SMARTER STRATEGIES

Time to Modernize Home Health Technology

Michael Steinhart | Date: 04-27-10 | Comments

Apnea monitors that hospitals prescribe to babies and adults can benefit from WiFi integration and other advances. Is the industry ready for a complete overhaul?

Eight weeks ago, I didn�t know the first thing about neonatology. My wife and I were expecting twins at the end of April, not at the beginning of March. But then the doctor announced that our twins were going to be delivered earlier than planned, and we were plunged into preemie-land�an alternate universe of cardiac and respiratory monitors, feeding tubes, incubators, and other neonatal ICU accoutrements.

The boys arrived on March 9. The older (by a minute) was sent home on April 1; the younger arrived home on April 8, but with a twist. He was prescribed an apnea monitor. Apparently, respiratory problems are a common symptom of prematurity, and there are many cases where a baby will be released from the hospital before his or her breathing issues are fully resolved. The monitor tracks heart rate and respiration, beeping loudly if it detects apnea (cessation of breathing), bradycardia (a drop in heart rate) or tachycardia (a spike in heart rate). Most of the time, the baby can "self-correct" these conditions by taking a deep breath. Sometimes, an adult needs to stimulate the baby to get him or her breathing again. In rarer cases, the adult must administer CPR.

The SmartMonitor 2 from Respironics is touted as the "newest" monitor technology available for home applications, but it�s already showing its age.

The monitor also serves to collect respiratory data over the prescribed period. After a month (usually), the data is collected and reviewed by a neonatologist or pediatrician, who determines whether the baby is well enough to be taken off the monitor.

In our case, a company called AtHome Medical is the service provider that delivered the monitor, trained us in its use and bills insurance for the monthly rental.

During the training session, I was struck by a number of incongruities related to the monitor:
- It beeps very loudly to alert adults of a condition, but it has no mute or silence button. The beeping continues until the problem (elevated heart rate, low heart rate, low respiratory rate or loose connection) is corrected, and an icon on the display stays illuminated until the machine is restarted.
- It has a 2MB data store, a modem interface and a PC Card slot. The modem works only with landline phones, but not VOIP lines. The PC Card interface is obsolete. To collect the data, AtHome actually sends a rep to the house.
Anyone familiar with modern consumer and WiFi technologies should be able to see several areas of improvement.

First off, a reset button would be a welcome addition. Second, a silence button that cuts the alarm would help in situations where the adult has to stimulate the baby. The piercing noise may help "wake up" the baby, but it�s very distracting to the adults. Third, if gentle stimulation is required and the heart rate reaches a certain level, the monitor could feature a vibrating attachment that delivers the stimulation immediately and corrects the issue.

Last, and most important, is WiFi integration. I have a home network. My BlackBerry can associate with it, my Wii can associate with it, even my $80 all-in-one printer can associate with it. Why can�t this apnea monitor?

Why do I have to wait a month before a doctor reviews the data? If there were a secure wireless connection built-in, the monitor could upload its data on a daily or weekly basis. If the data indicated that the child�s issues are resolved, the monitor could be returned after two weeks, say, instead of a full month. I can�t think of a single parent who�d object to that.

David Ferguson, vice president and general manager of AtHome, agreed that some of these improvements could streamline treatment and increase parent satisfaction. He did point out that the monitors are rented out and billed for in monthly increments, that data sampling periods must be determined by doctors, and that the data transfers must be completely secure. He also mentioned that, in today�s economic climate, insurance companies are looking for ways to cut expenses, not increase them, which may delay changes and innovations from being implemented.

In terms of the interface, �We�re definitely in a generation where consumers are more technologically sophisticated than in the past, but we still have a good segment of the population that�s not at that level yet,� Ferguson states. The challenge is to field equipment that�s simple enough for everyone to use.

Let�s say WiFi isn�t ubiquitous enough or secure enough to support these changes today. Let�s say the insurance and billing processes aren�t flexible enough to support shorter-term monitoring, either. I still maintain that the benefits to patients and their parents�not to mention the environment�are compelling enough that upgrade plans should be set in motion. Even if it takes a year or two or three, it�ll be worth the investment.

What medical applications do you think would benefit from a tech overhaul? Sound off here!