By Olivia R. Weidner, DHIT Global Intern | June 12, 2020

On Friday, June 12th, 2020 the Digital Health Institute for Transformation (DHIT) hosted the sixth installment of its digital web series in collaboration with the ASSIST Center at North Carolina State University.

The DHIT Frequency Webinar Series, which takes place biweekly, is a way to keep our community connected while many work from home. Each segment will be co-hosted by DHIT’s President, Michael Levy, and Adam Curry, ASSIST Innovation Ecosystem Director. The series will spotlight distinguished guests from across the ecosystem to discuss the state of digital health in the time of COVID-19. 

Amidst widespread fear and uncertainty, DHIT explores the role of digital health in the global response to COVID-19, gaining insight into the ways this crisis has catalyzed the usage and acceptance of telehealth and other digital health technologies. Last week’s panelists included:

  • Dr. Bryon Boulton, Surgical Director, WakeMed Structural Heart Program
  • Marc Saab, Founder and Managing Director, BML Technology
  • Dr. James Dieffenderfer, ASSIST Faculty, North Carolina State University

Introduction

This most recent installment of the COVID-19 Unites Us All web series focused on remote cardiac monitoring. This week’s panel included three distinguished guests, each of whom contributed valuable insight into technologies for cardiac health management. The spotlight of this discussion centered on wearables, particularly their potential role in detecting COVID-19 infection. The first guest, Dr. Bryon Boulton, is a cardiothoracic surgeon and Surgical Director of the WakeMed Structural Heart Program. Boulton gave viewers a look at the clinical side of remote cardiac monitoring, while Marc Saab, founder and managing director of BML Technology, explored the process of device commercialization. Finally, Dr. James Dieffenderfer, a faculty member at North Carolina State University’s ASSIST Center, talked through the research and development domain. 

COVID and Cardiac Health

Co-host Adam Curry kicked off the conversation by asking panelists about the potential for utilizing cardiac biomarkers for identifying COVID infections. For Dr. Boulton, these markers hold promise, especially for determining increased risk and mortality: 

“There is definitely potential there. We have seen that some major drivers of mortality from the disease occur when there are cardiac complications, particularly elevations in certain cardiac enzymes. This is suggestive of increased heart strain or heart attack, and also heart failure. This tends to occur later in the disease process, after the patient has been diagnosed with the disease. The earlier we can see evidence of cardiac changes, the better we can deal with cardiac complications because that’s the best opportunity to intervene and have an impact.”

“Adoption of these devices has completely exploded. Wearables are more accessible and accepted. What we’re seeing is an increased attention directed toward finding solutions as quickly as possible. There’s a crisis going on right now, and thus there’s a demand for products that fill certain needs. Moving forward, we’re looking to the application of wearable devices beyond the current pandemic. One thing COVID has made us realize is our vulnerability and the possibility of something similar happening again. Even a second wave of this existing crisis is something we are thinking about. Beyond that, we are realizing that this is not a singular event; it’s part of our collective challenge as a species.”

Individuals with cardiovascular disease (CVD) are among the many vulnerable populations at risk of complications from COVID-19. Trends in heart rate variability and oxygen saturation could serve as indicators or warning signs for pre-clinical identification of risk. However, the lack of symptom specificity for COVID-19 infection means that these indicators are not enough to diagnose. Rather, changes in cardiac patterns could signal concern and prompt patients to seek medical advice. 

COVID and Wearable Adoption: The Wearable Marketplace

After hearing from Dr. Boulton about the clinical domain, Marc Saab shared his experience on the commercial side of remote cardiac monitoring and the wearable marketplace:

“Adoption of these devices has completely exploded. Wearables are more accessible and accepted. What we’re seeing is an increased attention directed toward finding solutions as quickly as possible. There’s a crisis going on right now, and thus there’s a demand for products that fill certain needs. Moving forward, we’re looking to the application of wearable devices beyond the current pandemic. One thing COVID has made us realize is our vulnerability and the possibility of something similar happening again. Even a second wave of this existing crisis is something we are thinking about. Beyond that, we are realizing that this is not a singular event; it’s part of our collective challenge as a species.”

Saab’s comments speak to the benefits of using wearables during the current COVID-19 pandemic and beyond. If wearable devices can be used to monitor COVID-relevant biometrics like heart rate variability on a large scale, researchers and clinicians would be better able to identify trends and patterns. Although these tools can’t be used for diagnostic purposes just yet, data collection and analysis could serve to establish a better understanding of the biological mechanisms underlying the COVID symptom profile. 

Research and Development

Despite the many promising qualities of devices for remote cardiac monitoring, certain challenges exist as well. In any wearable device, signal quality and form factor are important considerations. Dr. Dieffenderfer seeks to address these concerns through his innovative work at the ASSIST Center: 

“The exciting thing about the potential for cardiac identifiers is that it’s easy to make low-power wearables to track heart rate. Some research I’m working on with my team at the ASSIST Center involves deploying a continuous ECG monitor that monitors for long periods of time. There’s a lot of design challenges, including the comfort factor, the need for electrode replacement as they dry out, and battery life.”

Wearability is of central importance to the ASSIST Center’s work; a device needs to be seamless and comfortable to ensure prolonged use. Furthermore, the more charging a device needs, the less time it spends on the user’s body, so low-power or self-powered devices are key. At the ASSIST Center, Dieffenderfer and his team are working on constructing a cardiac armband that uses electrodes placed on the bicep to gather ECG data. The use of compression eliminates the need for “wet” electrodes, which often dry out or need to be replaced. Additionally, because this device is worn on the arm, users won’t experience the chest discomfort that often accompanies devices worn on the torso. In order to minimize charging requirements, ASSIST is utilizing sunlight, indoor lighting, and body heat harvesting to power these devices. Dieffenderfer tells viewers: “the proof of concept is there, but we are still working on situational use cases.” Dieffenderfer states that there is a high level of readiness on the hardware development side; the regular product development cycle is estimated at about six months. However, software optimization (i.e. AI/algorithmic components) will take longer. 

Conclusion

From research and development to commercialization and clinical usage, wearable technologies are undergoing transformation as acceptance and demand continues to grow. Saab points out that regulatory bodies, especially the FDA and Health Canada, have recently eased up on regulatory restrictions in order to enable technological development that meets the needs of the current pandemic. As the process continues, Dr. Boulton calls for an integrated approach: “In terms of device design, partnering with a physician early and making them part of the team during the development process will accelerate progress toward the desired end.” With a dynamic interplay between researchers, clinicians, and regulatory bodies, it becomes possible to design and deploy helpful technologies for improving health in the current moment and beyond. One thing is clear: collaboration will be essential moving forward. 

DHIT thanks its guests for serving on the panel, and everyone who tuned in! If you were not able to catch last week’s webinar, check out DHIT’s Media page to see what you missed. DHIT and ASSIST would also like to give a special shout out to our Program and Innovation Champions: Pfizer Digital, RIoT, Excelerate Health Ventures, Device Solutions, Medallia, Charlotte AHEC, Elsevier, Cone Health Ventures, and Duke MEDx.

We are excited to announce DHIT’s partnership with the ASSIST Center to launch a Virtual Incubator using Crowdicity to collect crowdsourced ideas from the digital health community focusing on remote care. This innovation engine will serve as a catalyst to advance remote care by sourcing ideas from the ecosystem and nurturing them from inception to implementation. For more information, see our landing page for the Incubator and mark your calendar for Friday, June 26th for the next installment of the DHIT Frequency Webinar Series. Until then, stay safe, everyone! 

Resources

  • To learn more about the ASSIST Center, visit assistcenter.org
  • To learn more about the Virtual Incubator, visit dhitglobal.org/incubator
  • To view previous recordings, visit DHIT’s Media page here: https://www.dhitglobal.org/media/

ABOUT DHIT

The Digital Health Institute for Transformation (DHIT) is a 501(c)(3) non-profit education and research institute supporting communities through the process of digital health transformation. We collaborate with leading academic institutions, associations, and industry to cultivate talent and ecosystems with our immersive learning platform, harnessing real-world experiences that drive the adoption of next generation skills, emerging technologies, and mindsets needed to foster the digital health leaders and innovators of the future, today. For more information, visit dhitglobal.org.

If you would like more information on this topic, please contact our Executive Producer, Brian Cooper at [email protected].