Hospitals, patients embrace remote patient monitoring

After suffering two heart attacks at the age of 36, Shannon Wange depends on her cardiac app not just to stay alive, but to enable her to live the active life she has always enjoyed.

“I was actually in the gym, on the (stationary) bike when I had a heart attack,” said Wange, a 36-year-old Erie resident.  “Lucky for me, I had a friend there who is a cardiac nurse; she helped me and called 911. The paramedics whisked me off to Good Samaritan (Medical Center in Lafayette). My EKG (electrocardiogram) was normal, and then my blood pressure dropped to 50 over 26.”

A fitness buff who watches what she eats and doesn’t smoke or have any indication of coronary plaque, Wange soon found out she has a rare condition that appears to affect mostly young, fit women called Spontaneous Coronary Artery Dissection, or SCAD; a condition in which the coronary arteries tear for no apparent reason. Before leaving the hospital, she had a second heart attack, caused by the tear blocking the artery.

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Doctors believe the SCAD condition will heal itself with time, Wange said. “My chance of having another heart attack is supposed to only be 15 percent, but since I’ve already had a second, I’m not so sure,” she said.

So Wange bought a smartphone device called Cardia App, which has a single lead EKG monitor (hospital EKGs normally have 12 leads). If the findings are worrisome, or downright frightening, she can either email the results to her cardiologist, or speak instantly to a cardiologist the app company has on call.

Just a few weeks ago on a trip to the mountains with her family, Wange had a cardiac episode and was immediately checked into a local hospital for observation. Even though the use of the app wasn’t in her local hospital’s protocol, Wange said her cardiologist, Dr. Rajesh Sharma, and the rest of the Good Samaritan staff have been incredibly supportive of incorporating the data into her treatment.

“Honestly, the device has brought me almost total peace of mind, especially because SCAD is so spontaneous,” she said.

Remote patient monitoring is being rapidly deployed across the nation and throughout local hospitals, as well. Nationally, there were about 7 million patients under some form of remote monitoring year, a 44 percent increase over 2015, according to data from Berg Insight.

Local hospitals also are rapidly ramping up their remote patient programs, citing decreased expenses in return or routine patient visits, which also translates into a great deal of increased convenience for those patients. One area that most all local hospitals have in place is remote monitoring of pacemakers.

“Our physicians do recommend that patients receiving pacemakers do have remote monitoring,” said Rachel Hamaski, communications manager for Good Samaritan. “They can set it up on their phone, and it monitors the pacemaker (to ensure the device is functioning properly).”

At Longmont United Hospital, communications manager Kirsten Pfotenhauer said pacemaker monitoring is just getting off the ground, but the hospital’s LifeWatch program has been watching patients with heart arrhythmia for some time.

“A lot of times, the patient won’t feel that (minor arrhythmia),” she said. “But LifeWatch allows our clinicians to track these events over time, so we use it regularly with our patients.”

At Boulder Community Health, more than 1,200 cardio patients are part of the remote monitoring program at Boulder Heart, said Jeff Reed, executive director for specialties at the hospital.

“Most of these patients have pacemakers or event monitors,” Reed said. Event monitors such as Wange’s are turned on when patients feel they are suffering from abnormal rhythms, but the pacemaker monitors are largely designed to ensure that the device is operating correctly.

“A few years back, if you have a pacemaker, you’d have to come in to have it tested every three or four months,” Reed said. “It was not uncommon at all that were changes.”

The pacemaker monitor typically sits in the patient’s bedroom and looks somewhat like an alarm clock. “Every once in awhile (usually every 48 hours), it phones home,” Reed said.

“If everything is fine, nobody gets bothered,” he said. “But if something seems askew, the cardiologist on call gets notified.

The remote monitoring program has been in place for about a year, Reed said, and the event monitor has already found several patients with dangerous rhythmic patterns who were immediately hospitalized.

“We’re able to keep track of patients and intervene much more quickly than we have in the past,” he said. “It’s been a huge success. We have two nurses who routinely call these patients, and patients like that level of reassurance.”

While BCH would use remote monitoring in select cases before, after only a year, Reed said he is looking to ramp up the program again with another nurse.  “It doesn’t cost the patient anything. The cost of the implant includes this remote device.”

Data being transmitted is subject to HIPAA compliance, though the devices aren’t designed to be remotely set — meaning that a hacker would not be able to mess with someone’s pacemaker.

Centura Health has actually been employing some forms of remote monitoring for about 12 years, including at the Avista Adventist Hospital site in Louisville, said Samantha Lippolis, the telehealth director for the organization.  Recently, the organization added to its connectivity with devices from Vivify Health.

One of the more-inclusive monitoring systems used locally, patients suffering from Congestive Heart Failure are issued a computer tablet, which is connected to a scale, a blood pressure cuff and a pulse/oxygen sensor. Because CHF is often associated with a combination of conditions, such as obesity, keeping patients within defined parameters is an important goal, Lippolis said.

“Taking their weight on a regular basis is important, because we don’t want to see them going overweight,” she said. “Nurses are able to see when they go over those parameters and contact them.”

In addition, the tablets run congestive heart patients though some daily questions, such as “were you out of breath; we’re you sitting or walking when this occurred?” Those questions add important detail to the ongoing monitoring, Lippolis said.

Avista also has remote monitoring associated with its home health and Accountable Care programs.

“We have about 100 congestive heart patients, and we’re ramping up to another 200,” Lippolis said. She said that readmission rates in this program have dropped from perhaps 25 percent over a 60-day period to about 5 percent.

“But that doesn’t happen instantly,” she said, noting that Centura has been working with the program for years. “You need to be sure you are continuously monitoring the program,” and the rates will fall gradually, she said.

While cardiac services have largely been the standard bearers during the early years of remote monitoring, the Berg Insight report noted that they were overtaken in use for another disorder in 2016, monitoring for sleep disorders. Treatment for sleep disorders was largely treated in labs, such as BCH’s lab, which is run in conjunction with the Colorado Sleep Institute.

The Sleep Institute — with offices in Boulder, Longmont and Broomfield — is treating more than 2,000 patients now, mostly through its remote monitoring program, said Dr. Mark Hickey, the founder and president of the institute. His institute is now serving 12 area providers, largely for treatment of sleep apnea, or interrupted breathing during sleep.

The monitoring program uses a sealed mask that forces air into the patient’s nose and mouth, preventing the collapse of the soft palate and tongue that leads to choking in serious cases. Together with a device that measures movement, the system delivers very detailed information — the same data that would be collected in a lab, with the exception of brain wave data.

“Every morning, we get very detailed data from the night before,” Hickey said. “It’s a big deal for us. The real magic is in monitoring, we can track many patients at once.

“If we have someone we want to pay particular attention to, we can actually set the parameters,” he said. “For instance, if Mrs. Jones has a particular number of apneas a night, it will flag us, and we can make adjustments.”