Personal Health Technology and Covid-19
During the Covid-19 pandemic, millions of people are staying at home to practice social distancing. However, at a time when people might be more concerned about their health than ever, they may be reluctant to go their doctor or hospital for fear of infection. Fortunately, in recent years personal health technology and telemedicine have enabled people to monitor their health at home and communicate electronically with their healthcare provider.
Personal health technology refers to medical devices that can be used at home by people to monitor their health. Telemedicine refers to electronic communication usually through a secure internet connection between a patient at home and a remote healthcare provider. This combination of personal health technology and telemedicine enables a patient and doctor to continuously monitor and manage a patient’s health in real time at home. In a recent article in the Wall Street Journal Luciana Borio and Scott Gottlieb write: “A rapid expansion of telemedicine would promote social distancing and free up resources to care for Covid-19 patients.”
Also, Governor Ducey of Arizona in Executive Order 2020-15 “Expansion of telemedicine” recently extended insurance coverage to telemedicine in Arizona. The order states that “…in-person visits with healthcare professionals may increase the risk of Covid-19 transmissions“ and “…the CDC recommends that health insurers and providers promote the availability of telehealth services.“ https://azgovernor.gov/executive-orders
Personal health technology and telemedicine can improve the quality of health care, increase access, lower cost, save time, conserver medical resources, and avoid exposure to infection. For example, if a person is quarantined at home because of Covid-19 but has access to personal health technology and telemedicine, body temperature could be monitored with a contactless thermometer to prevent contamination. Blood pressure, pulse, and even EKG could be obtained with an automated digital machine. A smart scale could accurately measure body weight to detect possible dehydration or fluid overload. Blood oxygen could be checked with a pulse oximeter even while sleeping. If there is wheezing or a history of asthma or COPD, lung function could be assessed with a hand held spirometer. If there is concern for developing pneumonia or congestive heart failure, a digital stethoscope could record lung and heart sounds. Furthermore, all these results could be sent to a person’s healthcare provider. Thus, someone could be continuously monitored at home and not have to travel to a clinic spending hours in a waiting room at risk for infection.
It is important that health data obtained at home be sent to a healthcare provider for interpretation. Fortunately, most personal health devices have the capability to bluetooth data to a smartphone or upload to a computer for transmission to a healthcare provider. People without medical training should not attempt to interpret the results themselves. Their doctor should counsel them regarding the appropriate ranges for results, and provide clear guidelines for when to contact the physician.
Personal health technology is also useful when there is not a pandemic or viral outbreak like influenza. People with chronic health conditions such as high blood pressure, diabetes, or asthma could benefit from more frequent monitoring of these conditions at home rather than only every several months at a clinic. An important change in condition could be detected earlier, hopefully before becoming more severe, and treatment adjusted by their physician on a timely basis.
In the paragraphs below specific personal health technology devices that I am familiar with will be highlighted. All of this equipment is FDA approved or cleared, user friendly, relatively inexpensive, and most can connect to a healthcare provider
TytoCare is a FDA cleared telemedicine device that consumers may purchase for their home and use to connect to a healthcare provider. The kit consists of a high resolution exam camera, no-contact thermometer, otoscope adaptor for examining the ears, stethoscope adaptor for heart and lung sounds, and tongue depressor adaptor for the throat. A guided exam with a doctor can be conducted through the TytoApp on a smartphone or the exam can be recorded and shared with a provider at a later time.
With this device and its adapters, a remote physician can assess skin, ears, throat, lungs, and heart. The physician may be able to make a diagnosis,
order further testing, provide recommendations, and initiate treatment including prescriptions if needed, while the patient remains at home.
For example, if a person is quarantined or unable to leave home, and concerned about possible pneumonia, a healthcare provider can listen to lung and heart sounds via the stethoscope, and measure lung function and blood oxygen to aid in diagnosis and treatment. Similarly, a person with heart disease can be assessed for congestive heart failure at home. A child’s ears and throat can be examined remotely by a physician in order to diagnose an ear or throat infection, who then can order a throat culture and/or antibiotics if needed.
The guided exam may be performed by a person’s personal physician if the physician has the professional TytoPro device in their clinic to communicate with the TytoCare device at home. If the personal physician does not have this device or does not want to practice telemedicine, a person can obtain an online video consultation with a licensed network physician 24/7. Tyto uses a HIPAA-secure platform that only the patient and the doctor can access. According to the Tyto website, Tyto works with qualified and experienced physicians around the country. Each doctor goes through a rigorous selection process to become a part of the network. The charge for a physician consultation is $59.99 or less.
TytoCare is for sale by BestBuy. https://www.tytocare.com/. It is HAS/FSA eligible.
If a person has a chronic lung condition like asthma or COPD, or is concerned about pneumonia, it may be useful to monitor lung function at home. Two ways to do this are measuring blood oxygen saturation with a pulse oximeter, and measuring FEV1 (forced expiratory volume in one second) with a spirometer.
The pulse oximeter is often placed on a fingertip and uses light that passes through the finger to measure the percentage of oxygen in the red blood cell.
One such pulse oximeter is distributed by Proactive model #20110. It is intended for clinical use as well as for sports and exercise. The Proactive oximeter measures oxygen saturation between 70—100% with an accuracy +- 2%. It also measures pulse rate between 30-250 with an accuracy of +-2%, and indicates finger blood flow with a plesthmogram. Some pulse oximeters are cleared by the FDA only for healthy people during exercise. https://www.bettymills.com/finger-pulse-oximeter-proactive-medical-20110
Lung function can be tested with a MIR Smart One Personal Spirometer. Although not designed for a clinical environment, this device is FDA cleared to be sold over the counter. It can be ued at home to measure peak air flow velocity and volume during a one second rapid exhalation. A person connects the device to a smart phone with bluetooth and blows forcefully into the device. The results are displayed in real time on the smart phone and can be sent to the doctor. It is useful for monitoring changes in lung capacity due to asthma or COPD and other lung conditions, and can provide early warning of a change in condition.
A non-contact thermometer uses infrared technology to measure body temperature usually from the center of the forehead without touching the skin. Thus, it does not disturb a sick person and the thermometer is not contaminated. One such device is the iHealth No Touch Thermometer, which can measure temperature in one second if placed within 3 cm of the forehead and displays the results on its screen. It is cleared by the FDA to be used for children and adults. It is accurate to within 0.3 degrees centigrade.
Blood pressure and EKG
Covid-19 may affect the heart.
https://www.ahajournals.org/doi/pdf/10.1161/CIRCRESAHA.120.317055 The Omron blood pressure (BP) and EKG device is able to take blood pressure and also record a single channel EKG. The EKG is obtained by placing fingers on metal pads on both sides of the machine. The EKG tracing is immediately interpreted and displayed on a smartphone app, which can send the results to a healthcare provider through the app. It can thus detect changes in blood pressure and abnormal heart rhythms such as atrial fibrillation. Omron also sells BP machines without the EKG function, and even watch-like devices that measures BP at the wrist.
It is often advisable to monitor weight carefully during illness. Rapid weight changes may indicate fluid loss from dehydration or fluid overload from congestive heart failure or kidney dysfunction. One smart scale is the OMRON Body Composition Monitor and Scale with Bluetooth Connectivity. Using bioelectric impedance, it measures and displays body weight, body fat percentage, visceral fat (up to 30 levels), skeletal muscle percentage, resting metabolism (in kcal) and body mass index (BMI). The data can be transmitted to and stored on a smartphone.
Also, many elderly people lose muscle mass with aging, which is termed sarcopenia. This can cause weakness and falls. Sacopenia can be treated with diet and exercise, thus improving health and safety. A smart scale that measures muscle mass can detect sarcopenia and monitor response to therapy.
In people with diabetes blood glucose often fluctuates more than usual during illness. Stress, inflammation, and decreased exercise might cause glucose to rise, but poor appetite might cause glucose to fall. Thus, it is particularly important to monitor glucose when ill.
The Dario glucose meter is a particularly user friendly glucose meter. It is pocket-sized and thus unobstrusive. It does not require coding, needs only 0.3 microliters of blood, and displays results is less than 6 seconds. It works with a smartphone app to record blood glucose and send results to a healthcare provider or family member. It has a built-in emergency low glucose alert with GPS location for peace of mind. A premium membership is available that offers expert guidance from a certified diabetes educator.
According to David Simmons MD, who is a former Chief Medical Officer, Bayer Diabetes Care:
“In the context of the coronavirus and flu threats, it is critical for individuals living with diabetes and heart conditions to minimize their contacts with others and to avoid public spaces. They should do it for themselves as well as to contain the spread of the virus. In this context, DarioHealth, as a leader in digital therapeutics, is providing the best, most comfortable solution for its community of 46K customers. Through virtual interactions with practitioners and home delivery of supplies, Dario makes this challenging situation less of a burden. It allows them to stay within the protection of their home and to minimize their risk of infection while very efficiently taking care of their condition and monitoring their health.”
David Simmons MD
When monitoring health at home during this pandemic, be aware of symptoms of Covid-19. According to the CDC these include but are not limited to fever, cough, and shortness of breath.
If you develop emergency warning signs for COVID-19 including trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, and bluish lips or face, get medical attention immediately. Please consult your medical provider for any other symptoms that are severe or concerning.
Traditional medical care is costly, time-consuming, intermittent, and during an epidemic potentially dangerous because of the risk of infection. Personal health technology and telemedicine can provide medical care to people at home when they do not require physical examination by a physician, lab and x-ray testing, or hospitalization. Costly and time consuming visits to a clinic or emergency room might be avoided, and more severe illness may be identified and treated sooner. At a time when there is risk of infection, and clinic and hospital resources are stretched thin, personal health technology and telemedicine can play an important role in personal and public health.