Care by Remote Control

IN AN AGE OF EVER-EVOLVING TECHNOLOGY, advances are being made in every industry to facilitate services and improve efficiency. While healthcare has been slower than other sectors to wholly embrace the electronic era, the realization of the power of technology has begun to catch on in hospitals, healthcare facilities and physicians’ offices.

In fact, a recent survey of 1,500 nationwide hospitals, conducted by the American Hospital Association (AHA), found that nearly half of all responding hospitals reported moderate or high use of health information technology in 2006, up from 37 percent in 2005. One modern information trend that has begun to change the face of healthcare: telemedicine.

Telemedicine, defined as any use of electronic communication to practice healthcare from a distance, takes various shapes, from urban physicians providing medical services to patients in remote rural locations to the electronic transmission of patient records or X-rays. Fifty-eight percent of hospitals in the AHA survey reported some use of telemedicine in their practice.

Perhaps the most patient-friendly form of telemedicine is remote patient-monitoring, which allows clinicians to keep track of patients’ serious medical conditions even when miles apart. A 2006 study by Menlo Park–based Spyglass Consulting Group, which specializes in wireless technology in healthcare, determined that 65 percent of hospitals were investing in remote monitoring for patients with chronic diseases, including heart disease and diabetes. The benefits, according to the survey, include reduced healthcare delivery costs, improved patient outcomes and increased access to care for those living in remote areas.

In recent years, San Diego hospitals have jumped on the telemedicine bandwagon in their use of remote monitoring for patients suffering heart failure. Steven Higgins, M.D., chief of cardioelectrophysiology at Scripps Memorial Hospital in La Jolla, and director of the facility’s regional cardiac arrhythmia center, highlights the use of remote monitoring for those with implanted devices.

“It’s an exciting, new, high-tech way of allowing patients to be monitored more safely from the comfort of their homes,” he says.

Higgins, who uses Guidant’s Latitude Patient Management System on heart-disease patients with implanted defibrillators, explains that the wireless system allows physicians to know in a timely manner if a patient’s device isn’t working properly.

“Prior to this, we saw people in the office every three months and would learn about a problem only at that time,” he says. “Clearly, knowing about any problems sooner rather than later is better.”

The monitoring system sits on a patient’s nightstand and plugs into a telephone jack and power outlet. It automatically collects information from the implanted device and transmits it through the phone line to a doctor’s secure Web site. A physician, nurse practitioner or staff nurse in the physician’s office can be alerted of a low battery or a cracked lead in the device, as well as other potential problems, which can be monitored in more serious cases by an accompanying blood-pressure cuff and weight scale.

“Although it sounds fairly simple, one of the best measures of heart failure on a daily basis is a weight scale, which really looks at fluid balances and weight changes,” Higgins explains. “If you can intervene earlier with something like taking more water pills, you may be able to prevent a hospitalization. In the past we had to rely on patients weighing themselves at home and then calling in—there’s potential to forget. With this system, it’s automated, and it will send the weight and blood pressure directly to the office.”

Perhaps the biggest benefit remote monitoring provides is the increased sense of security and confidence for the patient that his or her condition is being kept under control.

“It’s hard for those of us who don’t have an implanted device to know how it feels,” Higgins says. “It’s reassuring for them to know their device is being checked on a daily basis and to know they can get feedback from a monitor right at their bedside.”

ULRIKA BIRGERSDOTTER-GREEN, M.D., director of the Pacemaker/ICD Clinic at UCSD Medical Center, says the need for remote patient-monitoring has grown in the past decade thanks to the increased use of implantable devices like ICDs (implantable cardioverter defibrillators).

“More than 400,000 pacemakers and ICDs were implanted in the United States in 2005, doubling the number of devices in 10 years,” she says. “We not only put devices in, but we need to follow the patients with the devices. Having the remote monitoring is phenomenally helpful for both physicians and patients.”

Birgersdotter-Green adds there are more than 100,000 patients and 1,000 clinics nationwide using remote monitoring, and says UCSD was among the first facilities in San Diego to embrace the technology. Using the CareLink Network, manufactured by healthcare technology giant Medtronic, heart-failure patients transfer their data electronically, even as they sleep.

“It’s very straightforward and doesn’t require great technology skills at all, so the patients love it,” Birgersdotter-Green says. “The overwhelming majority of patients really took to the technology right away. There are always a few who are concerned— the ‘Am I going to be able to do it? I don’t even know how to use a remote control’ kind of thing—but then they come back saying they can’t believe they were intimidated.”

Birgersdotter-Green is quick to point out that while remote monitoring is a great security net for patients and health care practitioners, it is in no way a substitute for in-person patient care. “The remote monitoring is not meant to replace the primary care physician or the patient’s general cardiologist,” she says. “It is strictly meant to replace clinic visits for device interrogation.”

Still, Birgersdotter-Green predicts remote patient-monitoring is a necessary way of the future and will only continue to improve in decades to come.

“We’re going to continue to put more devices in our patients and will need to provide our patients with the best available care. This will be part of that care,” she says. “It has been predicted we will have 20 to 30 million people with heart failure by the year 2025. We need better methods to manage our heartfailure population, and this will be a crucial component.”

REAL-TIME DIABETES MANAGEMENT

HEART-FAILURE PATIENTS are not the only ones benefiting from remote-monitoring technology. Thanks to devices like Medtronic’s Continuous Glucose Monitoring System, approved by the Food & Drug Administration in April 2006, patients with diabetes can measure their blood sugar every 10 seconds over a 72-hour period. An inserted sensor links to a monitor worn like a pager on a patient’s waistband. The sensor records an average glucose level every five minutes, while patients record the averages, their meals, exercise, medication and other instructed information. Software allows this information to be graphed to show trends and provide clinicians with indications for appropriate therapy. Healthcare professionals can download the information from the monitor to view the patient’s status.

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