Collaborating to Bring 24/7 Mobile Tech to COVID-19

Originally published in Chicago Medicine

Early in the COVID-19 pandemic, doctors and nurses at University of Illinois Hospital and Health Sciences System (UI Health) observed that close monitoring of infected patients alerted medics to intervene early for patients with advancing COVID-19.

Now, UI Health is using pinpointIQ, a new AI and continuous remote monitoring system developed by physIQ, a Chicago-based healthcare startup. PhysIQ developed the first FDA-cleared personalized analytics platform to offer actionable information using algorithms.

The first to use the new technology at UI Health will be certain frontline healthcare professionals and infected patients isolating at home as well as patients with risk factors for COVID-19. These groups will wear biosensor patches that detect subtle physiologic changes of illness progression that may indicate a need for early follow up with their physician.

Avoiding the ICU and Ventilator with Home Monitoring

It’s well known that mortality rates are especially high for patients placed on ventilators, higher than for those who aren’t.

“We paid attention to subtle changes in telemetry and breathing rates in our hospital so we could take early actions like improving oxygen levels,” said Terry Vanden Hoek, MD, chief medical officer at UI Health. These actions can prevent a patient from needing admission to an intensive care unit or even being placed on a ventilator, he said.

“It’s better to try to avoid ventilators in intensive care units and only use them as a last resort,” said the head of emergency medicine.

“We’ve taken care of well over 1,200 COVID- 19 patients at this point (July) at UI Health. And we’ve learned a lot,” said Dr. Vanden Hoek.

“And one of the things we learned is that we don’t necessarily want to put patients on a ventilator right away. Once somebody is on a ventilator they could be on that piece of equipment for weeks.”

Using the pinpointIQ system from physIQ, Dr. Vanden Hoek said UI Health now monitors the patient from home so the doctors can act early if the patient’s condition deteriorates before they come to the hospital or the ICU.

Bringing physIQ to UI Health

In April, CMS leadership reached out to Dr Vanden Hoek with an opportunity to utilize physIQ’s technology at UI Health. CMS had vetted physIQ and asked if UI Health would be interested in testing physIQ’s pinpointIQ solution to help address the COVID pandemic.

CMS introduced Dr. Vanden Hoek to the top executives at physIQ, founder and CEO Gary Conkright, a serial Chicago entrepreneur, and Chief Medical Officer Stephen Ondra, MD, a former U.S. Department of Veterans Affairs medical executive and a former White House consultant on implementing the Affordable Care Act (see “Chicago Exec Expands AI Concept from Jet Engines to COVID-19”).

Testing pinpointIQ on High-Risk Patients and Staff at UI Health

Dr. Vanden Hoek reached an agreement to try out physIQ’s pinpointIQ system on some COVID-19-positive UI Health patients and staff with such risk factors as hypertension, obesity and heart and lung conditions who were isolating at home. He said many staff at UI Health, like the communities it serves on the South and West Sides of Chicago, come primarily from minority groups, including Black, Latinx and Asian American populations. These groups are at increased risk for COVID-19.

“We thought these populations would be potentially better served if we could offer a home monitoring option for them. While they were recovering at home, they would also have the additional assurance of being monitored for subtle changes in heart rates and breathing rates that could potentially predict worsening outcomes they may not even know about,” said Dr. Vanden Hoek.

“Continuous monitoring of patients using physiological modeling with AI offers an opportunity to detect a virus exacerbation early. Early intervention may prevent the body from initiating the ‘cytokine storm’ that we think causes most of the severe complications of COVID-19,” he said.

Triggering Early Interventions with Remote Monitoring

Dr. Vanden Hoek said if a patient’s oxygen level is declining, then the patient can be given high-flow oxygen treatment. “We even use helmet devices to provide more oxygen,” he said.

Another approach that can be implemented is having patients lie in the prone position, which enables them to intake more oxygen. “Also, we can give them steroids and anticoagulation medicine. We think thinning the blood for some of these patients could be helpful, but it all depends on if you can identify early on who might be most at risk for further injury from COVID-19.”

The pinpointIQ system by physIQ had already shown benefits in research on patients with Ebola virus in Africa and on patients with severe congestive heart failure in VA medical centers (see “VA Heart Study a Model for Remote COVID-19 Care”).

PinpointIQ contains several components, said Dr. Ondra. Patients place a disposable adhesive bandage on their chest. The bandage has embedded biosensors, manufactured by Vital Connect, to measure heart and respiration rates, temperature, position and activity levels.

The biosensors stream data 24/7 that is broadcast to the cloud by a data-only Android phone. The patient is also asked to provide a pulse oximeter reading twice a day from a provided finger sensor.

Dr. Ondra said deep learning, or artificial intelligence, kicks in to model what’s normal and what’s not based on the patient’s vital signs. “The AI learns an individual’s baseline and can detect subtle changes over time,” he said.

Dr. Vanden Hoek said all the data is encrypted and HIPAA-compliant servers are used. “There’s no personal information left on the phone. So if somebody forgot their phone for whatever reason, there’s nothing on it,” he said.

He joked that they tested the system on a technology-challenged group—physicians. “It’s safe to say that it’s pretty easy to use. It’s [like] pulling it out of the box and putting on a Band-Aid.”

Imaging the Future of Early Interventions

Dr. Vanden Hoek said the home monitoring program at UI Health is going well so far. “Monitoring with wearable technology is a way to engage a patient and explain, ‘your monitoring looks quite different from what it usually looks like when you’re feeling well, and you may be getting sick. Let’s set up an appointment to find out what’s going on.

He predicts that such early intervention could benefit patients with arrhythmias, chest pain, abdominal pain, immunosuppression and sickle cell disease. “Additional technologies like pinpintIQ could tell us that this person is potentially sicker than we realized and be helpful in caring for them,” Dr. Vanden Hoek said.