Palpitations, dizziness, and fainting can often be symptoms of underlying heart disease. The key to the correctly diagnosing them is reliable documentation of the underlying cardiac rhythm when symptoms occur. Holter and Event recorders are the two noninvasive methods have been usually used to do such long-term ambulatory monitoring, but they often end up being insufficient or ineffective for various reasons (low yield, not long enough, etc.). In the recent few years, Mobile Cardiac Outpatient Telemetry (MCOT) term has gained ground, in part due to Cardionet’s products. MCOT is a viable alternative to conventional cardiac monitoring: it’s real-time, portable and can be done over extended periods.
With that background, Corventis becomes an interesting entrant to the MCOT space. Their technology platform consists of a bandaid-size wireless sensor patch called (“PiiX”) that detects, records and transmits physiological data to a portable hub (called “zLink”). zLink is a cellphone-size device that sends the data over wireless network to ‘Corventis Monitoring Center’, which is a staffed to do preliminary interpretation and urgent physician notification. They offer these capabilities in two forms: NUVANT (ECG based continuous arrhythmia monitoring) and AVIVO (non-ECG physiological paramters monitoring). Corventis has some big venture names behind it: KPCB, Mohr Davidow, DAG ventures. They recently got FDA clearance for NUVANT in January 2010.
Cardiac diseases are certainly the prime target for any wireless remote monitoring startup. Corventis is not alone. iRhythm’s Zio Patch is designed to diagnose cardiac arrhythmia by providing up to 14 days of continuous recording. Once done, the Zio Patch can be mailed back to the company for analysis. Unfortunately, the Achilles heel for all of these companies is reimbursement. So far, private insurance companies and CMS are not convinced that such services are worth paying for. MobiHealthNews has an interesting post about this trend here.
I’ve written about a number of consumer-oriented ‘wellness’ services by startups that are using wireless sensors to detect simple metrics like activity and help you achieve a healthy lifestyle. Corventis, iRhythm are good examples of medical-grade services utilizing the same basic technical framework and abilities for managing life-threatening conditions. Once we get over the barrier for reimbursement, you can bet on the remote monitoring market for serious medical conditions exploding. We can wait for that to happen, but I’m personally convinced that as consumers take more charge in managing their conditions (and health insurance continues to spiral the drain from a cost and outcome perspective), there is a growing scope for remote monitoring services that consumers will pay for themselves.
PS: I had a discussion with Corventis founder, Darryl Drinan a few weeks ago. He had three insightful comments for anyone thinking about getting into the remote monitoring space:
If you have a choice, focus on therapeutic service, not diagnostic
Product alone is not enough, always tie it to a service
Patient education is a big problem (if you need to do it for them to use your device, you are hosed)
Lately everything I find interesting has something to do with mobile platform. “mHealth” is the buzzword for it. Seems like most of new patient-oriented healthcare IT ideas have been conceived on the premise that mobile phones plays a key role in health-related data input and/or visualization. Or it could be that I’m just biased and need to look for news in other places 🙂
Child Count is an mHealth platform developed by the Millennium Villages Project aimed at empowering communities to improve child survival and maternal health. It facilitates the activities of field-based community health care workers in Africa. Using any standard phone, these workers are able to use text messages to register patients and report their health status to a central web dashboard that provides a real-time view of the overall community health. This enables an automated system that helps reduce gaps in treatment (sms-based rapid diagnosis, follow-up reminders etc.).
ChildCount is open-source. It’s built with RapidSMS, a framework that manages data collection, complex workflows, and group coordination using basic mobile phones. This short video does a good job of explaining the overall project and technology.
Public Health interventions are often based on simple logic, but have far-reaching effects. Screening regularly for malnutrition, malaria, diarrhea, etc. requires relatively simple documentation and measurements- making it perfect for sms-based communication. Even keeping a simple registry of births, deaths, immunization status enables local health teams and organizations optimize their efforts. Care delivery organizations in developed countries should also think about integrating the mobile platform into their services- its a great way to interact and keep in touch with patients. Medication adherence is a good example. NCPIE‘s 2007 report states that poor medication adherence is almost a crisis, costing $177B annually. Almost any population care management topic (outreach, screening, compliance, etc) would be a good use case.
Child Count is in good company -there are many interesting mHealth applications out there that deserve mention. The mHealth wikipedia page has a good running list of some applications. I’ll continue to post about what I discover and like.
RapidSMS is a SMS-based (text message) framework that manages data collection, complex workflows, and group coordination using basic mobile phones — and can present information on the internet as soon as it is received. So far RapidSMS has been customized and deployed with diverse functionality: remote health diagnostics, nutrition surveillance, supply chain tracking, registering children in public health campaigns, and community discussion.
More products designed around actigraphy keep surfacing. aXbo is a ‘Sleep Phase Alarm Clock’ by an Austrian company. The basic idea is to differentiate sleep phases (light, deep, REM) using body movements that are detected via a motion-sensor worn on the wrist. The bedside clock unit has other features like power naps, auto sleep melody fade, use for two people, smart alarm etc. A desktop ‘research’ application downloads the data and helps analyze it. So the overall service is similar to Zeo or Fitbit, except it looks like aXbo was perhaps first-to-market (2006 press release discusses launch).
Remote motion-sensor based alarm clocks are probably a nerdy gizmo for now. But it does provide a good use case of how everyday appliances are getting smarter and generating volumes of data. It’ll be very interesting to see how such data can be leveraged to further sleep disorder research- as I wrote in my Zeo post.
Of all the consumer healthcare device ideas, this may be the most ingenious one. In August 2009, Massachusetts-based Vitality announced availability of GlowCaps– a web-enabled $99 cap for prescription bottles that helps remind patients to take their medications on time.
GlowCaps fits the standard pill container, and uses short-range wireless communication to talk to a gateway hub at home that is connect to the internet. There is also a reminder light (looks like a night light) that plugs into any standard power outlet. If the bottle isn’t opened at the appointed time, the cap and night light start blinking to remind the owner to take the medication. If after an hour, the pill is still not taken, GlowCap starts start playing jingles as well. After yet another hour, it’ll send a message to Vitality’s system which can then place an automated phone call or send a text message with a reminder. Brilliant.
Beyond having a ‘smart lid’ for bottles, Vitality has integrated functionality that keeps caregivers in loop. There are social support features (shareable weekly email reports), refill facilitation (refill reminder calls) and physician interaction tools (printed monthly reports to you/doctor). So it hits all the major interaction points for a patient’s medication regimen. Last month AT&T put out a press release about GlowCaps running on its wireless network. So the Vitality gateway now has mobile phone technology, and I assume that precludes the need for an ethernet connection.
Every clinician knows that medication adherence is a huge problem ($100B figure has been thrown around as the cost of poor adherence in US). More than a consumer product, this is a fantastic service that can change medication packaging in general. And looking at the Managed Care (enhance the personal/medical record), Research (change patient behavior) and Pharma (reduce brand-switching) focused pages of their website, I think Vitality knows that. It’s definitely the next stage in evolution of the standard pill dispensers (like ePill, Philips).
Their CEO David Rose has an interesting background in creating internet-connected everyday devices at his last company, Ambient Devices. Somewhere in a press release I read his quote about “…providing minute-by-minute adherence data to motivate healthy behavior.” If you take the word ‘adherence’ out, that may be a basis for a lot of future medical solutions and an adage for next-generation of medical device companies.
I wrote about Proactive Sleep a while back and wondered how it would be to combine a sensor to automatically record sleep pattern. Well, Zeo gets one step closer to that.
Zeo system consists of a wearable headband that measure brain’s natural electrical activity. Although their blog has a high-level explanation of how it works, my understanding is that its a single-channel EEG, which seems to be a reasonable way to do sleep analysis in healthy individuals. That data is wirelessly transmitted to a bedside display and stored on an SD card.
Algorithms based on proprietary logic churn out a personal sleep score (called ZQ) to quantify the type of sleep you get. The display unit looks like a bedside alarm clock and shows current and past 2 weeks worth of sleep analysis. Also has some smart alarm clock features like SmartWake alarm that wakes you up at the most suitable time within half-hour of set time. You could upload the data to an online sleep journal through the SD card. The website gives graphs, trends and the ability log other supplementary lifestyle data that can affect your sleep. All that for $249. An additional $100 would get lifetime access to a personal sleep coaching program, which includes regular assessments, goal tracking, email tips etc.
There is no question that Sleep Science is a serious, mature field. Zeo can find its place as a useful adjunct for plenty of sleep-related disorders that affect people who are otherwise healthy. It’s not an FDA approved 11 channel medical grade polysomnogram, and it’d be a mistake to compare it to one. It’s perhaps a closer analog to Actigraphy where a wearable sensor measures overall motor activity during sleep. An actigraph unit is an accelerometer based device like the FitBit, WakeMate, SleepTracker or Axbo.
Accurate or not, Zeo is yet another proof that healthcare is slowly being transformed by sensor-based, portable devices that are capable of analyzing data in a consumer-oriented way to enable individual patient to manage their conditions better.
April ’10 Update: I ordered a Zeo from Amazon in March’10. Been using it for couple of weeks now. The hardware looks and performs well, but I have my complaints. The sensor in headband is bit bulky to sleep with, and I don’t think I’ll get used to the headband anytime soon. The fact that I need to replace the sensor pad every 90 days feels like a hidden cost (they are $24.95 for a pair without S&H) that was not disclosed completely in the marketing.
Software-wise, it’s bit less intuitive than I expected. I’m still wondering what the data tells me. I know Z-score is a overall indicator, but what about the breakdown? Are my 49 minutes of deep sleep enough? The fact that I woke up 7 times – is that normal? In the end, I’m asking the question- what does this $250 device do for me… Probably not much because I’m not the target audience for it. People suffering from sleep disorders would perhaps be more receptive.
May’10 Update: Returned it. Sorry Zeo.
June’10 Update: Learned about the Zeo API. Mobile fitness companies RunKeeper and Daily Burn are the first to integrate their services with Zeo. Neat strategy to promote it as a platform.
July’10 Update: Found out about NeuroVigil: another startup in the sleep-monitoring space. Their technology is also based on a single-channel EEG wireless sensor. They claim to be able to send the data (and its analysis) to any mobile device. NeuroVigil’s founder, Philip Low gave an interesting talk at TEDMED in 2009.
Nov’11 Update: Noticed that Zeo now has a cheaper, smartphone-based mobile ($99) solution and original clock has been re-packaged as bedside solution ($149). Smart move, since it makes them more relevant in comparison to other solutions like EASYWAKEme the market.
Another vital-sensing hardware with integrated service to keep you healthy. miCoach from Addias helps users create a custom workout plan and track progress with real-time feedback and audio coaching.
I was fortunate to see a demo last month. At the core of the offering is a set of remote sensors- a heart rate monitor (worn as a strap around torso) and a stride sensor (clips on to shoes, and measures stride pattern, distance and speed). These communicate wirelessly to a central unit called ‘Pacer’ (MSRP $139.99) which connects with your mp3 player and gives audio feedback about things like calories burned, distance, workout progress etc. Another peripheral that communicates with both sensors is the ‘Zone’ (MSRP $69.99) which is worn on wrist, and gives constant visual feedback (using colors) about your heart rate zone. Pacer connects and syncs to the personalized website, zone doesn’t. Coupled with all that hardware are workout ‘plans’ for your goals like run faster, get fit, loose weight, learn to run or to reduce stress.
My initial impression is that it all sounds too complex and too expensive. But maybe this is legit functionality for people who are serious about running. For the novice consumer who wants to track daily physical activity, I like the simple approach of FitBit. For those who run regularly, the Nike+Ipod offering is another (much) cheaper competitor. Either way, miCoach is yet another sign that consumer-oriented wellness monitoring solutions are becoming mainstream. Next logical phase would be moving similar technologies and frameworks to tackle real disease management and prevention.