long-term goals are. Apple iTunes offers apps such as iDiabetes, a blood glucose tracker, and Trac3-Diabetes, a dietary planner and carbohydrate counter. Many of these applications also allow a patient 's physician direct access to their test results. If any adjustments have to be made in the insulin dosage, or if a patient 's glucose levels are reading too high or too low, doctors and their staff will have immediate access to this information and the appropriate medical attention can take place to prevent further complications, hospitalization or even death.
Heart arrhythmias occur when the electrical impulses in your heart that coordinate your heartbeats don 't work properly, causing your heart to beat too fast, too slow or irregularly (Mayo Clinic Staff, 2013). In a normal heart, the electric signal that governs the rate and rhythm of the heartbeat follows a precise path through the heart. An arrhythmia can occur when those electric signals become interrupted in any way. While some occurrences of cardiac arrhythmia can be symptom-free, others can be fatal if not closely monitored.
Today the predominant method of monitoring an arrhythmic patient 's heartbeat is via a Holter monitor. A Holter monitor is a machine that continuously records the heart 's rhythms. The monitor is usually worn for 24 - 48 hours during normal activity (Medicine Plus, 2012). The test is performed using multiple electrodes placed on the patient 's chest and attached to a recording monitor for 24-48 hours. Then the doctor evaluates the readings, taking into account the patient 's recorded activities, in order to determine whether any abnormal heart rhythms have been detected.
Holter monitors will soon become an obsolete device. In January 2010, Corventis announced the Food and Drug Administration 's clearance of the NUVANT Mobile Cardiac Telemetry System. This device was designed as a patient-friendly solution for comprehensive detection and analysis of cardiac arrhythmia symptoms such as atrial fibrillation, which is the abnormal and irregular heart rhythm in which electrical signals are generated chaotically throughout the upper chambers of the heart. This device is an unobtrusive, water-resistant, wearable device designed for patient compliance and comfort. Automatic triggers capture ECGs for asymptomatic arrhythmia, while symptomatic patients can activate the device manually to record an ECG. When either an arrhythmia is detected or when a patient manually drives ECG collection, the device automatically transmits the information via a wireless data transmitter device called zLink® to a monitoring center. The device will provide up to thirty days of continuous surveillance of symptomatic and asymptomatic cardiac abnormalities to help physicians diagnose and treat cardiac arrhythmia. For patients who wish to maintain an active lifestyle, the convenience of having no wires on the Nuvant wearable device - thus enabling patient mobility and comfort - as well as the added benefit of automatic data collection and transmission, should minimize interfering with daily activities. For the physicians, the NUVANT MCT System is designed to support increased compliance by patients (without placing restrictions on patient activities) to ensure effective arrhythmic detection, data collection and transmission for physician review, automatic ECG collection for asymptomatic arrhythmias and patient-activated ECG collection to document symptomatic episodes and access to clinical information during the monitoring period to provide awareness of monitoring progress and to enable early intervention, when necessary.
Heart failure, also known as congestive heart failure (CHF), is a medical condition by which the patient 's heart can 't pump enough blood to meet the body 's needs. Over time, conditions such as narrowed arteries in your heart (coronary artery disease) or high blood pressure gradually leave the heart too weak or stiff to fill and pump efficiently (Heart Failure, 2011). For patients who suffer from heart failure or fluid management problems, Corventis provides the AVIVO MPM system. The AVIVO Mobile Patient Management (MPM) System was designed to provide continuous insight into the health status of ambulatory patients, such as those living with heart failure or fluid management problems, so healthcare providers can proactively identify concerning trends and intervene before problems progress (Corventis, 2012). This is a patient-friendly design that offers continuous monitoring to identify signs of heart failure and transmit them to the physician. The AVIVO MPM monitors fluid status, heart rate, heart rate variability, respiration rate, activity and posture. Physicians can also access the clinical information via fax, email or through the Corventis website. While medical monitoring for the various conditions listed above has made it easier for patients to monitor their vital signs and for doctors to evaluate those readings and intervene if necessary, Medical technology is always advancing, thus making these procedures obsolete over time.
While diabetes sufferers simply have apps to record glucose test results, soon diabetes patients will be able to wirelessly connect their iPhone to their glucose tester via Bluetooth. LifeScan received FDA approval in March 2013 for their OneTouch Reveal Diabetes app. This app works with their OneTouch Verio Sync Meter, which connects to the iPhone via Bluetooth. Once connected, it sends blood glucose test results directly to the Apple device, which can then store 2500 results and events or a maximum of one year’s worth of results and events. The app can alert users of high or low blood glucose patterns as well as the following features: time synchronization between the glucometer and Apple device, meal tagging, alerts when patterns are detected in test results, manual entry of carb intake/physical activities/medications/glucose readings and the ability to share results via email or SMS (The North Carolina Translational and Clinical Sciences Institute, 2013).
Patients with cardiac arrhythmia will soon have access to an iPhone app called AliveCor Monitoring App, which takes wireless ECG monitoring a step further. Approved by the FDA in 2013, this Class II medical device snaps onto your iPhone 4 or 4S like a case and wirelessly communicates with the app on your phone. No pairing between your iPhone and the Heart Monitor is required (AliveCor, 2013). On this device are two electrodes onto which the patient either rests his fingertips or alternatively, places onto his chest for 10 seconds. The app uses the input to record and encrypt the ECG and transmit wirelessly to the Cloud. Once the data are there, doctors can view, interpret and act upon the app’s findings from any internet browser.
For patients with Congestive Heart Failure, however, a smartphone app may be further away. Currently in development is an as yet unnamed app that is awaiting FDA approval. This app measures heart rate, heart rhythm, respiration rate and, with the help of an external pulse oximeter, blood oxygen saturation, by scanning the patient’s index finger for about a minute in front of the phone’s video camera. A color bar on the screen turns red if the heartbeat is irregular, indicating possible atrial fibrillation (Versel, 2012). The reason that an app for this medical condition is still on the horizon is because the signs of congestive heart failure are difficult to detect without large and expensive equipment and its symptoms are virtually nonexistent.
The dominant question in the world of wireless medical monitoring, especially in the realm of smartphone apps, is whether advances in smartphone apps for medical monitoring are feasible beyond what has already been achieved.
Have we reached the limits of our ability to monitor these medical conditions, or is the sky really the limit? In truth, the answer to that question is mixed. Speaking strictly regarding whether the technology will exist to accommodate the need for more advanced and less restrictive monitoring methods, there is no reason to assume that such advancements could not be achieved. However, in light of laws and regulations such as HIPAA, the ongoing issues of tort and the potential for lawsuits that these technological advancements could pave the way toward, it is impossible to determine whether or not our legal reach will exceed our technological
grasp.
Before five years ago, monitoring and reporting medical conditions such as diabetes, cardiac arrhythmia and congestive heart failure was limited to wired devices, requiring a doctor’s visit in order to use these machines, and then another visit to the doctor in order to address any anomalous findings. Then came the wireless monitoring machines: the OmniPod System for diabetics, the NUVANT MCT System for patients with cardiac arrhythmia and the AVIVO Mobile Patient Management (MPM) System for patients with congestive heart failure all began allowing patients the freedom to continue to monitor their conditions outside of the doctor’s office and then either having those results transmit wirelessly to the doctor’s office or else having the patients upload the data to the doctor over the world wide web or via an office visit. Now patients can gather data with their smartphones using, if necessary, various attachments for gathering the necessary information, and then emailing the results, without any office visits at all. In the next five years, smartphone apps will render obsolete wired (and some wireless) medical monitoring equipment. The Holter monitor is already experiencing such a status change in favor of more advanced and more efficient methods of monitoring. Patents are already being filed. FDA approvals are being made one by one. The future of wireless medical monitoring is now.
References
New Media Medicine. (2011). Congestive Heart Failure Management App. Retrieved from New Media Medicine: http://newmed.media.mit.edu/health-and-wellness-innovation-2013/congestive-heart-failure-management-app
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2011). National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Retrieved April 1, 2013, from Centers for Disease Control and Prevention: http://www.cdc.gov/diabetes/pubs/factsheet11.htm
Heart Failure. (2011, December 23). Retrieved from Mayo Clinic: http://www.mayoclinic.com/health/heart-failure/DS00061
AliveCor. (2013). AliveCor 's Heart Monitor. Retrieved from AliveCor: http://www.alivecor.com/
American Heart Association. (2009). Heart Disease & Stroke Statistics 2009. American Heart Association.
Boulos, M. N., Wheeler, S., Tavares, C., & Jones, R. (2011). How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX. BioMedical Engineering OnLine, 10-24.
Corventis. (2012). AVIVO® Mobile Patient Management (MPM) System. Retrieved from Corventis: http://www.corventis.com/us/avivo.asp
Dictionary.com. (n.d.). Smartphone. Retrieved from Dictionary.com: http://dictionary.reference.com/browse/smartphone
Joseph Kim, M. M. (2011). Medigus Announces World 's Smallest Video Camera for Medical Endoscopic Procedures. Retrieved from Medicine And Technology.com: http://www.medicineandtechnology.com/2011/05/medigus-announces-worlds-smallest-video.html
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