mHealth: Treat or Threat?

Pieter M. Vandervoort, MD

Innovations in Medicine

Challenge 1: Technology

Real-time Monitoring in the Hospital

Challenge 1: Technology

The patient of yesterday…

The patient of today…

The patient of tomorrow…

Challenge 2: Patients of Tomorrow

NEW Medicine or 4 P’sPersonalised

PredictivePreventive

Participatory

‘One-Treatment-Fits-All’

Challenge 3: New Medicine

mHealth potential:

1. Improve Quality of Care• Prevent acute episodes• Manage chronic conditions

2. Cost-effective

3. Broaden Access to Care

Remote Monitoring in CardiologyICD device management

Therapeutic intervention to prevent sudden cardiac death

Subject

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Record Analyze

Feedback

Remote Monitoring in CardiologyICD device management

Subject

Transmit

Record Analyze

Feedback

Remote Monitoring in CardiologyICD device management

DEVICE MANAGEMENTTechnically possibleSafe for the patient

Faster diagnostic informationFaster intervention

Able to replace ICD FU visitsSave money

Trust trail; Circulation 2010;122:325-332

Subject

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Record Analyze

Feedback

Remote CRT Device and Heart Failure Disease Management

Clinical Call Center

Subject

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Record Analyze

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Remote CRT Device and Heart Failure Disease Management

Clinical Call Center

IN-TIME trail: Lancet 2014;384:583-90

Only for a limited number of patients

Very sick patientsImplantable devices

Externe sensoren

Wearables

Smartwatches

Smartphones

Subject

Transmit

Record Analyze

Feedback

Remote Monitoring in CardiologyHeart Failure Disease Management

Not-significant

Not-significant

Not-significant

Not-significant

Not-significant

Heart Failure Disease Management

y = 0,2715x + 127,07

y = 0,1909x + 77,891

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18031

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Bloo

d Pr

essu

re (m

mHg

)

Gestational age (Weeks and days)

SBP

DBP

Linear (SBP)

Linear (DBP)

Hospitalization at the MIC

High Risk Pregnancy Management

Real-time contextual monitor for Medication Compliance

Before beta-blocker After beta-blocker

5min sit

5min stand

stairsdown

5min stand

stairsup

5min stand

5min sit

N=10 healthy subjects5mg EmconcorPlacebo control groupActivity protocol

Smartphone, reaching where other technologies can't?

Early diagnosis of patients with palpitations… AT HOME

CASE 1: Palpitations at home, with only a smartphone in the pocket…

Episode of Bigeminy, no action

CASE 2: Palpitations at home, with only a smartphone in the pocket…

Atrial Fibrillation19

Management of arrhythmia patients post-treatment ?

Pre- and Post PV AblationPost Electrical CardioversionPost Cardiac Surgery‘NOAC-in-the-pocket’

20

Closed loop feedback Telemonitoring feedback

“Big Mother”

How could a smartphone be used?

mHealth: Treat or ThreatPrivacy & Cyber Security

Doctor – Patient relationshipSecurity breachInsurance companiesEmployment

mHealth: Treat or ThreatAccuracy & Clinical Validation

Patients and doctors

Insurance companies and regulators

Developpers and businesses

mHealth: Treat or ThreatAccuracy & Clinical Validation

Patients and doctors

Insurance companies and regulators

Developpers and businesses

FitnessWelnessClinicalAPPS

mHealth: Treat or Threat ?

TreatThreat