Safety without Wires: How can we help keep patients safe without keeping them in hospital? By David Halperin We know that hospitals have protocols designed to keep patients safe while they are there, and most of us are familiar with the sights and sounds of hospital monitoring: the screens with moving graphs, the beeping alerts, the sensors attached to a patient’s body. They are there to keep tabs on patients’ vital signs and other important measures of their wellbeing. But what happens when the patient goes home, out of immediate danger but still at risk of an unexpected relapse, or simply vulnerable to the falls and other accidents that can befall any convalescent, or even relatively healthy seniors? What of people with chronic conditions that need to be watched carefully in case they become acute? How can we keep patients safe without keeping them in hospitals? The “wireless revolution” that has been transforming our lives through consumer electronics, including wearable sports and fitness monitoring gadgets, also offers solutions to some of these problems. At their heart are wireless sensors: small electronic devices that can measure heart rate, blood pressure, blood sugar or respiration, monitor movements, check bed occupancy, and much more. A home — or a patient — equipped with these sensors can be significantly safer. Depending on the setup, these sensors send the information they collect to the patients themselves or their families, and/or to healthcare providers. If something changes with the patient, the responsible parties are quickly alerted. Case studies: diabetes There are a number of different wireless sensor monitoring systems available, from a variety of manufacturers. Writing on behalf of one of these vendors, Joy Pape, a certified diabetes educator in New York, reported: “William is a 62-year-old man who had a stroke three years ago. He has diabetes, high blood pressure, and a family that loves him. He wasn’t writing down his blood sugars, he would have to read off every number to me. I was never sure they were correct, and it took a long time to go through them. William was not even checking his blood pressure.” Once he was on a wireless sensor, Pape says, “I got his blood sugar and blood pressure results automatically. The numbers were all high . . . medication changes were made immediately.” Pape also mentions John, a 35-year-old man diagnosed with type 1 diabetes. He was told to check his blood sugar at least four times a day. He was scared of his numbers going too high and having complications of diabetes. Pape was concerned about his numbers going too low. Long-term high blood sugars can cause a problem over time, but low blood sugars can pose more immediate dangers. When he started using wireless monitoring, the medical team started getting his numbers right away. They advised him to decrease his insulin, so avoiding any serious low blood sugars. How they work The wireless part of these systems is based on existing mobile technologies such as Bluetooth, Wi-Fi, cellular link and even smartphone. Sensors are attached to the patient’s skin, implanted internally or under the skin. (In the case of motionsensors monitoring the elderly for falls or wandering, they may be simply mounted in a bedroom.) Wearable or implanted sensors may send data to an Internet-connected base station in the house, or they may connect to the Internet directly via a cellular connection. Sometimes the measurements are streamed continuously, but often they are transmitted only when the wearer is close to the base unit. From there, it can either be displayed to the patient directly, or transmitted to a doctor or other medical staff. According to Jonathan Collins, a Principal Analyst at ABI Research, “Wireless monitoring has been used in hospitals for some time, but the next big opportunity is in the fast-moving consumer monitoring market. The Affordable Care Act contains real economic incentives for hospitals to extend care into the home. Readmission within one month mean the hospital gets less money for the retreatment.” All these systems need the Electronic Medical Records (EMR) that are gradually being introduced throughout the US healthcare industry. Around the New York area Many patients locally are enjoying the added safety of mobile monitoring. Dr. Yael Harris, Assistant Professor at the Division of Endocrinology and Metabolism of the Hofstra North Shore-LIJ School of Medicine, says there are about 200 patients in her practice who are monitoring their blood sugar wirelessly. “The primary purpose is to alert the patients to spikes or dips,” she says, “or even to rapid trends in that direction, so that the patient can take actions to make sure they never get there. The sensor will alert the patient not only to the numbers but the direction and rapidity of change.” There are multiple benefits. One is that patients do not need to check their blood glucose quite as frequently. It gives them extra comfort. “They are particularly helpful for patients who have hypoglycemia unawareness, and do not know when their glucose levels are low/dropping,” adds Harris. “For those patients, I would call the devices ‘life-saving.’ They definitely prevent harm, as the alerts notify patients that they need to eat something to avoid dropping too low (which leads to fainting, seizures and even death if prolonged and untreated).” Wireless monitoring can also improve diagnosis and treatment in cardiac patients. Dr. Bruce Goldner, Director of Electrophysiology at Long Island Jewish Medical Center, has been using wireless monitoring for several years now, and currently “thousands” of his patients use it. “I had a patient in his 50s,” he says. “He was passing out several times a year: not often enough that we could monitor it externally. He had undergone all sorts of diagnostic testing, all coming out negative, so we implanted a sensor. Several months later he was riding in a car his wife was driving when he passed out. His wife drove him straight to our institution where we interrogated the sensor device. It showed that his heart had stopped for 10 seconds — so he got a pacemaker.” Goldner adds, “There’s also remote monitoring for people who don’t have a diagnosis — those who have a history of palpitations, for example. The monitors can record for weeks; if a cardiac event occurs, it will be flagged, and we can interpret it and adjust our therapies accordingly.” Even defibrillators and pacemakers are wireless these days. A wireless modem is put at the bedside, and if the patient has a new arrhythmia, or if there’s a problem with the device, then that information can be transmitted to the doctors. Even if the patient is further away, the device stores information and then transmits it when the patient moves closer to the modem. “One brand of defibrillator even measures and informs us of fluid buildup that precedes heart failure, so we can take steps to deal with it,” says Goldner. In other cases, implanted defibrillators detected that one of their electrical leads had cracked, posing a dangerous risk of shock. Immediately the hospitals, the patients’ doctors and the device manufacturer were automatically and wirelessly notified; they in turn alerted the patients to seek urgent help. What about the money? As we know all too well, medical technology is expensive; but these systems can still be cost-effective. Dr. Harris’s reports that the cost of a the starter kit used in per practice is about $1200 and a pack of four sensors (each good for about five days) is about $300. “Clearly,” she says, “for people with multiple hospital admissions due to hypoglycemia or uncontrolled glucose, the sensor makes sense financially.” The good news is that most insurance plans cover the devices for patients with Type 1 diabetes, and some for patients with Type 2 diabetes, as well as for cardiac and other kinds of monitoring. They are covered by Medicare too, but only within certain guidelines. It is best to consult with your physician to see if those conditions are met in your case. A sense of security Clearly for some patients, remote wireless monitoring makes sense, both financially and medically. But just as important is how the patients and doctors feel about it. Says Dr. Harris, “Patients tell me they are doing better, just knowing someone is watching and someone cares. As a health care provider, I am working towards recommending this simple tool to all of my patients. It’s a relief for all of us: health care providers, caregivers, and most important, the patient.” About the author David Halperin is an internationally-recognized writer, editor, and photographer. His work over 25 years has covered a wide range of subjects and media outlets, from technology to travel to health. His stories and/or photographs have appeared in over 130 publications in eight countries. He is PULSE of NY’s resident writer/editor, and this story is intended to highlight a different side of patient safety. Email: mediaworkshop@runbox.om Phone: 516-830-0831