As Covid-19 has raged on, many patients with serious symptoms of heart problems have eschewed the hospital given their increased chances of death from the novel coronavirus. This hospital avoidance, ironically, has resulted in tragedy with patients dying at home either with deteriorating symptoms or by ignoring symptoms and formal diagnosis of arrhythmia.
However, the CEO of a San Jose, California-based cardiac remote patient monitoring company believes that had heart failure patients been prescribed its wearable patch connected to a cloud platform, lives could have been saved.
“The reality is yes, the technology could have helped save people,” said Peter Van Haur, CEO of San Jose, in a recent interview. “Had they been wearing a Vital Patch we would have seen in real-time levels of deterioration which would have allowed healthcare providers to make an educated decision on whether or not they should get them an ambulance to come to the hospital or it was safe for them to stay at home.”
Van Haur also argues that unlike larger players in the field that only focuses on remote cardiac monitoring, VitalConnect’s technology has broader vital-sign monitoring capability. The burgeoning cardiac remote patient monitoring market is a category where San Francisco-based iRhythm Technologies has carved out a niche for itself after it went public back in 2016. By the simplest of measures — stock price — the company has been successful, trading at about $145 currently compared with five years ago when the closing stock price of the first day of trading was about $25. Even in the private markets there has been M&A activity in cardiac RPM. Boston Scientific showed its interest in the space when it scooped up Preventice Solutions in a deal worth $1.2 billion. [Hillrom also wanted to be a player in this market by announcing its intention of buying Bardy Diagnostics for $375 million before changing its mind and getting sued for doing so.]
But Van Haur believes all these companies are “one-trick ponies” with their focus solely on cardiac monitoring. By contrast, VitalConnect does so much more.
“What they do is that they monitor the cardiac function of the heart in a recorded fashion and days later a physician receives a report,” Van Haur said of iRhythm. “What we do is we offer a Holter monitor, an extended Holter monitor and a mobile cardiac telemetry system all in one in one patch with the combined monitoring capabilities of respiratory rate, core body temperature, SpO2, blood pressure, fall detection which is important for syncope, activity and weight. We are the only technology on the planet that has the ability to monitor the physiological signs as well as the cardiac functions of the heart.”
He explained that hospitals would find its product attractive because “we have the capabilities to offer telemetry in the hospital setting in beds that previously were unmonitored beds.” Van Haur added that the company is expanding into the hospital-at-home market where there is a significant need for multi-vital sign monitoring in addition to cardiac monitoring, which includes arrhythmia detection.
In addition to its avowed technical prowess and FDA clearances, another aspect could attract health systems and providers to VitalConnect: reimbursement.
“We are fully reimbursed and accredited through CMS and Medicare on our cardiac monitoring platform,” Van Haur said. We are reimbursed through the national code set by CMS for the Holter, extended Holter and MCT (mobile cardiac telemetry) platforms. “On the hospital at home and general RPM, we are fully reibursed under the hospital-at-home guidelines and the DRGs as welll as the global codes established for monitoring physiological parameters.”
For many providers looking to boost remote patient monitoring, the reimbursement is what has been a stumbling block to make necessary infrastructure investments.
“At this point, the remote patient monitoring codes are really not probably adequate enough for our health systems to be able to make the investments that are needed,” said Dr. Raj Khandwalla, a cardiologist and director of digital therapeutics at the Smidt Heart Institute in Cedars-Sinai, in a phone interview. “When you talk about making the investments that are needed, you are not only talking about the equipment and integration within the electronic health record, you are also talking about the time — the time of nurses, of nurse practitioners to react to the data coming in and that’s expensive — and without reimbursement for that time, we’re still going to have challenges in the space.”
Dr. Khandwalla also made it amply clear that just having the technology to be able to monitor someone round the clock doesn’t make it insightful or even actionable.
“We need an infrastructure that limits the alerts to the clinicians and we need an infrastructure that enables cardiologists to identify those people who require care,” he said.
In other words, don’t create the alarm fatigue that the EHR has often been blamed for.
From Van Haur’s description of the way the system works, it appears that VitalConnect has taken into consideration the physician’s preference.
“Physician typically write the prescription for the product and the platform and they will also designate a pathway of notification that they think is appropriate for their workflow,” he said.
VitalConnect has technicians in its IDTFs – independent diagnostic testing facility – where they review any alerts triggered by the VitalConnect system. Van Haur explained that when patients fall outside the algorithmic safe zones as determined by their physician, such alerts can be reviewed by the technicians to determine whether they warrant notification to physicians and family members.
It’s not clear whether Dr. Khandwalla is familiar with or aware of VitalConnect’s wearable patch and monitoring platform. He declined to formally identify which company products he has prescribed to patients who he suspects of having a heart condition like arrhythmias saying only that he uses products made by market leaders – most likely referencing iRhythm Technologies, a company that he has mentioned in past interviews.
While he agreed with Van Haur that heart patients could have been served well during the pandemic with wider use of remote monitoring, he isn’t sure that the ability to monitor other physiological signs is such a key factor in taking care of these patients. Only the very sickest require that level of broad-based monitoring.
“Sensors are getting better and yes, it would be of value to really sick patients if the next generation of sensors could look at how quickly a patient would decompensate but this is not typical of most patients,” he said.
Meanwhile, VitalConnect, which has raised more than $130 million since inception, is working with more than just providers and health systems. The company’s wearable patch and cloud platform are being used in pharma clinical trials run by Eli Lilly, GlaxoSmithKline and Takeda.
“Pharma companies and other medical device companies will use our products because they want to monitor patients during and after the utilization of the trial drug, trial therapies and trial devices to see what the impact of those on patients nad because of the clarity and the sophistication of all the data that we collect and the multiple variables that we are looking at – all the vital signs .”