Health reform is outpacing information technology, and a disconnect has occurred. Recently a patient discussed a difficult diagnosis that defied diagnosis. She had breast cancer removed over 8 years prior to her developing shortness of breath, fatigue and other symptoms that affected her normal activities. She noticed her gradual recovery from breast cancer had taken a reverse course. She saw a number of cardiac specialists, other providers, did internet searches and analyzed what was occurring. She consulted many sources of information to no avail.
All her tests and examinations were within normal limits, and she left each visit hearing that "all is normal" She was well off financially and had invested in many consumer devices such as a Fitbit, Apple Watch, and a KardiaMobile monitor. or KardiaMobile6L FDA-cleared, clinical grade personal EKG monitor. KardiaMobile captures a medical-grade EKG in 30 seconds anywhere, anytime.FDA approved) (compatible with iPhone and Android This device attached to a smartphone and could display an EKG. The KardiaMobile6L produces a full six lead EKG which can be interpreted by a physician. Omron provides many remote BP monitors that record measurements, as well as EKG in one unit.
Alivecor EKG sensor
Omron BP and EKG Sensor and Recorder
Our cancer patient used all these devices including a number of blood pressure cuff which she calibrated against her physician's office manometer.
For each physician encounter, she would bring the record with her, but there was no means to enter the data into her own electronic health record from home. When another physician looked at her EHR there was no record of her home monitoring. EHR vendors are quickly adding this feature to their systems.
She discussed her symptoms with a friend who told her about a friend who had identical symptoms and was diagnosed with dysautonomia. She then discussed this with her physician, who reviewed the data and her history again, agreeing that was the most likely diagnosis. The patient devised her own dietary modification, adding salt to her diet when she excercised. Her symptoms abated.
The takeaway here is that the patient owned her diagnosis and made a considerable effort. Her collaboration with her doctor is the near-perfect example of patient-centered medicine
A number of manufacturers have designed smartwatches to measure BP and/or EKG
Omron Watch
Smartwatches are a compromise at best, for the time being. The addition of vital sign monitoring to a watch that tells time, messages, facebooks, weather reports, internet access, and phone capability is a stretch.
You want the best of the best and don’t mind paying for it.
Our pick: Apple Watch Series 5 ($400-$1,500)
More advanced features, like LTE connectivity and NFC payments, still work without a hitch. The only downside is battery life is still pretty short at an estimated 18-hours. However, in testing, we found the Series 5’s battery isn’t likely to run out on you before you make it home.
There is a multitude of EHR vendors designed for specific practice types from enterprise systems for large entities, universities, Mayo Clinic, VAH, and others, while smaller systems are designed for small groups or individual practices.
You may want to consult with your physician or the IT department of the large enterprise at which you receive care. Things change rapidly, try before you buy
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