Personal Medical Monitoring
Home medical monitors, such as those for blood pressure, have become a common presence in the personal health-care arsenal. But as with exercise equipment, many people neglect to use them. New ways to track and store the information gathered by such monitors online could make it easier for people to review and share test results, in turn perhaps changing the way that chronic conditions are managed.
“This kind of technology is going to fundamentally transform the definition of the practice of medicine [so that data can be gathered] not just at the physician’s office or hospital bed, but wherever the patient happens to be,” says Martin Harris, chief information officer at the Cleveland Clinic, in Ohio.
One option for tracking health measures at home is Microsoft HealthVault, an online personal health-record service that is compatible with a growing number of home health monitors. Data from these devices can be uploaded directly into a patient’s HealthVault record, where users can then create a handy graph of their blood pressure, weight, blood sugar, or other data, and share it with their doctors or family members.
As a prime candidate–I rarely remember to take my blood pressure at home, let alone bring the slip of paper that the measurements are written on to the doctor with me–I decided to test out the system. After opening a free HealthVault account, I ordered a few devices from Microsoft’s compatible list and installed software for the HealthVault Connection Center, which manages the different devices and uploads data directly into your health record.
Blood pressure is one of the most common–and most important–health measures taken at home. “Most people’s blood pressure is not well controlled,” says Eric Topol, a cardiologist and director of the Scripps Translational Science Institute, in La Jolla, CA. “And you really need to have multiple readings from different times of day to get a handle on an individual’s blood-pressure patterns.” According to Topol, I’m not the only one with lax recording habits. “In most cases, when I ask patients to take their blood pressure, I’m lucky if I get a few readings,” he says.
My doctor is definitely going to be impressed at my annual appointment next month, thanks to the Omron blood-pressure monitor ($129.99) that I tested. (While the price tag is considerably steeper than the $50 drugstore monitor I have at home, I was so satisfied with the results of this trial run that I am considering buying one for personal use.) It works just like any other cuff-based monitor, but it stores readings, along with the time and date, and can track data for two different users. It connects to the computer through a USB port, and the click of a button uploads any new blood-pressure readings. The data appears in my HealthVault record as a list or a graph, showing date, heart rate, and systolic and diastolic measures.
While being able to monitor one’s health is empowering, physicians say that it’s the potential to integrate the home and the doctor’s office that could transform health care, allowing medical staff to monitor certain conditions remotely. “Normally, I might bring someone back at six weeks or six months to make sure their medication is working,” says Philip Hagen, a physician at the Mayo Clinic. “But once we have a level of confidence that a patient has a good-quality device and is using it properly, we can do a lot of care at a distance. I might be able to avoid a doctor’s visit for them.” The Mayo Clinic launched a free software program this week, available to anyone, that piggybacks on HealthVault, integrating health history and data from medical monitors and providing reminders about vaccinations and other preventative measures. (Unfortunately, the electronic medical record system used at my doctor’s office does not currently interface with HealthVault, so I’ll have to print out the graph and bring it in or log on to HealthVault in her office.)
The Cleveland Clinic started a pilot program last fall, using HealthVault in conjunction with different devices to manage three chronic conditions, including diabetes, heart failure, and hypertension. (Other compatible devices include blood-sugar monitors; a peak-flow meter, which is used to measure an asthmatic patient’s ability to push air out of the lungs; a heart-rate monitor; scales for measuring weight; and a pulse oximeter, which is used to measure oxygenation of the blood.) Scientists will keep track of how effective the system is at changing both treatment and patient outcomes. “We want to gather information in near real time and, more importantly, act on the results of that information in a more continuous fashion,” says Harris. “The goal is to produce better control of blood pressure and diabetes.”
Motivated patients who don’t have access to this kind of program can use a number of applications available through HealthVault to manage specific conditions, such as a tool from the American Heart Association that allows patients to manage blood pressure, blood glucose, cholesterol, weight, nutrition, and physical activity. While many of these same tools are available in HealthVault, Sean Nolan, chief architect of the Microsoft Health Solutions Group, says that in the long term, HealthVault will function more as a database for storing applications, while third-party applications will help patients organize and act on it.
While I’m excited about this new way to track my blood pressure, it’s not yet clear if I represent the average patient. Topol’s team is collaborating with HealthVault on a genomics project at Scripps in which all 4,000 patients participating in the study opened HealthVault accounts. They all entered medical data into their record with the help of their physicians, but he says that few continually enter blood-pressure and other information. “It’s not easy to get people to use HealthVault in a religious way,” Topol says. “A lot of people set it up, but they are not good at putting data into it and keeping it updated.”
Topol says that such home health monitoring tools are a step in the right direction, but they are not enough. “It relies on a patient stepping on the scale or putting on the blood-pressure cuff,” he says. In the future, he says, Band-Aid-like sensors on the skin might monitor blood pressure or heart rate continuously. “You don’t have to do anything to get the reading–that will be a quantum jump,” he says.
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