The Evolving Role of Primary Care and Technology in Cardiology

Transcription

1 The Evolving Role of Primary Care and Technology in Cardiology Peter Tilkemeier, MD, MMM, FACC Chair, Department of Medicine Greenville Health System Professor, University of South Carolina School of Medicine Greenville Professor, Clemson University School of Health Research

2 Disclosures None

3 Current State How many of you receive information from patients through mobile health applications and devices today? How many receive this data through MyChart? Fitbit, Withings/Nokia How many use this to change therapy without an office visit?

4 New Innovations in Healthcare Bhavnani et al, JACC, 70:21, , 2017

5 Digital Health Innovations

6 mhealth Facts 325,000 Health Apps available today 78,000 added in the last year 84,000 health app developers/publishers 3.6 billion apps downloaded in 2017 Health Insurers are the #1 future distribution channel Research2Guidance 2017, mhealth Economics 2017;

7 Health Apps Downloaded Research2Guidance 2017, mhealth Economics 2017;

8 Digital Intruders in the Health Market Research2Guidance 2017, mhealth Economics 2017;

9 mhealth by Healthcare Sector Research2Guidance 2017, mhealth Economics 2017;

10 mhealth App Downloads The majority of mhealth apps are downloaded less than 5,000 times Research2Guidance 2017, mhealth Economics 2017;

11 Future Growth of mhealth Apps Research2Guidance 2017, mhealth Economics 2017;

12 mhealth App Distribution Channels Distribution channels with best market potential in next 5 years Research2Guidance 2017, mhealth Economics 2017;

13 Clinical Examples

14 Asymptomatic Atrial Fib Approximately 40% of patients with AF are completely asymptomatic Those who do experience symptoms are aware of only 5% to 20% of episodes. One quarter of all AF does not become symptomatic except by causing a stroke.

15 Arrhythmia Detection KardiaBand Apple watch compatible Single channel ECG Cardiio Use of cell phone camera to determine rhythm In development MIT

16 Kardia Single Channel ECG

17 Wearable Arrhythmia Detection

18 Ambulatory Blood Pressure

19 Blood Pressure Watch Measures physical activity and sleep Syncs with the Omron app to track and share vital data about your blood pressure Lasts one week on a charge In development. Final specs and pricing will be released once FDA Clearance is received.

20 Cuffless BP Monitor

21 Validation of Cuffless BP

22 Ambulatory BP Report

23 Wrist cuff based BP Bluetooth-connected blood pressure monitor Worn on the wrist and sends data to a smartphone for archiving or analysis FDA approved for direct to consumer sales

24 Duo ECG and stethoscope Smart heart monitor that is a combination of a digital stethoscope and portable electrocardiogram. Duo is intended as a prescription-only screening tool as part of an at-home monitoring plan It works with a companion app for remote monitoring or diagnosis. The idea is to keep continuous tabs on patients at risk for heart failure rather than relying on in-office visits that are inadequate in monitoring such complex medical conditions. FDA clearance for Duo

25 Direct to Consumer Marketing

26 Noteworth mhealth in a box Customizable based on patient need and diagnosis Uploads information to cloud MD review at their convenience

27 Innovation in the New World

28 Future Needs The role of the physician as a consumer of data Automated interpretation of data streams (AI) Engaged patients with self-management protocols Care teams led by providers manage exceptions based on complexity Only complex exceptions require physician involvement Office visits become tertiary care Hospital visits are failures of the health care system Terwiesch et al, Annals of Internal Medicine, 167:11, , 2017.

29 What does this mean for you? Understand what is available to our patients to monitor their own cardiovascular health. There are a myriad of options available to our patients You and I will probably not be able to control this Insurers Care managers EMR integration

30 Follow-up question mhealth will allow patients and the care team great access to self-management tools. Which of the following describes what will be required to make this successful: 1. Limiting application development to decrease variability 2. Validating applications, engaging patients, developing clinical pathways to manage exceptions 3. Workflows directing all patient based data to the provider 4. Use of large randomized control studies to develop clinical guidelines

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