How the iPhone Might Disrupt The Medical Device Industry

Doctors wanting to determine a patient’s atrial fibrillation burden have a myriad of technologies at their disposal: 24-hour Holter monitors, 30-day event monitors that are triggered by an abnormal heart rhythm or by the patient themselves, a 7-14 day patch monitor that records every heart beat and is later processed offlineto quanitate the arrhythmia, or perhaps an surgically-implanted event recorder that automatically stores extremes of heart rate or the surface ECG when symptoms are felt by the patient. The cost of these devices ranges from the hundreds to thousands of dollars to use.

Today in my clinic, a patient brought me her atrial fibrillation burden history on her iPhone and it cost her less than a $10 co-pay.  For $1.99 US, she downloaded the iPhone app Cardiograph to her iPhone.

Every time she feels a symptom, she places her index finder over the camera on the phone, waits a bit, and records a make-believe rhythm strip representing each heart rhythm. With it, comes the date and time.

When the rhythm is in sinus, she learned that her heart rhythm was typically in the 60’s at rest:

When the rhythm was in afib, it was considerably higher and sometimes displayed an irregular rhythm:

or sometimes it displayed an error message:

I got a relative picture of how often she was having afib and she got the opportunity to help me with her care.

Was this a medical device?  No, it was an iPhone app.

Was it perfect?  No it wasn’t.  I certainly couldn’t differentiate frequent PAC’s or PVC’s from atrial fibrillation reliably.  It was NOT an EKG after all.   But we were past that point in her evaluation.  I just needed to know how often she was having her known paroxysmal atrial fibrillation and she wanted to keep a convenient record of her episodes.

Was it helpful in this case?  Absolutely.

More importantly, she just saved herself and the health care system a ton of money.

Welcome, my friends, to the era of patient-empowered, individualized medicine and a whole new era of patient care.  Now, if we can just keep the FDA from screwing things up.

PS: I have no commercial interest in the Cardiograph app and do not endorse it as a standard of care, but merely use this case to demonstrate how innovation can facilitate cheaper, equally-effective health care in some cases.  I’d also like to thank my patient for allowing me to use her screen shots.

Westby G. Fisher, MD, (aka Dr. Wes) is a board certified internist, cardiologist and cardiac electrophysiologist practicing at NorthShore University HealthSystem in Evanston, IL. He is also a Clinical Associate Professor of Medicine at the University of Chicago’s Pritzker School of Medicine. He blogs at Dr.Wes, where this post originally appeared.

10 replies »

  1. Ever since Apple’s AppStore created a dedicated category for medical applications for the iPhone and iTouch, it seems that “the medical community is flocking to the iPhone,” as an Apple executive said. No doubt, taking care of patients with the latest in emerging technology is not a future thing anymore: patients are being followed through the remote monitoring terminal – device tracks weight and heart rate, with scales and a blood pressure cuff using Bluetooth technology.

  2. lauramontini–

    Good place for reviews by physicians and other professional health care providers..


    Reviews by app type, medical specialty
    Numerous discussion forums

    Hope this helps!

    “iMedicalApps is the leading online publication for medical professionals, patients, and analysts interested in mobile medical technology and health care apps. Our physician editors lead a team of physicians, allied health professionals, medical trainees, and mHealth analysts in providing reviews, research, and commentary of mobile medical technology. Our publication is heavily based on our own experiences in the hospital and clinic setting.

  3. Hi Wes, I love the distinction you draw between “medical device” and “consumer device” – I agree completely that a “single lead” cardiac monitoring app contributes important information that can meaningfully guide clinical decision making, even without the specificity or sensitivity demanded by a true medical device. For example, I’ve often struggled with how early I can discontinue anti-coagulation in a patient who has been asymptomatic and without recorded A-fib for some period of time. However, I recognize that I am currently only able to monitor rhythms intermittently when my patients present to my clinic – I’ll certainly be excited to recommend something like this to my patients so I can get data points between visits!

  4. On the “will disrupt the med device industry theme” – this is exactly why you’re hearing noises about Washington looking at regulating the medical app marketplace. Some of these new gidgets are clearly a threat to the existing industry and some services. On the other hand, done badly they’re also potentially dangerous little suckers — so there are two sides to this.

  5. I like apps that doctors like. Is there a place to go online for an easy way to see doctor reviews?

  6. I like it. Playing with it now on my iPhone. Simpler is better for the app thing. I really don’t need it tell me where my friends are and track the location of my cardiologist. Although I suppose that might be helpful ..