When I was a cardiology fellow, I spent time at San Francisco General Hospital. As the main county hospital in the city, it’s “real” medicine on the front lines, with patients from all socioeconomic strata and many with limited English language skills. While I was there I saw some of these patients being prescribed a Holter monitor, a portable recording device with wires and electrodes you attach to your skin, to diagnose suspected cardiac arrhythmias (heart rhythm problems).
Arrhythmias are tricky - they can come and go, and they can be harmless or extremely dangerous. So it’s important to diagnose them accurately and efficiently. But Holter monitors are archaic. They’re complicated to use, and have to be returned to the hospital. The technology really didn’t work very well for this population, which meant that many patients didn’t get monitored.
Later, as a Biodesign Innovation Fellow, I saw this problem again. This time, we were dealing with generally more well-to-do patients. But the Holter monitor, which can’t be worn during exercise or showering, was still a suboptimal solution. That's when it became clear that finding a better way to detect potential rhythm disturbances in non-hospitalized patients was a broad and important need.
As my team and I developed our solution, we were encouraged to design the highest tech product possible. Wireless technologies with real-time data transmission capabilities were becoming more feasible and some advisors urged us to incorporate this technology into our solution. But the experience I had with patients at the county hospital led us to make different decisions. For example, if we had built in real-time data transmission at that time, the product would have been too expensive to use on most patients. Instead, we designed the device to store the diagnostic data locally and then the patient could use the postal service to return it to us – everyone knows how to drop something in the mailbox. In addition, we intentionally opted not to make the interface too complicated or add too many features. Otherwise, people who are older or compromised in some way might not be comfortable wearing the device.
In the end, we came up with a solution that’s inexpensive and simple enough that it doesn’t have to be prescribed by a specialist, and it can be given to patients in the emergency room or at their primary care physician’s office. As a result, the technology has helped hundreds of thousands of patients over the past few years.
We’re currently adding wireless capabilities to some versions of the product to address the much smaller population of high-risk patients who need real-time data transmission. But this makes sense now because it can be done more cost-effectively, and it can be limited to those who need this feature. Just because you can make something more technologically advanced, doesn’t always mean you should. It’s more important to focus on the patients you’re trying to help and solve their problem in the most cost-effective way possible.
To date, medical devices and technologies initiated by Stanford Byers Center for Biodesign trainees while in the program’s courses and fellowships have been used to care for more than 1.5 million patients. In this new weekly series, some of our innovators will discuss their work and the patients that inspired them
Uday Kumar, MD, was a 2005-06 Biodesign Innovation Fellow.
Photo courtesy of Stanford Biodesign