At the very least, sales reps should be prepared for changes in the way physicians use traditional diagnostics
Editor’s note: In the fourth and final part in a series on wearables and mobile medical apps, Repertoire asks Midmark’s Dr. Tom Schwieterman how – or if – these technologies might affect the sale and usage of traditional physician office diagnostic equipment.
Dr. Tom Schwieterman
Will wearable/mobile medical devices from companies such as Fitbit, Apple or Livongo affect the demand for in-office equipment, such as ECG/EKG machines or blood pressure monitors? Way too early to tell, says Dr. Tom Schwieterman, vice president of clinical affairs and chief medical officer for Midmark. Still, reps should know where their test fits and how it relates to current protocol, as that might change as consumer technologies improve.
Repertoire: Fitbit says that 14 million U.S. adults subscribe to a digital health/wellness service, and pay an average $174 annually for different apps. Other studies show close to 40% of U.S. adults use or wear some kind of digital health technology. With that in mind, do you think wearables and mobile medical apps will change how or how often physician practices use traditional in-office medical technologies, such as ECG/EKG machines, blood pressure monitors, ultrasound units, etc? If so, how?
Dr. Tom Schwieterman: I feel this will change how common point-of-care tests are utilized. When people are monitored 24-7 for health issues with wearables, even when having no symptoms, it is common for the device to “pick up problems.” Often, these wearables findings – e.g., irregular beats, blood pressure spikes – have little clinical significance and would have gone unnoticed by the patient.
Providers have seen this occur with home blood pressure monitors, where patients present to the office with concerns about an overly high or low blood pressure at one point or another. Care teams must repeat the testing at the point of care, but also must investigate the patient finding by asking questions about factors known to temporarily drive up blood pressure, such as: “Did you just finishing exercising?” “When was your last cup of coffee?” Patient-driven testing comes with the added concern of how the test was done, when it was done, and with what device.
When diagnostic devices were only in the purview of the clinician, these issues were less common. Now that more sophisticated diagnostic devices – such as watch-based cardiac rhythm monitors – are in the hands of those with little or no clinical training, the actual findings are difficult to assess. Is there a problem or is there not a problem?
I suspect the provider-based point-of-care devices will be more commonly used to confirm or rule out a wearable “diagnosis” from a patient. It is yet to be determined whether the growth of wearables will improve the diagnosis of pathology and improve outcomes, or not. The answer is not clear at this juncture. Whether the constant monitoring will improve cost of care is, in my mind, an even larger question.
Repertoire: How might the popularity of wearables affect distributor reps who sell diagnostic equipment? Should they modify their approach, or emphasize different points to their physician customers than those they have traditionally emphasized?
Schwieterman: The term “point of care” is increasingly becoming less meaningful. Why? Because the point of care is quickly becoming all-inclusive. Instead of just referring to traditional healthcare settings like a physician office or hospital, it is increasingly referring to the home, retail clinic, or even place of employment.
With the majority of healthcare decisions and factors that influence health outcomes occurring away from a traditional healthcare setting, clinical thought leaders are seeking additional ways to diagnose or influence patients in these non-traditional points of care. Thus, it is likely we will continue to see an increasing number of diagnostic protocols to include wearables or home-based tests. For instance, it is now considered best practice to check blood pressure in the home before officially diagnosing someone with hypertension.
I would encourage diagnostic equipment distributor reps to understand the disease diagnostic protocols and understand whether wearables play a role in the conditions related to the diagnostic device. If they do, understand the role your device plays in that protocol. Is yours the official gold-standard test, such as an ECG or A1C test? Is yours a way to confirm a finding of an at-home test, or corroborate the finding, such as with a blood pressure or Holter monitor? Is yours a way to gauge the clinical severity of a situation, such as a spirometer for respiratory issues?
Know where your test fits and how it relates to the current protocol. It is quite possible that will change as the consumer technologies improve.
Repertoire: Anything to add about how the abundance of wearables and mobile medical apps might change the traditional office visit for patients and their physician?
Schwieterman: Wearables and mobile apps are arming patients with sophisticated information about their own bodies. This is a relatively new phenomenon for providers. Increasingly, instead of patients coming in with symptoms, they are coming in with preliminary diagnoses. “Doc, my device says I have a heart rhythm problem…” “Ruling out” a problem can be more complicated than “ruling in” a problem. So, yes, I feel certain at-home data is and likely will continue to increasingly change the traditional office visit.
These diagnostic devices also add incredible new power to manage health issues by giving the patient more tools to employ in their care paradigm. In many cases, they can shed light on the black box of information that can occur between office visits. We can now monitor heart rhythms, blood pressure, temperature, blood glucose, and other measures relatively inexpensively and often continuously. This can be of great help in understanding exactly what is going on with the patient and how the patient is doing.
Someday, this may help eliminate unnecessary testing and allow for fewer visits. However, we are still early in this transformation. So, time will tell how much these consumer technologies will augment – or possibly replace – some or all of the provider care management process.