Electronic health record data is unable to effectively characterize measurement error from pulse oximetry: a simulation study

Large data sets from electronic health records (EHR) have been used in journal articles to demonstrate race-based imprecision in pulse oximetry (SpO2) measurements. These articles do not appear to recognize the impact of the variability of the SpO2 values with respect to time ("deviation time"). This manuscript seeks to demonstrate that due to this variability, EHR data should not be used to quantify SpO2 error. Using the MIMIC-IV Waveform dataset, SpO2 values are sampled from 198 patients admitted to an intensive care unit and used as reference samples. The error derived from the EHR data is simulated using a set of deviation times. The laboratory oxygen saturation measurements are also simulated such that the performance of three simulated pulse oximeter devices will produce an average root mean squared (ARMS) error of 2%. An analysis is then undertaken to reproduce a medical device submission to a regulatory body by quantifying the mean error, the standard deviation of the error, and the ARMS error. Bland-Altman plots were also generated with their Limits of Agreements. Each analysis was repeated to evaluate whether the measurement errors were affected by increasing the deviation time. All error values increased linearly with respect to the logarithm of the time deviation. At 10 min, the ARMS error increased from a baseline of 2% to over 4%. EHR data cannot be reliably used to quantify SpO2 error. Caution should be used in interpreting prior manuscripts that rely on EHR data.

Remote patient monitoring in the management of chronic obstructive pulmonary disease

Remote patient monitoring allows monitoring high-risk patients through implementation of an expanding number of technologies in coordination with a healthcare team to augment care, with the potential to provide early detection of exacerbation, prompt access to therapy and clinical services, and ultimately improved patient outcomes and decreased healthcare utilization.In this review, we describe the application of remote patient monitoring in chronic obstructive pulmonary disease including the potential benefits and possible barriers to implementation both for the individual and the healthcare system.

Carbon Dioxide Sensing-Biomedical Applications to Human Subjects

Carbon dioxide (CO2) monitoring in human subjects is of crucial importance in medical practice. Transcutaneous monitors based on the Stow-Severinghaus electrode make a good alternative to the painful and risky arterial "blood gases" sampling. Yet, such monitors are not only expensive, but also bulky and continuously drifting, requiring frequent recalibrations by trained medical staff. Aiming at finding alternatives, the full panel of CO2 measurement techniques is thoroughly reviewed. The physicochemical working principle of each sensing technique is given, as well as some typical merit criteria, advantages, and drawbacks. An overview of the main CO2 monitoring methods and sites routinely used in clinical practice is also provided, revealing their constraints and specificities. The reviewed CO2 sensing techniques are then evaluated in view of the latter clinical constraints and transcutaneous sensing coupled to a dye-based fluorescence CO2 sensing seems to offer the best potential for the development of a future non-invasive clinical CO2 monitor.

Integrated Telehealth and Telecare for Monitoring Frail Elderly with Chronic Disease

Objective:To investigate the potential of an integrated care system that acquires vital clinical signs and habits data to support independent living for elderly people with chronic disease.

Materials and Methods:We developed an IEEE 11073 standards-based telemonitoring platform for monitoring vital signs and activity data of elderly living alone in their home. The platform has important features for monitoring the elderly: unobtrusive, simple, elderly-friendly, plug and play interoperable, and self-integration of sensors. Thirty-six (36) patients in a primary care practice in the United Kingdom (mean [standard deviation] age, 82 [10] years) with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) were provided with clinical sensors to measure the vital signs for their disease (blood pressure [BP] and weight for CHF, and oxygen saturation for COPD) and one passive infrared (PIR) motion sensor and/or a chair/bed sensor were installed in a patient's home to obtain their activity data. The patients were asked to take one measurement each day of their vital signs in the morning before breakfast. All data were automatically transmitted wirelessly to the remote server and displayed on a clinical portal for clinicians to monitor each patient. An alert algorithm detected outliers in the data and indicated alerts on the portal. Patient data have been analyzed retrospectively following hospital admission, emergency room visit or death, to determine whether the data could predict the event.

Results:Data of patients who were monitored for a long period and had interventions were analyzed to identify useful parameters and develop algorithms to define alert rules. Twenty of the 36 participants had a clinical referral during the time of monitoring; 16 of them received some type of intervention. The most common reason for intervention was due to low oxygen levels for patients with COPD and high BP levels for CHF. Activity data were found to contain information on the well-being of patients, in particular for those with COPD. During exacerbation the activity level from PIR sensors increased slightly, and there was a decrease in bed occupancy. One subject with CHF who felt unwell spent most of the day in the bedroom.

Conclusions:Our results suggest that integrated care monitoring technologies have a potential for providing improved care and can have positive impact on well-being of the elderly by enabling timely intervention. Long-term BP and pulse oximetry data could indicate exacerbation and lead to effective intervention; physical activity data provided important information on the well-being of patients. However, there remains a need for better understanding of long-term variations in vital signs and activity data to establish intervention protocols for improved disease management.

Oxygen saturation measurements in telemonitoring of patients with COPD: a systematic review

INTRODUCTION

Telemonitoring applications are expected to become a key component in future healthcare. Despite the frequent use of SpO₂ measurements in telemonitoring of patients with chronic obstructive pulmonary disease (COPD), no profound overview is available about these measurements. Areas covered: A systematic search identified 71 articles that performed SpO₂ measurements in COPD telemonitoring. The results indicate that long-term follow-up of COPD patients using daily SpO₂ spot checks is practically feasible. Very few studies specified protocols for performing these measurements. In many studies, deviating SpO₂ values were used to raise alerts that led to immediate action from healthcare professionals. However, little information was available about the exact implementation and performance of these alerts. Therefore, no firm conclusions can be drawn about the real value of SpO₂ measurements. Future research could optimize performance of alerts using individualized, time-dependent thresholds or predictive algorithms to account for individual differences and SpO₂ baseline changes. Additionally, the value of performing continuous measurements should be examined. Expert commentary: Standardization of the measurements, data science techniques and advancing technology can still boost performance of telemonitoring applications. All these opportunities should be thoroughly explored to assess the real value of SpO₂ in COPD telemonitoring.

Interoperable End-to-End Remote Patient Monitoring Platform Based on IEEE 11073 PHD and ZigBee Health Care Profile

This paper describes the implementation of an end-to-end remote monitoring platform based on the IEEE 11073 standards for personal health devices (PHD). It provides an overview of the concepts and approaches and describes how the standard has been optimized for small devices with limited resources of processor, memory, and power that use short-range wireless technology. It explains aspects of IEEE 11073, including the domain information model, state model, and nomenclature, and how these support its plug-and-play architecture. It shows how these aspects underpin a much larger ecosystem of interoperable devices and systems that include IHE PCD-01, HL7, and BlueTooth LE medical devices, and the relationship to the Continua Guidelines, advocating the adoption of data standards and nomenclature to support semantic interoperability between health and ambient assisted living in future platforms. The paper further describes the adaptions that have been made in order to implement the standard on the ZigBee Health Care Profile and the experiences of implementing an end-to-end platform that has been deployed to frail elderly patients with chronic disease(s) and patients with diabetes.