Timothy Aungst, PharmD

One of the biggest problems for patients with

are microvascular (i.e., neuropathy, retinopathy, neuropathy) and macrovascular events (e.g., cardiovascular events). The American Diabetes Association recommends routine monitoring to identify patients at high risk for these complications and to prevent them from becoming a large issue for patients care. These include doing blood work, foot exams, and seeing an optometrist for screenings. Nonetheless, it is easy for patients and providers to miss appointments or identify patients at high risk.

Digital health and technology help patients and providers to better manage chronic conditions like diabetes. These days, there are a number of companies offering services that use technology to help empower patients to live healthier lives. In turn, providers have access to more electronic tools to analyze data to help them with their clinical decision-making process.

One app that designed for patients with diabetes is Retina Risk, which is available on the iOS App store and Google Play store. This app, based on the work of a team of clinicians in Iceland, aims to help patients identify their own personal risk scores for retinopathy, which their providers could recommend them to use.

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Retina Risk aims to help patients identify their own personal risk scores for retinopathy, which their providers could recommend them to use. 


Retinopathy Screening Through an App for Patients with Diabetes

I've been giving some thoughts to a discussion online, and from personal interactions with patients, regarding visits with their providers and care teams. The crux of the issue is whether it is appropriate for patients or caregivers to record their visits.

Now, maybe this sounds new to you, but it's been an ongoing discussion for some time. If you think about it, almost everyone now has a readily accessible recorder available: their smartphone. So, after the nurse takes your vitals, and asks some introductory questions, the patient or caregiver switches on the audio recording feature, and slides the device into their purse, pocket, or place it facedown on a chair to record the visit.

Now, the issue is whether this is appropriate or not. Patients are entitled to keep records of their appointments, but until there are open notes available for patients (which is another issue altogether), many are taking this head-on and just tracking the data shared during appointments themselves. In a way, they are now creating the black box of their health. Many providers have mixed feelings about this. Foremost, many fear that the act of being recorded may limit what they want to be stated on the record, which calls into question some form of accountability. On the other hand, many providers also seem to want to encourage this act as they see it as a useful means of facilitating clear communication with their patients.

So, what strikes me as exciting is that some companies are looking to stake a claim in this issue, such as Harper, an online service that enables patients to upload a visit recording (via their app) and have it transcribed. What is interesting about this platform, is that its analytics system can identify critical terms or phrases for the patient to look up. Take for instance, if the transcription included "...your blood pressure is high, and I feel you have hypertension and could use some treatment. I am going to prescribe you lisinopril..." the platform would highlight 'hypertension' and 'lisinopril' as terms that the patient can look up for further information.

Technology is allowing patients to record visits with their healthcare providers. Will this help improve outcomes? Or will providers be reluctant to discuss some things?

Patient Recordings at Heart of Emerging Technology

) highlighted the value of ambulatory blood pressure (BP) monitoring over in-clinic assessments.

Essentially, researchers in Spain ran a study from 2004 to 2014 in which almost 64,000 patients were assessed to determine whether 24-hour ambulatory BP data compared with clinic measurements had any significant difference in predicting all-cause and cardiovascular mortality. No study in the past has been this large or run as long when asking this question, but other studies published before and during this study looked at the same question, and the results indicated that ambulatory measurements are valuable.

What this study adds to the literature is that not only are ambulatory measurements a better predictor of mortality, even patients with masked or white coat hypertension were at higher risk of death than those with sustained hypertension. That is a shock, as many clinicians may not have been as aggressive with treatment in such populations, which may have led to less treatment, predisposing those patients to adverse outcomes.

But the concept of 24-hour BP measurement opens up other items for discussion. One is the use of technology to accomplish this goal. When the study launched in 2004, what was used to conduct 24-hour BP measurements? The product was the Spacelabs model 90207 from Spacelabs Healthcare.

This product has been around for about 30 years. This is an excellent example of a study that used a tool that became outdated over the course of the trial. For starters, the device is worn on the arm and waist, and it looks big and bulky. One of the advertisements found online has a guy holding up a CD. This really demonstrates how far the field of digital health has progressed.

1. Banegas JR, Ruilope LM, de la Sierra A, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality.

2. Spacelabs Healthcare. 90207/90217 Ambulatory Blood Pressure Systems. spacelabshealthcare.com/wp-content/uploads/2013/09/ABP-EN.pdf. Accessed April 30, 2018.

3. Omron Health. Going for Zero. omronhealthcare.com/generation-zero/. Accessed April 30, 2018.

A recent study in the New England Journal of Medicine (NEJM) highlighted the value of ambulatory blood pressure (BP) monitoring over in-clinic assessments.

Timothy Aungst, PharmD

Articles

Retinopathy Screening Through an App for Patients with Diabetes

Patient Recordings at Heart of Emerging Technology

Does 24-Hour Ambulatory BP Monitoring Represent an Opportunity?