The patient wanted to know if the smartphone’s interpretation of those rhythm strips was correct, and if he was really having frequent asymptomatic recurrence of his atrial fibrillation. Unsurprising to me or anyone who has used one of these (or other) phone-based EKG devices, the watch-generated rhythm strips looked clean and clear and the interpretation was spot on. It correctly identified his frequent asymptomatic episodes of atrial fibrillation. This was important information, which markedly affected his medical care.
These two very different examples are early indications that the way that we will be collecting information will rapidly and radically change over the next few years. It has always been clear that making long-term decisions about the treatment of hypertension based on a single reading in the office setting is not optimal. It has been equally clear that a single office EKG provides a limited snapshot into the frequency of intermittent atrial fibrillation. Deciding how to treat patients has never been easy and many decisions are plagued with ambiguity. Having limited information is a blessing and a curse; it’s quick and easy to review a small amount of data, but there is a nagging recognition that those data are only a distant representation of a patient’s real health outside of the office.
As we move forward we will increasingly have the ability to see a patient’s physiologic parameters where and when those values are most important: during the countless hours when they are not in our offices. The new American Heart Association hypertension guideline, issued in late 2017, has placed increased emphasis on ambulatory blood pressure monitoring. Determining how to use all this new information will be a challenge. It will take time to become comfortable with interpreting and making sense of an incredible number of data points. For example, if a patient checks his blood pressure twice a day for 3 months, his efforts will generate 180 separate blood pressure readings! You can bet there is going to be a good deal of inconsistency in those readings, making interpretation challenging. There will also probably be a few high readings, such as the occasional 190/110, which are likely to cause concern and anxiety in patients. There is little question that the availability of such detailed information holds the potential to allow us to make better decisions. The challenge will be in deciding how to use it to actually improve – not just complicate – patient care.
What are your thoughts on this? Feel free to email us at info@ehrpc.com.
Dr. Skolnik is a professor of family and community medicine at Jefferson Medical College, Philadelphia, and an associate director of the family medicine residency program at Abington (Pa.) Jefferson Health. Dr. Notte is a family physician and associate chief medical information officer for Abington (Pa.) Jefferson Health. Follow him on twitter (@doctornotte).