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