From WPC 2023
From WPC 2023
Monitoring tech - ready or not?
Jonathan Bromley
Bas Bloem is Parkinson’s royalty. A first-rate academic, he’s also a clinician who has campaigned tirelessly for better patient-centred care for Parkinson’s. And he’s a compelling speaker. Some of you may know this first-hand from the online presentation he made to our Branch a couple of years ago.
We heard him at WPC in Thursday’s plenary session, sharing his clinical experience of something most of us know instinctively: patients “put on a good show” for their neurologist, making that meagre half-hour per year of expert review even less valuable. His conclusion is inevitable: we need regular (maybe even continuous) tracking of patients’ symptoms. The tracking data could help both clinician and patient to monitor progress, adjust treatment, and support the patient and care partner’s planning for the future.
Almost every patient now carries a smartphone packed with sensors and connectivity that could facilitate this tracking and monitoring. As Bas Bloem said, “the future is here”.
Although the basic technology to do the monitoring is fairly easy to find, the reality is much more difficult and complicated. I tried to trawl the exhibition floor looking for remote monitoring solutions and… there are a LOT of them. It’s a confusing Wild-West landscape with many competing providers, each offering partial solutions and targeting subtly different segments of the market. Almost all offer a smartphone app that makes and tracks various measurements. Some ask you to perform specific tests for a few minutes a day, some run continuously and gather what information they can from your movements. Some include other features such as medication scheduling aids and game-like challenges to encourage you to exercise. They all collect your measurements “in the cloud” (in other words, on computers owned by the app company) and offer various ways to present those measurements both to you and to your clinician.
The obvious question is: how can we expect clinicians to take any notice of this information? Will it be summarized for use just once a year in the routine consultation? Our good friends at Neu Health here in Oxford claim to offer a continuously updated “clinician dashboard” highlighting high-priority patients - for example, those who appear to be at high risk of falling, or whose symptoms have worsened very rapidly. Are we looking at a future where a clinician’s first job in the morning is to scan this dashboard and make direct contact with particularly needful patients? And if so, how could a clinician do this for data from maybe half-a-dozen different providers?
Another interesting challenge relates to getting these products accepted in the medical community, and - especially in the US where almost all health care is paid for by insurance - getting them accepted by the medical insurance companies.
In another post I’ll write up some details about the various medical tech companies I spoke with in Barcelona, not only for monitoring but also for gait cueing and other therapeutic interventions. Meanwhile I’m going to stick my neck out and say that this is all very exciting, but not very pretty. Perhaps, just this once, Bas Bloem was wrong: the future is clearly visible on the horizon, and it’s not a mirage, but there’s a lot of treacherous ground to cover before we reach it.