CHEYENNE — People are wearing, carrying and using more technology and devices than ever, and many of them have the ability to monitor a person's health to some degree.
Apple Watches and Oura smart rings, for example, promise to accurately track heart rate, blood pressure, blood glucose, sleep stats — or in some cases the lack thereof — and so much more.
But so far, the medical community hasn't fully embraced this treasure trove of health data on their patients. Doctors aren’t asking us for it. Neither, so far, are insurance companies pushing them to ask for it.
Industry experts cite everything from privacy concerns to questions about the data’s accuracy.
The latter is getting a closer look thanks to a partnership between Apple and Stanford Health, which will take a deep dive with 400,000 users into how well Apple’s wearable health gadgets stack up.
But even if accuracy is proven, that doesn’t mean there are processes and systems in place to accept such data into a clinical setting.
That’s what Anthony Schirer, the executive director at Cheyenne OBGYN, discovered when his clinic started to rethink its blood pressure monitoring for high-risk pregnancies, which needs to happen on a daily basis, and sometimes twice daily.
“Oftentimes, we have patients driving from long distances,” Schirer said. “I think probably our longest distance is either Casper or Saratoga.”
For those patients, a way to monitor blood pressure without going into a clinic that’s three to four hours away is a game-changer.
Schirer and his team quickly found there are a lot of moving parts when it comes to integrating that kind of idea into a clinical setting.
“There’s a cost to buy all this equipment and have an inventory of all this equipment,” Schirer said. “And most likely I would need to have, like, a dedicated triage staff that was 24/7 data monitoring, which I think that could just be overloaded. ... We’d have to figure out some type of software system to monitor all that information.”
No Need To Reinvent The Wheel
The deeper Cheyenne OBGYN dove into what was involved, the more they started to question doing such a program themselves.
Hypertensive disorders of pregnancies are a leading cause of maternal deaths every year, claiming the lives of more than 50,000 mothers worldwide and more than 500,000 babies, making the effort too important to give up on.
Then the clinic discovered a company called Babyscripts, which has already set up a system that includes everything a clinic would need to integrate remote blood pressure monitoring into its practice, from enrolling at-risk mothers to advocating for them with their doctors.
“They have a dedicated staff of care managers who follow up with the patients constantly,” Schirer said. “And so, the continual monitoring, as long as the patient is compliant and monitoring their own blood pressure daily, then the assistance that Babyscripts provides to the patient just really streamlines that clinical workflow.
"And it truly frees up the patient from having to come in here all the time.”
More than just that, Babyscripts will advocate for patients with their doctors if they start seeing concerning trends with the patient’s blood pressure.
“They have access to reach our physicians 24/7,” Schirer said. “We’re on call. So, at any time they can call up and say, ‘Hey, you know, I have this patient here who their blood pressure is just, we’ve tested it X number of times.’
"And then they can talk about well, maybe it’s time to send them to the hospital. So, it’s just a really interesting and neat way of providing care to the patient and trying to also make it convenient.”
The service even came with an educational app called My Journey, which helps guide the clinic’s patients through their pregnancies. The app itself is so beneficial, the clinic provides it to all of its patients, not just those with high-risk pregnancies.
Welcoming Ari Nishida Into The World
Leina Nishida, a 32-year-old from Cheyenne, is a new mom with a healthy baby girl named Ari. Nishida credits the Cheyenne OBGYN’s new remote health monitoring approach for that.
Nishida is a kidney transplant recipient, making her pregnancy particularly high risk when it comes to hypertensive disorders.
Regular blood pressure checks, up to twice per day, were key, for both her health and the health of her baby.
“The monitoring program would call my doctor and just kind of advocate for the fact that my blood pressures have been high,” Nishida said. “And I feel like that really helped get the care I needed because they did, eventually, I did eventually have my baby a month early for the preeclampsia and everything went really well.”
The peace of mind the remote monitoring system brought, and the convenience of not having to drive into the clinic twice per day to test her blood pressure were huge.
The device was also easy to use, Nishida added.
“You just pull it on, and it tightens on your arm without having a second person to put it on your arm for you,” she said. “And then there’s a little device that’s maybe half the size of an iPhone that pumps up the cuff. Then it talks to your phone. As soon as you take your blood pressure, the reading goes straight into the app, and the nurses who watch the app can see the results.”
Why Isn’t There More Wearable Tech In Health Care?
Regulatory bottlenecks are among the challenges remote health monitoring devices face as they look to integrate themselves into the medical ecosystem, Babyscripts founder and CEO Anish Sebastian told Cowboy State Daily.
“Whether it’s like an Apple Watch or an Oura ring, these are consumer devices,” he said. “When you start applying these consumer devices for medical, clinical decision making, it raises the bar. There’s an additional kind of regulatory clearance that you need to go through.”
That, like any drug or medicine or even procedure, requires clinical trials to prove out the accuracy and usefulness of the data, as well as how it would be clinically applied. That’s the kind of data both doctors and insurers would want to see before incorporating wearable health technology into their programs.
But even if doctors themselves were just curious and wanted to look at the data, there are also lots of questions to answer, ranging from reimbursement for time spent, as well as responsible application of such information. There are no clear guidelines as yet for clinical applications.
Many doctors already have so many patients, they have little extra time to sort through and consider such things on their own.
“It’s like this new thing that they’ll have to understand and really appreciate the end value of this from a clinical standpoint,” Sebastian said. “It takes time for it to disseminate.”
To get Babyscripts remote blood pressure monitoring going, Sebastian said the company had to engage in clinical trials, as well as work with actual clinical practices on the ground to develop the right workflow, training protocols, and other best practices.
“That’s some of our job, is to be this tip of the spear,” Sebastian said. “The Oura rings of the world, those companies need to do a better job of either partnering with other companies or they themselves really educating on the clinical value of this. I think that’s for them to do.”
Wearable Tech Could Be Big Boon To Rural Wyoming
Schirer does expect to see more remote monitoring systems come along eventually, and his clinic is already exploring the possibility of adding a different remote monitoring program related to postpartum depression.
“Remote patient monitoring is like a telehealth thing,” he said. “So, they might have other things like, if a patient, and I don’t know what this technology would look like exactly, but like your blood glucose levels if you’re diabetic. I’m not a clinician, I’m just the business manager, but they’re often doing a little finger prick daily to test their blood glucose levels. So that might be something, I suppose, in terms of remote patient monitoring that I think one could easily set up.”
The approach could be a huge boon to Wyoming, Schirer added, given that so many rural areas lack access, causing patients to drive hours for routine tests and monitoring.
“I’m sure you’re going to see a lot more of this remote patient monitoring,” he said. “It’s just a convenient thing. And for us out here in Wyoming, who have a hard time getting to where they need to go for specialty care, I think it would be a great service.”
Renée Jean can be reached at renee@cowboystatedaily.com.
