From remote patient monitoring to 3D printed body implants, health care organizations are making more use of technology than ever before. We spoke with some area institutions to catch up with their latest advances.
In October, St. Joseph’s Health announced it was the first New Jersey institution to perform a spinal procedure using a 3D printed patient-specific spinal implant. Dr. Geoffrey Appelboom, chief of neurological surgery at St. Joseph’s Health and instructor of spine surgery at New York University Grossman School of Medicine, performed the procedure on a patient who was having difficulty walking and was suffering from chronic pain. Appelboom utilized a personalized implant to replace a diseased disc after “the patient had already undergone several unsuccessful surgeries to treat the chronic and debilitating pain.”
“Personalized implants are a game-changer for patients with spinal misalignment and other spinal cord disorders,” added Dr. Mark Connolly, chairman, Department of Surgery at St. Joseph’s Health. “As the first hospital in the state to utilize an implant that is manufactured to precisely match the specific needs of each individual patient, instead of a one-size-fits- all approach, this advanced treatment represents the advanced care our highly skilled surgeons provide at St. Joseph’s Health.”
Technology is also providing “new and expanding opportunities to detect, monitor and treat heart problems and related conditions,” according to Dr. Partho Sengupta, “and a clear example of this is the Center for Innovation, launched in September by Robert Wood Johnson University Hospital and Rutgers Robert Wood Johnson Medical School.”
Located on the main campus of the hospital, “We’re creating an environment where we can solve real-life problems with technology by bringing together multidisciplinary teams of clinicians, researchers, engineers, industry partners and other stakeholders from the health system and community,” added Sengupta, the Henry Rutgers Professor of Cardiology and chief of the Division of Cardiovascular Disease and Hypertension at Rutgers RWJMS, chief of cardiology at RWJUH, and a member of RWJBarnabas Health Medical Group.
The Cardiovascular Services team currently has a series of clinical trials underway, including evaluating an U.S. Food and Drug Administration-approved robotic ultrasound telemedicine system to effectively capture expert-quality cardiac ultrasound images remotely, and a study of the use of armbands and other wearable sensors that collect health data from patients diagnosed with high blood pressure and/or early-stage heart failure. The information is then used to initiate guideline-directed medical treatment remotely. Other high-tech advances include earbuds that may be able to both deliver music and provide such real-time heart rhythm metrics as heart rate and heart rate variability, and a medical vest with sensors that a patient can put on to record vital information capable of indicating a heart attack without requiring a blood draw and analysis.
“It’s important to create a space and environment that is optimized for creativity, innovative thinking and collaboration,” Sengupta said. “We see a whole journey of patient care that incorporates wellness, development of conditions, care in the hospital, and disease management.”
At Valley Health System in Ridgewood, a team is using the SmartCurve breast stabilization system for breast imaging; and a non-invasive, artificial intelligence imaging technology, developed by Cleerly, for cardiac imaging, according to Dr. Scott DeGregorio, director of breast imaging, The Valley Hospital; and Dr. Himanshu Gupta, director of cardiac imaging, Valley Health System.
“The SmartCurve system delivers a more comfortable mammogram without compromising image quality or dose,” said DeGregorio. “The system features a proprietary curved surface that mirrors the shape of a woman’s breast to reduce pinching and allow better distribution of force over the entire breast. SmartCurve not only enables us to improve the experience for our patients by providing them with a more comfortable mammogram they’ve been waiting for, but more importantly allows us to do so while maintaining clinical accuracy by providing our physicians with the industry’s fastest, highest-resolution 3D images to accelerate screening and analysis.”
In cardiovascular imaging, the team uses AI technology to prevent heart attacks by characterizing unstable plaque buildup with a high potential to rupture that can lead to a heart attack. Cleerly’s approach leverages coronary artery phenotyping — a technique to define the characteristics of plaque buildup, according to Gupta. “This approach builds upon traditional CT angiography testing to help physicians identify which high-risk, non-symptomatic patients are at higher risk for heart attack.”
Using an artificial intelligence approach and machine learning algorithms, Cleerly compares each patient’s plaque characteristics to a database comprised of cardiac imaging and data from large-scale clinical trials, he added, providing clues to possible underlying heart disease, characteristics of any present coronary blockages, and risk of a future heart attack. “In my opinion, this analysis combined with the physician’s review and analysis, provides an increased level of confidence in evaluating coronary artery disease, especially patients with significant coronary calcification.”
Other hospitals are also implementing technologies that advance digitally integrated care across acute and ambulatory functions. At Englewood Health, for example, “Outside all patient rooms are wall-mounted Epic monitors that alert care providers to crucial patient details like fall risk, isolation precautions, dietary restrictions, and more,” said Vice President and Chief Information Officer Inderpal Kohli. “Inside each room is a large, interactive, patient-friendly whiteboard with relevant details regarding the patient’s stay, including care team names, medications, upcoming treatment schedules, and recovery goals. The digital whiteboard also has an interactive section where patients and family members can post messages to each other and to care providers.”
The whiteboard also doubles as a clinician’s dashboard that displays active medications, vital signs, intake and output, lab resultsa nd imaging to complement interdisciplinary rounding (IDR) activity. “These monitors and digital whiteboards are designed to streamline information, foster collaboration, and improve the patient,” he said.
Other tech initiatives include “a remote patient monitoring program powered by RPM Healthcare that helps patients manage their conditions between office visits, utilizing at-home monitoring devices and personalized health coaching,” Kohli added. “Patients transmit their physiologic data automatically to their clinicians, improving outcomes and treatment adherence and reducing emergency department visits and hospital admissions.”
The mix of traditional medicine with technology raises a question: Will tomorrow’s doctors need an engineering or IT degree, as well as a medical degree? “The next generation of clinicians will not need an IT degree but will certainly benefit from increased technology awareness,” he said. “An understanding, knowledge, and even formal education in technology will go a long way in fostering a culture in which clinicians play a role in the design and implementation of new tools and solutions. This idea has taken root in several U.S. universities, and we see this trend predicted to persist within pre-med education programs and, for that matter, across all industries. Everyone will be in the technology business, if they are not already.”
Opportunities and challenges
Technology in health care settings is “constantly evolving in order to improve patient outcomes. In recent years, telemedicine and remote patient monitoring have become increasingly popular in health care systems across the country,” according to St. Joseph Health System Chief Medical Information Officer Dr. Beth Kushner. “For many health care providers, behind-the scenes technologies such as remote patient monitoring, provide various strategies for enhanced, more-complete documentation and data collection concerning a patient’s health.”
Remote patient monitoring includes devices that allow for non-face-to-face monitoring and analysis of physiologic factors that can help health care providers better understand a patient’s health status. “This can include common activity trackers that allow patients to monitor and collect data about their health at various points throughout the day, then electronically transmit this data to their physician,” she noted. “Remote patient monitoring also allows the patient to have the ability to trend their own data. This [offers] more detailed parameters for providing information to their providers to help have more informed conversations about chronic disease states.”
The increased use of remote patient monitoring devices has led to shared decision making between the patient and provider while leveraging IT solutions, but “these new technologies are not without their own set of challenges,” Kushner cautioned. “Physicians need to be nimble and willing to take a leap of faith when it comes to new technology. While they may not need any specialized degrees, they have to be willing try new devices to see which works best for them and their patients. Physicians must also expect that relationships with their patients will change once these technologies become more widely used. Health care providers must adjust their expectations when using these technologies. Instead of only seeing patients in person, patients and providers are communicating increasingly through telehealth visits from remote locations. Although technology can be daunting to some, with proper training and usage, it can help provide physicians with additional tools to help them better care for their patients.”