Features

Chronic conditions and long term illnesses account for a large percentage of patient visits to emergency rooms, hospital visits, rehospitalizations, and subsequent death in hospitals. In the United States alone, 28.1 percent of Medicare beneficiaries classified as chronically ill died in hospitals in 2007.* Several chronic conditions such as congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disorder, and pain, among others, can be controlled and prevented with practical technology innovation using biomedical sensing instrumentation and mobile technology that can assist in many ways.† Coupled with patient participation, avoidable patient hospital visits and patient outcomes can be improved.

Heart failure is an epidemic in the U.S., with 5.7 million Americans affected with congestive heart failure in 1991. Of this group, 670,000 new cases of CHF were being diagnosed per year, with a morbidity rate estimated at 870,000 hospitalizations and 200,000 patient deaths per year. CHF costs today account for 10% of all hospital admissions with an annual U.S. cost exceeding $50 billion. #### A Remote Monitoring Solution Aventyn (Carlsbad, CA) and Plessey Semiconductors (Plymouth, UK) have joined hands to integrate Plessey's Electric Potential Integrated Circuit (EPIC) sensor in a mobile platform to capture non-intrusive ECG measurements personalized to individual heart failure patients. The measured ECG data is displayed on the patient's smartphone device and integrated with Aventyn's Vitalbeat™, a software application designed for remote monitoring and chronic disease management of patients diagnosed with heart failure and related co-morbidities. Vitalbeat is an easy-to-use integrated chronic disease management system for at-risk congestive heart failure patients. The patient solution is a mobile application tailored to supporting a goal-oriented diet and medication adherence/ compliance to maintain the patient’s health. With Vitalbeat, clinicians are able to remotely monitor patients using smartphones and tablet computers, and design long-term disease management programs for improved care quality at lower cost. Patients, doctors, and healthcare providers securely record, share, and manage heart data to keep the patient healthy. Users can manage diet and medication compliance by configuring alerts and reminders based on thresholds, goals, and clinical requirements. Access to social networking sites like Twitter and Facebook provide group sharing and networking with likeminded friends and groups. Plessey Semiconductors' EPIC sensors are optimized for use as an ECG sensor and provide a resolution as good as or better than conventional electrodes. The EPIC sensors offer several advantages that save money and speed up the process of taking readings. First, the EPIC sensors are dry contact so that no gels or similar fluids are required to make contact. Second, the sensors can be simply cleaned between uses unlike conventional ECG sensors that have to be disposed of after every use at a cost of$2 a set. Third, only one pair of sensors is required; they are held in each hand, which is more convenient than the current approach, which requires seven or more leads to be carefully applied to specific locations on the body while the patient is lying down.

The EPIC sensor is integrated with Vitalbeat in a mobile ECG platform to create a personalized patient monitoring solution that, for example, monitors heart failure patients for HRV (Heart Rate Variability). This personalized patient software solution is being tested for remotely monitoring heart failure patients and securely sharing patient vital sign information in the form or ECG, heart rate, activity levels, and skin temperature with monitoring clinicians to care for patients to be recruited in a heart failure patient monitoring study. The software has been developed to provide easy navigation and use, with provision for standard data capture of parameters used in heart failure monitoring. The patient-entered data and ECG measurements captured from a wirelessly enabled smartphone platform are instantaneously available on the portal monitored at the physician’s end. Patients will be recruited from international centers across three continents for different phases of the study. For these patients, each center is provided with mobile smartphone devices activated by a local mobile service provider.

Clinicians and study coordinators are also equipped with tablet computers for monitoring secure patient data, providing mobility and immediate access of information. EPIC-enabled wireless ECG devices, automated blood pressure (BP) monitoring apparatuses, and weight scales are used by the patient to send their vital sign data along with diet and medication adherence and activity levels to the monitoring clinician.

This approach and technique of using a non-intrusive approach to monitor patients in various settings enables new ways of delivering effective healthcare, clinical decision making, and tailoring long-term disease management, wellness, and preventive programs to individual patients.

#### References

*Source: Dartmouth Institute for Health Policy and Clinical Practice †Scherr D, Kastner P, Kollmann A, Hallas A, Auer J, Krappinger H, Schuchlenz H, Stark G, Grander W, Jakl G, Schreier G, Fruhwald FM; MOBITEL Investigators. Effect of home-based telemonitoring using mobile phone technology on the outcome of heart failure patients after an episode of acute decompensation: randomized controlled trial. J Med Internet Res. 2009;11(3):e34.