Mobile Health Application Solutions

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Raja Selvaraj, JIPMER

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e-health

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Dual core - 1.2 GHz (x 200) 16 GB RAM (x 1000,000) Rs 3100 250 gms

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m-health

Software (apps)

  • For providers - Drug information, medical information, guidelines
  • For consumers - Medical information, medication reminders, visual acuity testing
  • Patient portals - Ayushman, health records

Accessories

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Ingestible sensor

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Patient monitoring

  • Biological factors
    • ECG
    • Heart rate
    • Blood glucose
  • Behaviours
    • Activity
    • Sleep

Mobile Rhythm Monitoring

ECG with sensors

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Rhythm using photoplethysmography

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Rhythm using photoplethysmography

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Implications of mobile rhythm monitoring

AF study - self administered

  • Subjects recruited by newspaper ad
  • Using photoplethysmography
  • 12,328 patients recruited by newspaper ad
  • Two measurements daily for 7 days
  • AF identified in 1.1% overall, 11% for those older than 80 yrs

Vandervoort PM. Digital-AF. Late-Breaking Science in Telemedicine. Presented at: European Society of Cardiology Congress; Aug. 25-29, 2018; Munich.

Fibricheck

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Apple watch study

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Apple watch study

  • 4,19,297 subjects
  • Notification of irregular pulse in 2,161 (0.52%)
  • 450 of these evaluated with ECG patch (external loop recorder) for 7 days
  • 34% identified to have AF

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Pacemaker recorded arrhythmias - Preparation for the data deluge

Pacemaker detected AF

  • AHRE can indicate higher risk of AF
  • Not equivalent risk
  • Prolonged AHRE with high risk - can benefit from anticoagulation

Pacemaker detected VT

  • Device detected NSVT
  • No significant additional information in patients with LV dysfunction
  • No prognostic importance in patients with normal LV function
  • Borderline LV function ? - No suggestion of prognostic value

Future

  • More pervasive monitoring
  • Internet of things
  • Improved accuracy of detection
  • AI / automatic evaluation / classification
  • Virtual human agents
  • Physician as final arbiter
  • Use for general public questionable, but may be valuable in a vulnerable subset of patients