70 Years Later and 1000 Times Smaller
It took 70 years and a 1000-times size reduction to bring a high-end diagnosis tool to the patient, instead of the other way around.
The digilog project showed, that it is not only possible to make Arrhythmia Risk Diagnosis more comfortable for the patient and conclusive for the doctor, but to bring it straight into the daily lives of said patients and carry it out almost completely unnoticed by them.
The first successful data transfer of biological signals was carried out in 1949 by an American researcher by the name of Norman J. Holter. To do this, he used a homemade machine weighing 45 kg, which he carried on his back.
By the 1950s, this technology was already being used in clinical environments. In Germany, similar technology made its first appearance in 1965. Today, the regular recording of ECGs and the automated examination of possible Arrhythmia is a standard process in Germany, implemented over a million of times every year, in order to provide the most patient-relevant therapies.
Today’s challenges are somewhat different. The questions that we must answer are:
How can we continue to meet the high demand for state-of-the-art diagnosis and health risk reduction in patients in all risk groups, without compromising the capacity and financial limits of our healthcare system?
How can we bring the technological solutions that we already have and use to the patient instead of the patient to the device?
Und genauso wichtig:
How can we ensure that specialists can treat more patients, regardless of where they are geographically?
There is a need to bring adequate, specific and practical solutions to today’s problems with the means of our age. One such problem is atrial fibrillation, which is one of the most common causes of stroke, and as such, it is a high risk for the person affected as well as a very high financial risk for the health care system. Another problem is that of palpitations, which can cause anxiety and consequently leads to time-consuming and possibly expensive, but likely unnecessary trips to the healthcare facilities. These are all challenges that are becoming increasingly relevant for an ageing population.
These challenges have motivated the team at AthenaDiaX (Start-up, founded 2012) to bring a technical solution for Arrhythmia diagnosis to the market, which can provide not only health-related clarity and security to those affected, but can also do it “everywhere”, at “any time”, without breaking the bank.
Through the digilog project, the clinical use of this system in a decentralized care provision structure was demonstrated. The developed system includes a sensor, which is stuck directly onto the patient’s chest and, for 7 days straight, records and documents the patient’s ECG, activity, body temperature and skin impedance. In addition, the system has an accompanying diagnosis software, cloud-based data storage and a data telemetry system. The recorded data are sent securely and encrypted through an internet connection to a specialist that analyses it. Then, the assessed results are sent back over the secure internet connection straight to the patient’s local GP. As such, patients suffering from Heart Arrhythmia can receive a full diagnosis and associated care entirely locally, without leaving their hometown. This closed-loop of care provision uses the GP as its central point of contact for the affected patient. Furthermore, this system allows for ECG data seven times longer than that of a typical Holter examination, and as such can provide a far more reliable diagnosis. The instantaneous sending of the results from a team of specialists to a local GP makes a quick therapeutic intervention possible.
Through a clear focus on the implementation of the system, the AthenaDiax team was also able to achieve a significant cost reduction. Through the empirical experience of the digilog project, it can be confidently said that the total cost of a clinical routine procedure is no higher than the average transport costs of bringing a patient to a specialist.
8 GP practices in a radius of 60 km around the specialist diagnosis Center (eHealth Center) participated in the digilog project between April and December of 2018. In total 382 patients, now over 400, were examined using the system. The total duration of recorded data comes to 26,613 hours. Furthermore, 82 patients were continuously observed for a total of more than 170 hours. The remaining 300 patients were observed for an average of 48 hours. This is the equivalent of 1,109 long-term Holter ECG examinations.
During the course of the project, it became evident that transferring big data (24 hrs equate 120 MB) securely and consistently even on a slow internet connection requires certain measures to be taken. For IT specialists, this is no new discovery. However, there has been no situation in the medical realm to date, where such quantities of data had to be transmitted for routine processes. An effective and tested technical procedure normally used in IT fitted to this specific use case could solve this problem.
The most important highlight of this project was the high rate of acceptance amongst patients. This acceptance confirms first and foremost that wearing the product is both comfortable and has little to none interferences to the patient’s daily life. Equally important however, is that having the possibility to be entirely treated by your own GP is a significant plus for patients suffering from Heart Arrhythmia.
This system has been able to prove itself proficiently capable in the medical world. It is accepted by doctors and patients alike. The existing infrastructure for internet connection in the test region of Northwest Brandenburg is good enough for this particular use case. Finally, only through the combination of the technology attached to the patient, the incorporation of the patient’s GP and secure and encrypted transmission of data (and the analysed results) to and from the eHealth Center is the full potential of this system realised and made apparent.
If we assume that the current need for long-term ECG monitoring can be met with this new system, the question to be answered remains; which patients can benefit from this technology? To answer this, targeted clinical trials need to be carried out to determine whether this system has benefits for patients with other heart-related diseases, particularly heart failure. Minimising the time spent in data handling particularly in the eHealth Center, remains an ever-important task.