Becka DeSmidt, Technology Insights
Hospital administrators often express concern regarding the cost of the da Vinci robot and its questionable impact on clinical outcomes. This issue is especially pressing given the imperatives of improving value and reducing cost under accountable care.
Though the da Vinci is undeniably a powerful technology, it is not perfect. There are several improvements and innovations that competitors could offer down the line that stand to greatly advance the field of robotic surgery.
Read more »
On Sept. 15, the National Joint Registry (NJR) of England and Wales issued their annual report on joint replacement procedures performed in the UK. The registry, which now houses over 1.1 million records of joint replacement procedures, had it's highest number of single-year submissions in 2010, and continues to offer a wealth of data to providers and researchers on joint replacement surgery. This year's report continues to substantiate the role of the NJR in identifying issues with metal-on-metal hips, issues that were initially flagged by the NJR along with other national registries worldwide.
Read more »
Earlier this summer, the American Joint Replacement Registry (AJRR) completed its pilot phase, pulling data from over 3,600 primary and revision joint replacement procedures from eight different reporting sites. The registry, a collaborative effort of the American Academy of Orthopedic Surgeons (AAOS) and other clinical organizations along with health insurers, the device industry, and the government, aims to have participation from 90 percent of hospitals by October of 2013. Getting that level of participation in just over two years will likely prove a significant challenge, but the rewards inherent to such a broad data set can be significant. Today, as the recalls for DePuy's ASR metal-on-metal hips lead to countless lawsuits and FDA complaints, the need for more transparency into orthopedic procedures are devices becomes more apparent.
Read more »
Greetings from CRT 2011! We are at the Omni Hotel in Washington, DC for the annual Cardiovascular Research Technologies (CRT) conference sponsored by Washington Hospital Center (WHC). This boutique interventional cardiology conference began Sunday and will continue through Tuesday afternoon with scientific sessions spanning medical and interventional cardiology, electrophysiology, and vascular research.
At yesterday's ACS and AMI Management workshop, presenters from the Washington Hospital Center highlighted its novel telemedicine pilot program, the CodeHeart Application, to aid the management and treatment of ST-elevated myocardial infarction (STEMI) patients. If successful, care innovations such as these could drastically reduce door to balloon times and heighten efficiencies at hospitals performing emergent percutaneous coronary intervention (PCI).
Through the program, hospital leaders collaborated with AT&T to create a secure network, enabling EMS staff to transmit live video containing EKG readings from the emergency ambulance to physicians' Apple iPhones for patients experiencing a STEMI. Physicians can interpret results quickly and accurately to determine whether to activate the cath lab and team should treatment with emergent percutaneous coronary intervention (PCI) be necessary. The system--using cloud technology and a single 5 MB iPhone application--downloads information using password-protected Apple iTunes software. Likewise, hospital administrators worked closely with cell phone service providers to ensure that data transmission is HIPPA compliant.
So far, the hospital has found that images are interpreted with 95 percent accuracy for patients experiencing ST-segment elevation myocardial infarction, ventricular arrhythmia, and other cardiovascular events. Further, these data can be downloaded to the hospital's electronic medical records (EMR) and movable workstations within the ED and patient rooms, expediting hospital operations. WHC is now delivering smart phones to ambulance staff, hospital cardiologists, ED physicians, fellows and several referring hospitals in Maryland that send their patients to WHC for intervention. Though an initially expensive endeavor, this telemedicine initiative has the potential to impact care in areas beyond cardiology. Additional disease states, including stroke and trauma, are areas for expansion for these programs and could result in additional clinical and potentially financial benefits in the future.
Stay tuned for more updates from Technology Insights' coverage of CRT 2011.
Awareness of chronic disease technologies and remote monitoring among not only the medical community but the general population has continued to increase dramatically, as evidenced by the recent New York Times article about implantable defibrillators ability to remotely track heart failure patients. News coverage of these devices, which are poised to significantly improve quality of life for the 6 million people in the U.S. who suffer from HF, emphasizes the shift toward patient- and consumer-focused care and highlight's the public's increasing involvement in self-managing their health to a greater extent. In the Pipeline, we've covered numerous different developments in remote monitoring, which can all be found here.
For more information about remote monitoring, continue reading after the jump, or contact me at WynnP@advisory.com to discuss how Tech Insights is tracking these devices and their effect on EP and HF strategy.
Read more »
The ACC's Door to Balloon (D2B) initiative helped establish the concept "time is muscle," showing that early intervention for patients suffering a heart attack can significantly improve outcomes. Despite huge improvements in the hospital efficiencies in treating heart attack patients, however, individuals often wait too long to seek medical attention. A new implantable device presented this Wednesday at the 33rd annual scientific sessions for the Society for Cardiovascular Angiography and Interventions (SCAI) could help close the gap between symptom onset and medical attention by providing a clear alert to the patient that he or she is suffering a heart attack.
Angel Medical Systems' AngelMed Guardian is about the size of a pacemaker and is implanted into the chest and connected to a lead that is attached to the heart. The lead provides electrogram measurements that are constantly compared to a stored copy of the patient's normal electrogram. Any potentially dangerous shift in ST segment causes a series of alerts--the device itself buzzes inside the patient's chest, and an external hand-held telemetry device beeps and flashing LEDs.
Read more »
The remote monitoring of EP devices has grown considerably in recent years. Today, hundreds of thousands of patients are implanted with cardiac rhythm management (CRM) devices that are capable of being monitored remotely (i.e., outside of a device clinic). The operational advantages of remote monitoring are obvious and easily demonstrated: a remote device-check takes less than half the time as an in-office check and eliminates 50 to 75 percent of clinic visits for routine check-ups. For these reasons, electrophysiologists have been quick to adopt the technology.
With the operational advantages well-understood, physicians are now trying to determine the clinical advantages of the technology. Today in Atlanta, Dr. George Crossley presented findings from the Clinical Evaluation Of Remote Notification to Reduce Time to Clinical Decision (CONNECT) trial. The trial used a wireless remote monitoring and notification system available through Medtronic's Conexus-enabled ICDs and CRT-Ds and compared its use to standard in-person clinic visits. The study showed that remote monitoring with automatic notification cut the time to clinical decision making by nearly two-thirds.
The largest randomized, prospective study designed to quantify the advantages of remote monitoring with automatic notifications, CONNECT followed nearly two thousand ICD and CRT-D patients at 136 sites in the United States. Data from the study showed a sizeable reduction in the time between the onset of an arrhythmic problem and a clinical decision on how to manage it (an average of 29.5 days in the standard-care group vs. 10.5 days in the remote-monitoring group). There was also a reduction in length of stay (LOS) for remote-monitored patients that had to be hospitalized, which Dr. Crossley estimated resulted in hospital savings of approximately one million dollars.
One interesting aspect of the remote-monitoring data was the gap in time between a notification and a clinical decision, which could be as long as 4 to 5 days. Dr. Crossley suggested this may show a 'Laissez-Faire' attitude among physicians to respond to data, but it may also reflect that the data does not carry an imperative for immediate action. We often hear complaints about data overload, a complaint that will only grow as more and more devices start transmitting an endless stream of bits and bytes. Could it be that the speed of data transmission may have out-paced its clinical need?
This article in The Economist really caught my eye this morning. Some pharmaceutical companies are beginning to bridge the gap between drugs and technology with so-called "smart pills" that are able to relay feedback after being swallowed. Once one of these pills hits the stomach, the acids activate the communication technology to send wireless signals through the body to another chip embedded in the skin. The skin patch can then wirelessly upload data to a smart phone or an internet site for physicians. Physicians can use the data to track whether the patient is taking the right meds at the right time and may also potentially track adverse reactions.
The Economist notes that some major pharmaceutical companies, like Novartis through their purchase of the start-up Proteus Biomedical, are pursuing this strategy to make up for the fact that many lucrative drugs have patents about to expire.
While this technology certainly is interesting by itself, I think it speaks volumes to where health care is headed. I've blogged a lot recently about how remote monitoring is beginning to play a larger role in the care of patients with chronic disease. While in TI our research focuses more on biotech than on pharmaceuticals, we do of course often track how advances in pharma may impact hospital-based business. As chronic disease management is often greatly concerned with adherence (or lack thereof) to pharmaceutical protocols, these "smart" pills may one day play a large role in the continuing management of these patients. There are obviously concerns, though, with a "big brother" type mentality associated with watching patient adherence to medical protocols. The article has a lot of interesting perspectives--I'd encourage anyone with a few extra minutes to read it.