Can remote monitoring make for a healthier pregnancy?

Kathryn Marko MD, Assistant Professor of Obstetrics and Gynecology, Residency Program Director, GW School of Medicine; Nihar Ganju MD, Instructor of Obstetrics and Gynecology, GW School of Medicine; Anish Sebastian, Co-founder/CEO, Babyscripts; and James - Print  | 

IoT meets medicine, and pregnant mothers win

Due to the burgeoning phenomenon known as the Internet of Things (IoT), the wireless exchange of digitally encoded data is beginning to pervade the everyday lives of the average person by way of Internet-connected devices. Information technology is no longer limited to businesses seeking efficiencies for a specific set of corporate functions. To the contrary, IoT has enabled the collection of data that is relevant to the everyday activities of individual people, such as daily activity (Fitbit), thermostat monitoring (Nest), and even one's refrigerator's contents (Samsung's Smart Fridge). Every aspect of daily life is being digitized and analyzed in such a way that it seamlessly helps people to understand and efficiently manage their lives.

But what does this mean for healthcare, an industry that tends to change slowly? Given the recent paradigm shift towards "value-based care" (as exemplified by the Affordable Care Act), the healthcare system is being creatively reinvented to improve quality, expand access and reduce costs. The advent of IoT technologies affords an incredible opportunity to achieve this so-called "triple aim" of value-based care. Whether it's biosensors or mobile apps, there has been slew of technological innovations that are enabling physicians to digitize all aspects of someone's personal health, while deriving meaning from this data in real time.

From the perspective of value-based care, here are the key benefits of IoT:

1.) Improved outcomes. By establishing a digital monitoring environment, these devices enable providers to collect patient vitals remotely from a patient's home or work. With this high-resolution data, such real-time monitoring might further facilitate early diagnosis and intervention. Consequently, physicians will be enabled to provide higher quality of care with improved outcomes.
2.) Precision care. As with most technologies that have been developed in human history, IoT provides an opportunity to create operational efficiencies for even the most sophisticated hospital system. Through remote collection and analysis of biometric data, patients will be able to visit their provider less. Armed with accurately collected and meaningfully analyzed data, healthcare providers are enabled to tailor the timing and content of their patient's in-person visits, according to their unique medical needs.
3.) Expanding access to care. Because the ease-of-use and ubiquity of smartphone technologies and internet-connectivity, IoT devices will help expand access to care by bringing high quality care to at-risk patient populations.

A real-life example might help to illustrate the point. A 33-year-old Hispanic woman, married with one child, presented at the clinic of an urban academic medical center for the verification of pregnancy. Her pregnancy was confirmed at seven weeks, six days. Her first pregnancy was complicated with preeclampsia at 40+ weeks, a life-threatening condition that required increased blood pressure monitoring during her current pregnancy. However, as a working mother in a two-income household, the clinical requirement for an increased frequency of prenatal and postpartum care proved to be burdensome.

Given her situation, she was placed on a tailored prenatal care plan that consisted of an optimized in-clinic visit schedule and an integrated technology platform. The alternative schedule for her prenatal care consisted of 8 in-clinic visits, as opposed to the traditional 14 visits. Provided by a mobile/digital health firm, Babyscripts, the technology platform incorporated prenatal education and remote patient monitoring by way of a mobile app on her smartphone and two Internet-connected devices (a wireless weight scale and wireless blood pressure cuff). The platform also included data analytics software to identify aberrant data points thereby enabling the early detection of certain high-risk conditions, such as preeclampsia. In the event of a "trigger" (an abnormal data point potentially indicative of a high-risk condition), both the patient and provider are immediately alerted so as to resolve the situation. Thus, for this patient, instead of frequently going into the clinic simply to have her weight and blood pressure readings taken, she only had to go into the office for her core prenatal tests, such as the genetic test and the anatomy ultrasound. Ultimately, by way of IoT technologies, the Babyscripts program enabled this patient to safely participate in her prenatal care without excessive disturbance to her busy life.

Not only did the program enable a more convenient delivery of her prenatal care, the technology also helped to identify a high-risk condition for this patient. Her prenatal course was routine without complications. She had a normal spontaneous vaginal delivery at 39 weeks, 6 days, and was discharged the next day. However, the patient had abnormal blood pressure in the time between her delivery and her scheduled post-partum visit to the doctor's office. On postpartum day five, the patient generated an "elevated" blood pressure > 140/90. The aberrant value was identified by the remote monitoring platform "trigger alert" system. The system alerted the patient who was asked preeclampsia-based symptoms questions and notified to re-check her blood pressure within 30 minutes, all of which were normal. Four hours later, the patient generated another elevated blood pressure. Upon re-taking her blood pressure, the patient generated a "critical" blood pressure, which led to an immediate trigger alert call to the triage line of her clinic. The clinic called the patient, gave precautions and advised the patient to go to the hospital. On postpartum day six, the patient arrived at the hospital for evaluation and was admitted for monitoring and management of postpartum preeclampsia. Two days later, the patient was discharged and received a prescription for an anti-hypertensive medication, Nifedipine. After discharge, her blood pressure readings normalized and the patient is no longer displaying symptoms of preeclampsia.

This is prime example of how technology can be used to improve the lives of patients and facilitate healthcare systems to achieve the triple aim. This patient did not have to see her doctor as much as usual, and yet a life-threatening condition was identified and treated in a timely fashion. Paradoxically, despite the decreased frequency of care, she was more connected to her provider by way of the Internet-connected devices. Thus, care can be delivered more efficiently without sacrificing outcomes, and this can be accomplished through the power of technology.

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