The Alivecor iPhone ECG Monitor in the Hands of an E-patient:
Peril or Promise for the Future of Medicine?
This is a reprise of a post from Feb 21, 2013 on my old blog site.
This is probably one of the most exciting social media feeds that I have ever read on Twitter. Last night, Hugo Campos, an e-patient advocate for access to his own medical data and who wears a Medtronic defibrillator for his heart condition, felt a fluttering sensation in his chest. So he grabbed his iPhone ECG recorder, licked the electrodes, put it against his chest, got an ECG recording and shared it on Twitter.
He noticed what looked like atrial fibrillation on the reading, but a debate started among some of the doctors to whom he tweeted.
Was it atrial fibrillation which is a life-threatening condition, or was it artifact?
Dr. Wes suggested that it was artifact, but Hugo brought up a good point: he did the recording because he was symptomatic, which is a valid clinical reason to do a heart ryhthm recording.
Before the advent of the AliveCor, the pattern might have gone unnoticed, because he would not have had the tools for recording his own EKG on a Wednesday night at home; nor does he have access to his own data from his defibrillator, as noted so astutely by Gene Moy.
Dr. Wes and Dr. Albert (the inventor of the AliveCor) suggested that he send the tracing to his physician.
Hugo took 2 aspirins in case it was atrial fibrillation.
Dr. Wes retweeted and commented: “A new world indeed: self rx?”
A heart monitor in the hands of the patient: Is it a perilous journey with an uncertain outcome, or is a promising act of liberation for the patient?
Peril: It’s dangerous and irresponsible to give the patient too much of their own data.
To date, EKG interpretation has been solely in the control of the physician, rather than the patient. Because of this, patients aren’t formally trained to read EKGs, and there are concerns about whether they might interpret artifact as disease activity, potentially leading to additional self-administered treatments that might endanger their health, increase their anxiety and worry unnecessarily, and increase costs to the health care system.
Promise: It’s liberating and it’s the right of every patient to have access to their own data.
The patient is the expert of his own disease. He knows better than anyone else when the symptoms begin, and when to check a heart rhythm. If he can measure his heart rhythm in real-time, he now has data that he can use to make decisions about his health. For example, Hugo has previously described how he was able to correlate the onset of his arrhythmias with drinking scotch, so he gave up scotch. As Hugo writes, “I believe we all have the right to access any and all health data collected from our bodies, whether or not we are capable of understanding it.”
Are EKGs in the hands of patients a new frontier for American medicine? Maybe, but maybe not. Let’s think about other diseases, like diabetes. Endocrinology used to be like cardiology; in the absence of any tools for home monitoring, glucose could only be measured and interpreted by the doctors. But then technology for monitoring the condition at home was developed. We first sent patients home with crude tools like urine strips, then home glucometers, and finally continuous glucose monitoring (CGM) systems, all versions of the portable modern-day EKG for the diabetes patient. Would we ever say that it’s dangerous to give a patient with diabetes a glucometer or CGM device? I don’t think so; those devices are the cornerstone of self-management to achieve the best outcomes possible.
Whenever new technology enters the medical landscape, there is a steep learning curve, for providers, for patients, and for the health care system (see Dr. Wes’ post here which brings up some legitimate concerns). We are at the beginning of that learning curve now, but I predict that the AliveCor, in the hands of one motivated e-patient, will be just one of many mobile health monitoring tools that will transform how we define “self-management” of disease for the future.
Hugo sums it up nicely in this tweet: