Paul S. • I had to re-post this after all discussions were archived today upon switching to a semi-open group. I tried to make two announcements of this impending and actual change, but LinkedIn's group announcement function, well, malfunctioned!

The original discussion comments can be found here (members-only): http://tinyurl.com/29lxfvh

Also, here are some comments by David Hoglund (http://www.linkedin.com/in/integratech) on his "Healthcare Wireless and Device Connectivity" blog:

I-Phone and EKG Application
http://davidhoglund.typepad.com/integra_systems_inc_david/2011/01/i-phone-and-ekg-application.html

Tom B. • John Maschenic wrote:

[snip]

"Changing the mindshare of licensed physicians will be a tough road. Showing them to trust this device and its measurements to be as accurate as any tool they use today will be a hurdle. It will also beg the question of great data set but what do you do with it. Who is responsible for making sense of it? If this is to be a clinical device and help folks with managing their cardiac conditions then it will require more than just the device. It will need software that can use algorithms to make sense of the data. To be able to calculate anomalies and present back to patient, physician or care giver for response."

--- I don't think it will be a challenge to get physicians to "trust" this device. The proof is in the pudding. If they look at the stored events and see a clinical quality ECG that shows atrial fibrillation, atrial flutter, ventricular tachycardia, frequent PVCs, etc. with good data quality, that will speak for itself.

--- As for "who will makes sense of it" the answer is, anyone who is qualified to make sense of it. When you consider that there are literally millions of physicians, nurses, and other allied health care professionals who are perfectly capable of interpreting ECGs (and already drooling over this device) you realize the market would be HUGE even if limited to medical professionals.

--- Consider this scenario. An acute care NP is having dinner with her husband and they notice a commotion in the corner of the restaurant. Someone is "down". She comes over and and assesses the patient. His pulse is slow and weak. Out comes the iPhonECG and she captures third degree AV block. By the time EMS arrives the arrhythmia has resolved. She says to the paramedics, "Here's my phone number. Have the ED physician call me and I'll transmit the ECG for the patient's medical record." Now, instead of being blown off as "vaso-vagal syncope" they know the patient has a significant conduction problem in his heart. You could imagine dozens of other similar scenarios.

--- I also hope this is a "shot across the bow" for established medical device companies that are keeping the cost of ECG transmission artificially inflated. To quote Ivan Rokos, M.D. (EM representative to the D2B Alliance), "It seems incredible that we can email a photograph around the world, but we haven’t yet found an easy way of transmitting an ECG to a nearby hospital." Well, there's no incentive for device companies to make it easy. Better to keep that data "locked" into a cardiac monitor/defibrillator unless you buy "STEMI Management System" which is a million dollar solution to a five cent problem.

--- What about people who don't know what they're looking at? What about laypersons who can't read an ECG? Okay, what about them? They can record their ECG when they have symptoms (like palpitations) just like they push the button on their Holter monitors now. Or, perhaps they will get online and learn how to read ECGs on their own. Perhaps they transmit their ECG to a monitoring company and have an expert over-read the ECG to see if it needs to be sent to a physician. What does it matter? It's their own electrical signals from their own heart. What business is it of ours if they want to look at it?

Tom

Tom B. • iPhonECG on Fox News videos:

http://video.foxnews.com/#/v/4487282/sneak-peek-at-latest-greatest-gadgets/?playlist_id=87485

Tom B. • From KOKO-TV News 5 in Oklahoma City

http://www.koco.com/health/26359301/detail.html

Machivei D. • Applications like these would really benefit less developed regions like Africa because so many people have phones and countries like Kenya are building up their mobile networks.

Rik W. • With 4g iPhone having both front and rear cameras it would seem a benefit if the application could allow streaming of images of patient and surroundings. Images could stream to monitoring center or pvt server for management/ archive and redirection to provider mobile device adding additional information to the stream. If location were incorporated, the mobile user would be assured of correct PSAP dispatch if required.

Chad C. • Interesting product. Some good points on how it could be used, but still missing key effectiveness possibly. Would I like to have one at some point in my bag just for the heck of it, possibly. Chest plates (Non-Looping Event monitor) have been around a very long time and have always lacked value because of the ability to catch real time arrhythmia's. Say you have severe palpitations and by the time you get the device to the chest it is over and you are in normal sinus rhythm? What then? Also monitoring AF is becoming a bigger issue. Being able to track AF burden is important in treating AF in most cases. How will this be able to do that? Can they tell a Doctor you were in AF 85% of the day at an average rate of 95? I do not believe it will be able to. Also most AF patients are A-Symptomatic, they are unaware of being in AF. This will not serve them well. I do think it is cool and if I saw one on the shelf at Best Buy someday might carry it around. If they can build in the reimbursement model MD's might have the ability to purchase and keep monitoring in house, possibly.

Rik W. • Chad how do you propose we get this real time data from the BAN to an archive where it is available for review?

David A. • Let me address all these questions one at a time. First, Chad, today clinical ambulatory monitoring is at best every 6 months (and for many plans it is covered only once a year). Sampling 30 seconds of ECG (from the Hands BTW, so much faster to record than from the chest and it is a true Lead I) several randomly timed (tell pt by text msg) in addition to current ambulatory monitoring would probably (we dont know and would have to prove it with clinical research- ongoing) improve our knowledge of a patient's rhythm status. Obviously, once a year or every six months is a significant under-sampling of rhythm and that is what is paid for because of cost today. Now that we know that around 20% of AF patients who are in SNR post ablation will revert to AF every year post ablation and that many docs are advocating cessation of anit-coag therapy 2-3 months post successful ablation, we clearly have a long term issue of patient safety. As you said, recurrence can be asymptomatic. My device would clearly (with clinical proof) provide useful supplemental data). Given that I can sell this at a disruptively low price compared to any current ambulatory monitoring tech, it is even more attractive. Rick, today we can stream data securely to our web site (where it can be reviewed or viewed in real-time using only a web browser), format rhythm strips as a pdf and print them wirelessly via AirPrint or send a secure ecg file to a monitoring service. All are not only possible but DONE. I look forward to more questions. th strongest steel is forged in the hottest fire. thanks Dr Dave Albert

Rik W. • Yes Good Dr. Heated, folded and hammered again and again. So again I ask and further display my ignorance of cardiology and the data recorded by ECG s and their ilk. "

So please excuse my repetitive questioning.

Are there thresholds which can be assigned the data and the individual which when exceeded signify an "exception" of note and a therefore a "call to action"? It doesn't matter if this recognition occurs in the handset or the server, if recognition occurs in real or internet time.

If so, does this result in feedback to the user.

David A. • We have the capability of complete automatic rhythm analysis on the device so it can call AFib (or VTach or CHBlock) and send to a monitoring service just as the current ambulatory monitors do. We have a 1GHz RISC processor that can do much more than most of the current monitors.

Jeff B. • David, great there are many skeptics around mHealth and how it can reduce the cost of health care. Bravo, this is how it is done. I will be using your product as a reference in my discussion for a while.
Jeff

Jason H. • Hi David, how about we take a break from all this medical talk for a technical question or two about your awesome device.

How does the device communicate with the iPhone, via the iPhone's connector or perhaps a short-range wireless link? If wireless which technology is used?

The recent MobiHealthNews article mentions an upcoming Android version, and they quoted you as saying: “We will make a credit card sized device that will allow this to work with any tablet, any smartphone, any laptop in the future.” Seems like this would use Bluetooth or WiFi?

Thanks!
-Jason

PS: You should partner with Skinit.com. :-)

Paul S. • Jason: Dave and I had a chat last night here in SD. The device is very sleek, lightweight, and communicates via a proprietary wireless communications methodology/protocol that works with the iPhone's wireless modes. I can't say whether it's Bluetooth, WiFi or perhaps both. Dr. Dave also mentioned that he is being inundated by people wanting to work with him and buy his product -- which is very good! I say this because he may not have the bandwidth to respond directly in this forum, hence I'm responding, albeit I am not his representative by any means!

Rik W. • There are now NFC technologies which are secure, have lower power use and greater range than BT and ZigBee and require no internal modification or dongle. If anyone is interested please contact me offline and we can discuss it.

Paul S. • Rik: Thanks for the reminder about NFC. I just Googled and found a research lab in Austria with an NFC glossary and an event I'm going ot add to my Event list:

International Workshop on Near Field Communication - NFC Congress 2011 (3rd Annual)
Organizer: NFC Research Lab - Upper Austria University of Applied Sciences
Feb 22-23 in Hagenberg, Austria
http://www.nfc-research.at/index.php?id=3

The NFC Research Lab in Hagenberg is part of the Research Center Hagenberg at the Upper Austria University of Applied Sciences. It was founded in 2005 focusing on new NFC use cases, hardware implementations and security aspects. In 2006, Austria's first NFC Trial was launched in Hagenberg providing a variety of services never implemented in a trial before.
Home page: http://www.nfc-research.at/
Glossary: http://www.nfc-research.at/index.php?id=40

Rik W. • You are welcome Paul, Gentag is using NFC in interesting ways, but the coolest I have seen is Dash 7 (not so near field) as their technology partners create secure transmission of data over greater distances with great power management.

Jason H. • Hi Paul, thanks for the info! Can't wait to hear more on Dr. Albert's device, especially the version that works with other phones/tablets besides the iPhone/iPad.

Prasanna Y. • Hi, the iPhone ECG attachment pasted here does not open. Any solution please.

David A. • Here is the mobile YouTube link: http://m.youtube.com/index?desktop_uri=%2F&gl=US#/watch?xl=xl_blazer&v=dY7ZQM5eah8

Just search YouTube for iPhone ECG.

Dr Dave Albert