Automated Patient Monitoring
Technology can also facilitate patient monitoring between office visits. There are apps in development that give patients a push notification on their phone—a text message—that asks, “Did you have a headache today?” A yes or no response is recorded and, as appropriate, additional questions are asked. For example, “Did you have trigger exposures?” Some patients say, “My headaches are tied to the weather. I have no control over them.” The same app includes technology to monitor barometric pressure changes, so correlations can be drawn between headaches and weather changes. Another example is sleep. “Every smartphone can monitor your sleep. If you have an iPhone, it has that technology in it. If you put the phone under your pillow it can tell you, using movement as a correlation, how well you slept,” Dr. Cowan said. “It is not as good as a sleep study, but it will, at least, in general terms, tell you if you had good quality sleep.” That data can then be correlated with headache days.
Predictive Modeling
Predictive modeling is also currently available. An iPhone can provide a push notification that says, “You didn’t sleep well last night, there’s a storm front coming in, you might want to skip red wine with dinner because all of these are risk factors for you.” Wearable technology such as Fitbit or Up can monitor heart rate variability and other autonomic changes and suggest that there is an imminent migraine ahead. “By imminent, I mean within the next hour,” Dr. Cowan said. If patients were wearing something similar to the Zecuity patch, they could actually have their phone say, “You’ve got a headache coming, do you want medication?” If the patient responds yes, the patch could be activated and medication delivered. “This is off-the-shelf technology that is available now that we don’t take advantage of,” Dr. Cowan said.
“The app that I was just describing can send information to the cloud that can then be accessed by the physician at any point. For example, the physician could receive an email saying, ‘Patient X had 13 headache days this month, and it is only the 13th day of the month. Last month, she had 13 headache days in the whole month. She had five triptan days last month, already nine triptan days this month. Things are not going well.’” Alerts can be generated. “It is possible to monitor patients in real time without having to bring them into the office,” Dr. Cowan said.
Also in development is a calendar app that can correlate data at the end of each month and generate a printout that can, for example, observe, “More headaches this month. Not responding to acute care medication.” The treating physician can then say, “More headaches? Preventive medicine. Not responding? Change the acute care.” And those clinical decisions can be based on the patient’s own personal data.
Patient Compliance
Technology can also help increase compliance. A company called Proteus has an ingestible sensor that can be put on any pill. When the pill reaches the stomach, the sensor sends a message to a smartphone and the cloud. “So, compliance is no longer subjective. You can actually see when patients are taking their medications and tie that information to data from a wearable device and information entered by the patient,” Dr. Cowan said. This technology is also capable of sending messages to patients saying, when appropriate, “Missed your pill. You might want to take that pill.”
In summary, Dr. Cowan said, “That’s a glimpse as to where we are and what is just around the corner. Everything I described could be happening for every patient today. It is not, but this is what we can do technologically.”
—Glenn S. Williams