Touchless Patient Monitoring in the Works

January 16, 2020

Jaquie Finn imagines a future where hospital patients won't have to wear or plug themselves in to devices because vitals monitoring will be "contactless".

We already know it can be done, said the head of digital health at Cambridge Consultants in the United Kingdom, whose team is currently working to develop touchless monitoring systems. To show how this could work in a hospital setting, they are applying it to sepsis monitoring.

Although she counted 649 companies presenting wearables at the Digital Health Conference and Consumer Electronics Show (CES) 2020 in Las Vegas, "there are only so many that a person can possibly wear to catch all the vital signs they feel like monitoring," Finn explained.

And to capture all those data, the technology must be compliant. "You need a charged battery and updated apps," she told Medscape Medical News. For many, that is a challenge.

"Contactless technology would give you compliance," she said, but she acknowledged that privacy and security are a concern. Patients wouldn't have physical control over being monitored, as they wouldn't be able to remove the monitoring devices themselves, she explained. "It's a give and take."

From an economic perspective, the benefits of contactless monitoring are huge, particularly for sepsis. Each year, about 1.7 million people in the United States develop sepsis, and 270,000 of those die, Finn reported.

"Someone dies from sepsis every 2 minutes, and many of those deaths are preventable," she explained. "It can kill within 12 hours, so you want to be able to continuously monitor the critically ill for sepsis."

Contactless Sepsis Monitoring

Finn's team is working on a way to monitor the six physiologic parameters considered to be early-warning signs for sepsis: respiratory rate, level of consciousness, oxygen saturation, systolic blood pressure, temperature, and heart rate.

With infrared technology, sensors, several video cameras, and machine learning, they were able to put together a system that covered four of the six parameters.

But there are several challenges the team is still working to overcome.

Patient movement is a big one, Finn explained. To gather heart rate data, "people had to sit really still." Skin tone also complicated the monitoring because darker skin is more difficult to read.

"Another challenge is blood pressure," she said. And facial-recognition technology needs improvement.

The technology is not ready for the real world, but "we wanted to show the excitement of what's to come," said Finn, who spoke about contactless monitoring at CES.

The team from the global product-development company hopes to work with others to overcome these obstacles.

Constant contactless monitoring would identify patients in need of urgent care.

Remote Data Collection

"Truly passive, noninvasive sensors have a really big future in healthcare, but we're not there yet," said Drew Schiller, chief executive officer and cofounder of Validic, a company that has built a platform to connect in-home patient data with healthcare system electronic medical records.

He said he sees the benefit of getting continuous data to clinicians, but agrees that the infrastructure is lacking.

Most of the remote-monitoring solutions exist outside of the clinical workflow, he explained, "so care teams need to go to a separate portal. That makes it dead on arrival when you want to scale up."

Validic has first-hand experience with what can happen when the data smoothly make their way into electronic medical records.

The company's technology has been used to monitor 34,000 patients with diabetes, gestational diabetes, and hypertension in the west coast Kaiser Permanente health system.

"Once patients are enrolled in the program, they simply connect their devices and the data seamlessly go into the clinical workflow," he said. "Care-team managers are alerted to take action when necessary."

Patients with type 2 diabetes experienced a nearly full point reduction — 0.9 — in A1c levels within 65 days, and the average time the patient and clinician spent on the phone decreased significantly, from 15.0 to 5.5 minutes.

When a patient has a problem, "we're getting the data in front of the clinician," Schiller said. And most patients do input their data. "After 90 days enrolled in the program, 70% of patients are still uploading data at least twice per day," the data show. "The average patient with hypertension moved from stage 2 to normal ranges within 45 days," he pointed out.

This is certainly not "normal" across the healthcare system. "Historically, there has been no model for reimbursement for remote monitoring," he explained.

But that just changed. Last year, Medicare issued four new remote telehealth reimbursement codes. The codes allow physicians and other healthcare workers to be reimbursed for checking patients' data and even for setting them up with devices.

"It's fantastic that we have the codes for remote-monitoring infrastructure now," said Schiller, who spoke about innovation in healthcare at CES. "We need to give doctors time to look at this. We also need administrators to think operationally about how to put these into practice."

Some of these technologies will more likely be adopted in a consumer setting before they enter hospitals, Finn added.

Digital Health Conference and Consumer Electronics Show (CES) 2020. Finn presented January 7, 2020; Drew presented January 9, 2020.

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