By Alexandra Bailey and Baotran Vo

Technology Meets Medicine: Are We There Yet?

By Alexandra Bailey and Baotran Vo

Telemedicine is becoming increasingly important, especially during the COVID-19 pandemic. The need for virtual doctor visits is essential when social distancing is required. Telemedicine serves those who need to be seen by a physician in the comfort of their own home. However, telemedicine is limited by the inability of the physician to touch the patient, making the use of many traditional diagnostic tools impossible. To bridge this gap, new medical devices have been introduced to the market, making such vital examinations through telehealth platforms a reality. Such technology acts as the physician’s eyes, ears and hands even thousands of miles away. These innovations are perfect examples of the intertwined future of medicine and technology, working hand-in-hand to improve the health outcomes of all patients.

One example that truly brings the annual checkup to your doorstep is the N9© device from Nonagon©, originally MyHomeDoc©.1 The FDA has cleared both the all-in-one device and interactive user application (app).2 The N9© simply allows the user to record abdominal sounds, photograph the inner ear, listen to the heart, record lung sounds, take body temperature, act as an oximeter to monitor oxygen levels, determine pulse rate and capture pictures of the throat and skin for tests.3 Patients or supervising adults are instructed on each process via an app on their cell phones. The significant number of capabilities makes this a great prospect in integrating telemedicine into health care. Conversely, it would not be sufficient to replace all instances of office visits. While the application may provide some assistance, acquisition and initial readings are still evaluated by the patients themselves, which may introduce

areas of error in the procedure. To even reach a comparable level of accuracy to results taken by nurses and medical assistants with extensive experience would require extremely explicit guidance by the device or accompanying application, some which haven't been made available to the public yet.

With the current thriving era of smartwatches, the technology of wearable devices that gather health information has been improving every day. We are familiar with the smartwatches that connect to our phone, tracking our fitness activities, sleep cycle, heart rate, heart rhythms and more. A new “fashionable accessory” device called the Oura© Ring has been developed. In addition to tracking heart rate 24/7 and sleep analysis, the Oura© Ring also has temperature sensors to monitor changes in body temperature as a sign of illness or correlation with changes in body hormones from monthly menstrual cycles.4 A new feature for the ring is SpO2 sensing to measure oxygen levels during sleep, therefore analyzing sleep quality. The technology for wearable devices is constantly growing and adapting. And along with the affordable cost, fashionable designs and user-friendly features, it will become a common household item in the near future. However, the different devices from different manufacturers come with various sensors, calibrations and readings, so the question for us physicians would be: which heart rate, temperature or oxygen level readings from the variety of these devices should we consider?

During the pandemic, pregnant women are a particularly vulnerable group, and the risks increase with frequent office visits for ultrasound exams and checkups. For these expectant mothers, frequent visits to the obstetrics office for ultrasound appointments will become a thing of the past. Pulsenmore©5 is a prenatal home ultrasound device that allows the patients themselves to perform ultrasound exams and share the results with their physician. The Pulsenmore© acts as an attachment unit for the patient’s smartphone, the bottom of the unit being the ultrasound transducer that communicates with the phone via an app. The app also provides training and guidance to the user, and additional training from the physician’s office so the ultrasound scan can capture quality results. Captured images are then shared with the patient’s clinical team, and those can be used to guide further decisions. This new tele-ultrasound device provides vital information to determine if the baby is healthy, helping expectant mothers have assurance at home regarding the health of their fetus and avoid unnecessary trips to the emergency room. In most ultrasound videos captured by Pulsenmore©, the fetus’s heartbeat, movement and amniotic fluid were detected.6 However, a potential limitation for this device would be adequately training patients on probe placement and positioning that give clear and reliable images. Therefore, considering risk and benefit, usage of the device is dependent on the recommendation of the patient’s physician. In-office ultrasound visits might be warranted for at-risk pregnant patients in case emergency management is needed.

Another new device is the BIOTRONIK© Biomonitor III Injectable Cardiac Monitor©,7 a small implantable electrocardiogram (ECG) device capable of continuously recording heart rhythm over time and storing information about any arrhythmias. The sensors in this device provide remote monitoring for patients with atrial fibrillation (AF) or recurrent unexplained syncope. For these patients, this device will lessen the burden of being hooked up to an ECG for long hours of in-office studies. With the device already coming preloaded in an injectable tool, the BIOTRONIK© Biomonitor III is injected under the skin, in the left parasternal region. This is a quick and simple procedure that can be performed under local anesthesia in the physician’s office. Unlike a traditional external heart monitor, the cardiac monitor operates without cables or external attachments to the skin so that patients can maintain normal daily activities (and even go for an MRI) without any interference. Stored ECGs can be transmitted to the doctor through the BIOTRONIK© Home Monitoring Service Center daily. Therefore, physicians can use the recorded rhythms to correlate with the patient’s activities or the onset of symptoms as recorded in the patient’s activity journal or via the BIOTRONIK© patient app. In a 2020 trial,8 an adverse device effect was a permanent implantable device damaged by external cardioversion, requiring a new device replacement. In addition, the difficulty of removing the implantable device in order to implant a permanent pacemaker was classified as a device’s shortcoming. There is no doubt that medical device companies such as BIOTRONIK© are diligently improving their devices and engineering new technology to impact patient care positively.

Many devices we have discussed above will gather health-sensitive information and will be transferred from the patient to the physician’s office via the internet. Therefore, there is a need for HIPAA-compliant software to allow patients to upload data, files, images or videos while maintaining a level of confidentiality. There are currently hundreds of HIPAA-compliant telehealth platforms, such as Zoom© for Healthcare, Doxy©, GotoMeeting© and many more. However, the privacy, security of patient information and usability of these platforms should be the main priority. Furthermore, each medical device comes with its application and platform from its manufacturer. As technology progresses, having a universal telehealth platform or platform that can interpret and store data from all different applications from individual monitoring devices would be highly efficient for clinical workflow.

This final innovation is different than the above. Instead of focusing on how to bring health care home, Augmedix© has chosen to fix the problems still plaguing in-person office visits.9 While the devices and platforms emerging can bring health care to those who may not have the ability to access it, the gold standard will still be a history and physical examination, at least for the time being. With the rollout and integration of electronic medical records, patients and physicians alike feel that a computer screen gets between them, even though they are faceto-face. There is no doubt these records streamline things like insurance and billing, but can hinder the relationship between patient and physi-

cian. A HIPAA-secured system oversees pre- and post-visit documentation in addition to providing accurate medical notes during interactions. With a combination of natural language processing, machine learning and medical data specialists, the Augmedix© platform takes care of charting while doctors can care for the patients. During consultations, the Augmedix© platform extracts pertinent clinical information from conversations and then uses AI to generate and organize detailed medical notes for electronic records. Leveraging a multifaceted system to accurate, detailed medical data, the information can be reviewed and then signed off by the physician. Services even prepare clinicians with relevant information prior to a visit. This technology currently augments physician care without replacing the physician and their expertise. In all, Augmedix© claims to save physicians up to three hours a day on charting, improving efficiency and work satisfaction.10

There is no doubt that technology will be an integral part of the medical future. However, it would be naïve to look past the immediate limitations of such a world. This technology is undoubtedly miraculous, but without the understanding and infrastructure associated with such a system, it remains out of reach for many patients. If a patient is not versed in the technology that houses the application, such as the elderly, vulnerable population, it makes little difference. While it may seem that such groups with less technology-savvy literacy are disappearing, this is surely not the case. There is much to celebrate and look forward to for the future of telehealth, but there is still a long way to go. With the changing world, as we can see from the COVID-19 pandemic, technology and medicine are evolving and adapting to serve mankind.

References 1. NONAGON. MyHomeDoc Announces Rebrand as NONAGON - Reflecting Commitment To Make Healthcare Accessible To All.

PR Newswire. https://www.prnewswire.com/il/news-releases/myhomedoc-announces-rebrand-as-nonagon---reflecting-commitment-to-make-healthcare-accessible-to-all-301277917.html.

Published April 27, 2021. Accessed March 2, 2022. 2. NONAGON LTD. Nonagon MHD-100-02-001 Medical Device

Identification. FDA; 2021. https://fda.report/GUDID/ 07290018446102 3. How It Works. NONAGON. Published April 17, 2021. Accessed

March 2, 2022. https://nonagon-care.com/how-it-works/ 4. Ouraring.com. https://ouraring.com/. Published 2022. Accessed

March 18, 2022. 5.Editors M. Medgadget. https://www.medgadget.com/ 2020/08/pulsenmore-at-home-tele-ultrasound-for-pregnantwomen.html. Published August 10, 2020. Accessed March 2, 2022. 6. Israeli startup offers at-home pregnancy ultrasounds with handheld device. KrASIA. https://kr-asia.com/israeli-startup-offers-at-homepregnancy-ultrasounds-with-handheld-device. Published August 20,

2020. Accessed March 18, 2022. 7. BIOMONITOR IIIM Cardiac Monitoring. Biotronik. https://www.biotronik.com/en-us/healthcare-professionals/professional-education/biomonitor-iiim-cardiac-monitoring. Published 2019. Accessed March 2, 2022. 8. Mariani JA, Weerasooriya R, van den Brink O, et al. Miniaturized implantable cardiac monitor with a long sensing vector (BIOMON-

ITOR III): Insertion procedure assessment, sensing performance, and Home Monitoring Transmission Success. Journal of Electrocardiology. 2020;60:118-125. doi:10.1016/j.jelectrocard.2020.04.004 9. Augmedix. Our Solutions. Augmedix. Published 2022. Accessed

March 2, 2022. https://augmedix.com/solutions/ 10. Augmedix. Physicians and Group Practices. Augmedix. Published 2022. Accessed March 6, 2022. https://augmedix.com/physiciansand-group-practices/

Alexandra Bailey is in her final year at the University of Texas at Austin, getting her BS in Biomedical Engineering with a focus in Cellular and Biomolecular Engineering. She has past experience with image acquisition technology innovations. Alexandra plans to attend medical school this fall.

Baotran Vo is a fourth-year medical student at the University of the Incarnate Word School of Osteopathic Medicine. She is graduating in May 2022, pursuing residency in Internal Medicine. Baotran completed her BS and MS at the University of Southern California in Biomedical Engineering with an emphasis on Medical Device. Baotran worked as a Design Quality Engineer for a medical device company prior to medical school.