Better technology for better healthcare

Apple has just released a compelling video profile that examines the impact of mobile technology on patient care at Hospital Corporation of America (HCA), the world’s largest private healthcare organization.

You can click here to watch the video and read the profile. You may also click here to download the video from iTunes.

The video and accompanying profile point to specific platforms and applications that help physicians deliver better, faster treatment to millions of patients. From the profile:

Specialized obstetric and cardiac applications help deliver healthy babies, initiate immediate treatment for cardiac emergencies, and explain procedures to patients, while other healthcare apps enable doctors to manage and review patient data as they make their rounds.

“It’s amazing to look back at how technology has changed, and how it has changed medicine in the process,” says Dr. José Soler, a cardiologist at Northwest Medical Center in Margate, Florida. “Once you start using this technology, it becomes indispensable. Mobile medicine is here.”

I have used this blog to present information and evidence that show how the targeted use of mobility solutions can confront the challenges faced by the healthcare industry, which is undergoing a historic shift in the patient care model. In future posts I will continue to present real-life examples of mobility’s impact.

The bottom line: lives can be saved when clinicians have anywhere/anytime access to information presented in a visually compelling manner that supports faster, more informed and better coordinated decision-making.

For now, the new Apple case study is a thoughtful look at how a healthy dose of mobility can give providers a strategic patient care advantage.

It's All in What You SEE That Matters!

Imagine that you are a cardiologist on call. You are at home, just winding down at 11:45 PM when you receive a call from a nurse on the telemetry unit, who reports that a patient who is three days post coronary artery bypass surgery has developed new onset atrial fibrillation. This is particularly concerning because the patient is reportedly on sotalol prophylaxis.

What is going through your mind? Can you trust this person’s interpretive clinical judgment? Is there additional information that would be helpful if only you had immediate access? Perhaps the current lab values, such as magnesium level? As you consider the differential diagnoses you are probably worried that this could be a sign of clinical deterioration. Myocardial infarction? Heart failure? Bleeding?

The nurse asks, “What should I do”? You are trying to determine the best course of action for this patient given their clinical situation – and while trusting the nurses’ assessment, or waiting until rounds the next morning, or heading back to the hospital are all options – none of these are ideal.

With AirStrip – PATIENT MONITORING, you have mobile, anytime, anywhere access to vital clinical data – including waveforms in real time  – that will allow you to SEE important information, presented in a meaningful way for clinicians. In seconds you identify that, in fact, this is not atrial fibrillation – it is simply a rhythm with irregular R-R intervals - the patient is having flutter with variable atrioventricular conduction. It’s understandable that this could be viewed as atrial fibrillation by someone with less clinical experience.

This is just one of hundreds of clinical scenarios that happen thousands of times in hospitals across the globe every day. It’s all in what you SEE that matters. With a few taps of a button on your smart phone, you have overcome obstacles to data access and data sharing, you’ve improved communication among the members of the treatment team, and you facilitated more accurate, timely, and targeted treatment for this patient. And you’ll sleep better tonight. Great things can happen with mobility.

Remembering Steve Jobs

On behalf of the entire AirStrip Technologies team, our prayers and thoughts go out to Steve Jobs’ family, and the people at Apple who work their hardest to make Jobs’ innovative vision a reality.

The impact that Jobs and Apple have had on healthcare is extraordinary. Steve Jobs will be missed – but his presence will continue to be felt long after his passing.

Obviously, AirStrip Technologies owes a debt of gratitude to Jobs, his vision, and his groundbreaking mobile products. To say that Jobs has changed the face of patient care forever is an understatement. He has enabled a revolution that is really just beginning.

The future of healthcare holds extraordinary promise. Steve Jobs is among those who paved the way - putting a world of possibilities in the palm of our hand.

The Doctor's Tech Toolbox

This is a fascinating peek at just how quickly physicians are embracing the tools and functions of mobile healthcare. Of particular note: monitoring patients in hospitals is among the top three uses physicians have for mobile-based technology. (Credit to spinabifidainfo.com for presenting this infographic.)

FDA Mobile Health Application Regulations

Right now there are an estimated 17,000 medical apps in use. By 2015, the FDA expects that 500 million smartphone users around the world will be using some kind of healthcare app.

Those are staggering numbers. It is understandable that the FDA sees the need to assert a degree of regulatory guidance over what the agency calls ‘mobile medical applications,’ and has proposed a set of guidelines to do just that.

Our first solution, AirStrip OB, was cleared by the FDA back in late 2005 and first marketed in 2006. It was also the first FDA-cleared app to be made available in the App Store. In reviewing the proposed guidelines, it appears AirStrip’s compliance activities have blazed a trail for other mobile apps to follow.

We knew from the start that we wanted to work closely with the FDA to ensure a high level of quality compliance, due to the innovative intended use of AirStrip Technologies applications. AirStrip gladly chose to do this at the time and will continue to do so. 

The proposed FDA guidelines mirror the compliance efforts AirStrip Technologies has engaged in since its inception. AirStrip has benefited greatly from committing to rigorous quality compliance. An excellent safety record and growing market share tell the industry that AirStrip’s leadership in this regard is hard-earned and well-deserved.

While all AirStrip applications - including CARDIOLOGY and PATIENT MONITORING - are FDA cleared, many other apps in the marketplace are not.

The FDA is indicating that medical apps that do not adhere to agency standards will fall under increased scrutiny for non-compliance. Those app creators will now be expected to offer a level of documentation that they are likely not used to providing, and this will surely alter the mobile medical app landscape. At the same time, true innovation that shows a commitment to quality compliance in the interests of patient safety should have ample room to flourish.

The FDA is now seeking comments online or in writing. The public comment period ends October 19, 2011. You can find more information about the FDA action here.

Early Findings Following AirStrip Cardiology Deployment at Three Hospital Systems

We know that communication technologies that transmit ECGs directly to a smart phone or mobile device allow rapid viewing of ECGs by experts and can be used to overcome logistical and geographic barriers to care. This approach has been proven to reduce E2B times, reduce mortality, reduce morbidity, reduce cardiac damage following STEMI, and improve clinical outcomes. [1] [2]

We hypothesized that by improving logistics, visual clarity, touch screen manipulation, and more data for analysis, providers may be able to more quickly and accurately interpret ECG findings. We delivered this with AirStrip Cardiology™ and we added simultaneous and comparative access to historical ECGs from hospital ECG management systems and from EMS in the field. We demonstrated this technology in previous blog entries. [3]

Over the past several months, we have successfully deployed this technology at a number of hospitals. At least 50 clinicians, most of them cardiologists, are presently using AirStrip Cardiology in a dozen facilities at three major health systems across the country – and that number is expected to quadruple by mid-July 2011.

The preliminary results show a great deal of promise. Physicians currently using AirStrip Cardiology have already reported that the clear, concise resolution and touch-enabled analytics significantly improved their ability to diagnose specific conditions, fostered more timely decisions, supported more rapid intervention, and afforded them an experience of freedom and workflow efficiency. This feedback is consistent across all users. We will publish our physician surveys in whitepapers and highlight them in future blogs.

We are learning that great things can happen with mobile, digital, enhanced ECG. For example, AirStrip Cardiology hospital clients have reported improved STEMI patient care, including reduced time to intervention and reduced false activation of the cath lab. Preliminary findings by hospitals include:

• A median time of 9 minutes from ECG acquisition to view time by a cardiologist, with a resultant 7 - 15 minute reduction in time to intervention.
• A reduced length of stay of 0.85 days per STEMI case, attributed to earlier intervention. Each STEMI day saved is estimated at $2,500.
• A 4% -5% reduction in false activation of the cardiac cath lab. The savings per false activation prevented is estimated at $7,500.

How? Physicians and program directors are attributing these benefits to the following features:

• Immediate, anytime, anywhere access to ECGs, creating the “un-tethered” cardiologist
• Twentyfold improvement in visual display over paper tracings and pdfs;
• Automated interval & axis deviation measurement and more digital data; 
• Elongated strips, making pattern variability more apparent;
• Access to historical tracings, allowing serial presentation and comparison

We will continue to share lessons learned from the deployment of this mobility solution. We are offering a complimentary webinar series detailing customer results from the use of this technology. We’ll post a link to the registration page in our next blog.

References
[1]  Sanchez-Ross M, Oghlakian G, Maher J, Patel B, Mazza V, Hom D, Dhruva V, Langley D, Palmaro J, Ahmed S, Kaluski E, Klapholz M. The STAT-MI (ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction) trial improves outcomes. JACC Cardiovasc Interv. 2011 Feb;4(2):222-7. Patients had significantly shorter D2B times (63 minutes versus 119); lower peak troponin I (39.5 ng/ml vs. 87.6); creatine phosphokinase-MB (126.1  ng/ml vs. 290.3); higher left ventricular ejection fractions (50% vs. 35%); and shorter LOS (3  days vs. 5.5 days).

[2]  Khot UN, Johnson ML, Ramsey C, Khot MB, Todd R, Shaikh SR, Berg WJ. Emergency department physician activation of the catheterization laboratory and immediate transfer to an immediately available catheterization laboratory reduce door-to-balloon time in ST-elevation myocardial infarction. Circulation. 2007 Jul 3;116(1):67-76. Epub 2007 Jun 11.

[3]  http://airstriptech.blogspot.com/2011/04/youll-never-look-at-ecg-same-way-again.html

You’ll Never Look at an ECG the Same Way Again

AirStrip Technologies recently launched a global partnership with GE Healthcare to digitize and mobilize ECGs. At AirStrip Technologies, we feel very strongly about providing meaningful mobility for cardiology care in the form of mobile, enhanced, digital ECGs, which we believe will improve and expedite critical decision making capacity for Cardiologists. I have recorded a short demonstration of the new technology and I am positive that you will never look at an ECG the same way again.

Why? There are 16.8 million people with coronary heart disease, and 14.4 million people with cardiac dysrhythmias in the U.S. More than 10 million people suffer from cardiac-related chest pain [1] and this year, 6 million patients with chest pain will arrive at hospital emergency departments across the nation. 38% of 1.45 million actual heart attack victims will die; [2] more than 225,000 will die within one hour of the onset of symptoms and before ever reaching a hospital. [3]

No matter what the location or level of care, the 2010 International Liaison Committee on Resuscitation (ILCOR) ACS-MI Task Force confirms what we all know - ECGs are essential [4] to the diagnosis and treatment process of Acute Coronary Syndrome (ACS).

Time is of the essence in achieving the desired clinical outcomes and performance measures for these patients. The literature clearly shows that reducing time to intervention reduces morbidity, mortality, and sequelae. Hence, getting an experienced cardiologist involved early is critical in the diagnosis and management of abnormal ECG findings. [5]

Digital technology advancements now support unprecedented visual clarity, touch screen manipulation, enhanced analytics, and the ubiquitous delivery of this vital intelligence - current and historical ECGs - to a provider’s mobile device.

AirStrip Technologies and GE Healthcare recognized the potential of mobile, enhanced ECG delivery, and responded in kind with an FDA-cleared product designed specifically to make a difference. Now that's Meaningful Mobility for Healthcare℠.

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[1] Heart Disease and Stroke Statistics — 2009 Update, American Heart Association

[2] American Heart Association Statistics. http://www.americanheart.org/presenter.jhtml?identifier=3061132

[3] Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart Disease and Stroke Statistics—2010 Update. A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2010;121:e1-e170.

[4] Hazinski MF, Nolan JP, Billi JE, Böttiger BW, Bossaert L, de Caen AR, Deakin CD, Drajer S, Eigel B, Hickey RW, Jacobs I, Kleinman ME, Kloeck W, Koster RW, Lim SH, Mancini ME, Montgomery WH, Morley PT, Morrison LJ, Nadkarni VM, O’Connor RE, Okada K, Perlman JM, Sayre MR, Shuster M, Soar J, Sunde K, Travers AH, Wyllie J, Zideman D. Part 1:executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010;122(suppl 2):S250 –S275.

[5] Massel, D. Observer Variability in ECG Interpretation for Thrombolysis Eligibility: Experience and Context Matter. Journal of Thrombosis and Thrombolysis 15(3), 131–140, 2003.