“A very long Wait”

#The Topic

“One month after my episode I finally got the device, I wore it for 2 days, and then I gave it back. My doctor called me 10 days after, I will have to go through the process again because she needed more data. So… almost two months will be passed by the time I get a diagnosis. It’s a very long wait”.

This is one comment I got from one of the patients I interviewed. The feeling of being involved in a process that takes a lot of time to give a result back creates a feeling of uncertainty in the patient while waiting for a diagnosis. This can lead either to anxiousness or tedium depending on the patient’s personality.


The old-school Holter devices method of data transmission relies on the patient returning the device, downloading the data to the hospital, and analyzing it by the doctor. In addition to time, the effectiveness of the collected data is questionable due to the fact that these devices record information for two days in which there may or may not be heart rhythm disturbances.

New devices are testing the use of advanced algorithms that allow data to be recorded 24/7, offering clear advantages when it comes to making a proper diagnosis. In addition to this, they allow the possibility of comparing with other data already recorded from patients with similar indications, which can facilitate the analysis process.

The use of this new technology is not yet fully widespread, but it is obvious that this is the way that must be taken to increase the speed of diagnosis, facilitate the doctors’ work, and care about the patient’s mental health. Maybe the use of this type of new generation holters, which can be easily used by patients at home, combined with specific and occasional medical tests (if necessary) carried out in the hospital by more complex devices that can record more interesting data, is the recipe that offers both better results and better user experiences. But, could domestic use devices reach the complexity of hospital devices without leaving aside their comfort of use for the patient? Probably, but when? Is it going to be a very long wait?

Pocket ECG Holter Monitor | New Generation of Holter Monitors

Improving medical interfaces for patients

#The Topic

The Holter Monitor Interface is quite dated, bulky, and unintelligible. Patients do not feel involved in the process and do not understand what parameters are being measured.

In a world where technology users are more educated and informed than ever before, leaving patients out of the loop feels paternalizing. Making users feel disconnected from their own condition poses risk to their own health.

In the case of the Holter Heart Monitor, it is a much more advanced and capable device than the health wearables available in the market for consumers (e.g. Apple Watch, Miliband, Fitbit). But the interface in these wearables is more user-friendly and clear to inexperienced eyes.

Marrying the accuracy and depth of the data from the Medical Grade device with a tad of UX from the consumerready devices can help the patient understand what is going on in their body and be proactive towards a solution.

A better interface is the start of a change: From “patient”, by definition, waiting and passive, to an active player in their health status.

Garmin/Apple Watch/Fitbit

Living with a Heart Rate Monitor

# The Topic

heart rate monitor (HRM) is a personal monitoring device that measures heart rate in real-time or records the heart rate for later study. It is commonly used to collect heart rate data while performing various types of activity which are part of the patient’s day-to-day life. Portable medical devices are referred to as Holter Monitor which is designed for everyday use and does not use wires to connect.

Modern heart rate monitors commonly use one of two different methods to record heart signals: electrical and optical. Both types of signals can provide the same basic heart rate data, using fully automated algorithms to measure heart rate.

_ Electrical Devices: The electrical monitors consist of two elements: a monitor/transmitter, which is worn on a chest strap, and a receiver. When a heartbeat is detected a radio signal is transmitted, which the receiver uses to display/determine the current heart rate. This signal can be a simple radio pulse or a unique coded signal from the chest strap.

_ Optical Devices: More recent devices use optics to measure heart rate by shining light from an LED through the skin and measuring how it scatters off blood vessels. Smartwatches and cell phones can be included within this category, but their use for medical purposes is limited even though the accuracy in detecting several diseases increased significantly in recent years. Many professionals recommend anyway their use as support in data collection processes.

# Holter Monitor

A Holter monitor is a small, wearable device that keeps track of your heart rhythm. The doctor may want the patient to wear a Holter monitor for one to two days. During that time, the device records all heartbeats. This procedure can be repeated several times if the medical practitioner requires it to accomplish the goal of the overall study.

A Holter monitor test may be done if a traditional electrocardiogram (ECG) doesn’t deliver enough information about the heart’s condition. A Holter monitor may be able to spot occasionally abnormal heart rhythms that an ECG missed due to the short time that the patient is hooked up to the machine. The medical practitioner uses information captured on the Holter monitor to figure out if the patient has e a heart rhythm problem or a heart condition that increases your risk of an abnormal heart rhythm.

# What Patients say:

After interviewing two patients who had to wear the Holter monitor due to different heart conditions, plus the information collected in different clinical studies, these would be the most significant insights referring to the patient experience:

_ Most of the patients found the device uncomfortable. Sometimes, some of their daily activities were difficult to carry out due to the device.

_ Some patients had difficulty putting the device back on after showering. Due to this, the collected data wasn’t accurate.

_ Even though the majority of patients expressed full trust in their doctors, many did not feel involved in the process. They simply had to “follow orders” but did not understand what kind of data was being measured.

_ Some patients experienced a feeling of vulnerability when they gave the device back to their medical facility. Although the device was uncomfortable to wear, it made them feel safe, assuming that their heart was being controlled. Once they removed it, that feeling of security disappeared.

_ Some patients experienced skin allergies due to the adhesive tape on the device.

# What Doctors say:

After interviewing a cardiology physician and a general practitioner, I was able to gather the following insights:

_ It is difficult to ensure successful measurements with elderly patients due to the technical requirements of the device. The majority of patients using this device are older than 60 and sometimes they need to repeat the procedure more than once.

_ Although the device collects valuable information, some conditions, which might be symptoms of more serious heart problems, go unnoticed. (ex. certain types of arrhythmias).

_ They get frustrated because they cannot find the time to explain all the details of the procedure to their patients and they feel patients’ dissatisfaction and uncertainty.

_ “It takes too long to get the data that we need”. Patients must return the device back to the medical center, then the technicians extract the data from the device by connecting it to their system, then the data are included within the patient’s records and saved in databases. Only then doctors are able to have a clear vision of what is going on with their patients.

# Compared with other Devices for Heartbeat Monitoring:

Despite the fact that the Holter monitor is one of the most used devices to measure the heartbeat even today, for a few years, other heartbeat monitors have been coming onto the market offering significant improvements for patients. This is the case of Zio Patch, from iRythm Tech.

But even though this new monitoring option is more manageable, less cumbersome, and has a higher level of data accuracy than the original Holter Monitor, it requires longer use than the Holter Monitor to detect the same number of conditions. This makes procedures a bit harder to perform with both children and the elderly.

As mentioned before, many smartwatches and mobile phones can provide a service similar to heartbeat monitors but are not capable of perceiving certain abnormalities that may indicate heart problems. They are a very good aid for home use because they measure many different parameters such as oxygen saturation, thanks to the use of sensors including accelerometers, gyroscopes, and GPS.

# Conclusions and Challenges

Finding the ideal device is not easy. Both patients and medical professionals have needs that should be met in order to succeed when going through these procedures, and it seems that if you try to improve one part, the other will get worse.

For me, the main challenge is to rethink the design of the device. It is clear to me, that it needs to be something free of technical assistance. The ease of use must be a basic requirement due to the characteristics of the patients who generally use this type of device.

On the other hand, it should offer some kind of interface that could deliver clear information to patients, making them understand what data is being collected. This is already offered on smartphones or smartwatches.

And last but not least, the data collection. The more accurate data collection in the shortest possible time, the medical professionals will be able to deliver better diagnoses in less time. In this way, they will be able to care about the psychological needs of patients before, during, and after the procedures. In my opinion, finding a way to shorten the process from data collection until professionals can access and evaluate this data, should be a priority.

# References:

https://www.healthline.com/health/holter-monitor-24h#results

https://www.mayoclinic.org/tests-procedures/holter-monitor/about/pac-20385039

https://medicompinc.com/introducing-newly-improved-holter-monitoring-system-medicomp/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3882198/#:~:text=Extending%20arrhythmia%20monitoring%20periods%20results,patients%20than%20the%20Holter%20monitor.

https://noticiasdelaciencia.com/art/9874/mediciones_cardiacas_constantes_con_un_nuevo_y_pequeno_dispositivo_adhesivo

Data visualization in health systems.

Knowledge is power. Nowadays all kinds of sensors are continuously gathering data about our behavior, our physical activity levels, and different health indicators like blood pressure, blood oxygen levels, and more. All of this can be monitored through phones, smartwatches and other IoT devices conceived specially for medical applications

What happens with all this data? Raw data is useless if we don’t know what we are looking for.

A good strategy for data visualization is the key to the proper use of data.

When trying to create a better user experience for both health professionals and patients, we need to distinguish which information is needed for each side and how it should be presented:

Medical Staff:  An overloaded system can be helped by synthesizing and simplifying the amount of data that the doctors need to analyze.

A good presentation of numbers and facts can help the doctors identify low-risk patients faster, so they can prioritize and leave more time for those who really need it.

Patient: Being a patient is already a stressful situation. Medical terms that patients are not familiar with and uncertainty don’t help make the situation more comfortable. Feeling lost and uneducated is not the feeling of reassurance that a medical visit should give.

Presenting facts and figures in a clear and didactic way will make the patient feel included in the process and learn about the condition, gaining implications for the treatment.

_ Literature

http://ehealthmasterminds.com/visualize-your-data/

https://www.eecs.harvard.edu/~kgajos/papers/2020/fischer20visualization.pdf

https://www.therapeuticshub.com/data-in-healthcare/

IoT devices for medical applications

Data is driving change in most industries in the past years. Enterprises gathering significant data from users can tailor their experience better to them.

Major tech players have entered the field of Health in recent years. Fitness promotion, health indicators monitoring, and emergency contact are some of the key features that companies like Apple, Samsung, Meta, Fitbit, or Garmin have in their offerings through tracking wearables in form of smartwatches with GPS, Barometer, Gyromenters and an array of medical-grade sensors, like Apple’s FDA Approved ECG sensor in the Apple Watch.

This ability to gather data from the user in a non-invasive and continuous way is great news for health services around the world. Some of the main Health indicators, like blood pressure, oxygen levels, and glucose levels that previously required a visit to the doctor now can be done in real-time and telematic, reducing pressure on a strained health system and reducing cost in an ever-increasing expense for governments around Europe.

Telehealth or remote doctor’s consultations are another great option for non-urgent questions that don’t require a physical appointment anymore and help prevent overcrowded hospitals.

A sensible way to collect data can help health administrators track a population’s overall health and implement policy to help their citizens lead a healthier life because prevention is always a better solution than treatment. An easier and most continuous way of following up with patients via Telehealth is also a better way to ensure that people are on track with their treatment in a more efficient manner.

Literature:

https://blog.kiversal.com/que-es-la-iomt/

https://builtin.com/internet-things/iot-in-healthcare

https://www.businessinsider.com/iot-healthcare

eHealth as the way to Improve Patient Experience

#Topic

As we have seen recently, the health systems of the countries can be subjected to great burdens of responsibility and work for medical staff who must monitor the well-being of patients and in turn, seek psychological wellness during medical procedures to which such patients are subjected.

Since 2005, the World Health Organization (WHO) recognized eHealth as an essential part of healthcare systems and since then it has not stopped growing, expanding in multiple directions such as mHealth (use of mobile technologies to shorten the distance between patients and medical services ), TeleHealth (as a way of offering medical services over a distance – about 80% of consultations not related to covid were made by telematic means in 2020), the integration of AI (to suggest treatments or clinical diagnoses – the so-called Clinical Decision Support) or Data visualization (to bring the understanding of patients concerning their own health and facilitate to medical staff the sharing of data about their patients). These are just some of the central topics in this growing field.

#Intention

Within this infinite topic, I am especially interested in everything that is focused on the patient experience, meaning everything that in some way will improve the patients’ experience from when he/she decides to go to the consultation until he/she obtains the recommendations for treatment and subsequent follow-up.

There are already many things done in this regard, even not related to technology and making use of more analog processes, but I would like to see what are the possible improvements or development of new functions in the field of AI (for example, assistance to patients outside of consultation) or imaging/data visualization (focused on the understanding and engagement of the patient in their health status).

#Good practices

MRI Scan to improve childrens’ experience – by Doug Dietz from GE Healthcare

#Design Challenges

Health systems are an environment where designers encounter many pain points that could be addressed. Trying to find a solution to these pain points entails certain challenges such as:

_To try to focus on only one thing at a time: There are many issues that need to be addressed, but it is important for designers to choose one of them and keep the focus clear during the whole design process.

_ The field requires a lot of time spent on research, understanding, and empathizing with users’ needs. There are thousands of people, both medical professionals, and patients, who might be affected by the same issue. It is important to take the time to collect all information and insights related to the topic.

_ To keep aware of what is going on out there. Since healthcare is a worldwide topic, many companies, designers, and institutions may be way ahead in their discoveries regarding the same issue. To be part of the huge healthcare community is mandatory to move forward in making improvements.

_ To become familiar with the treatment of sensitive data, data visualization, and techniques/machines which are commonly used in medical practices to treat different medical conditions.

_ To be mentally prepared to face a long design process with possible significant unanticipated changes.

Virtual Nurse App – by Sense.ly

#Literature