Wednesday, November 20, 2013



Earlier this year, 498 asthma patients in California were split into two test groups. One group puffed their inhalers normally. But the second group was given a sensor that attaches to the top of the inhaler and beams data about their usage back to Dr. Rajan Merchant of Woodland Health Care. Each day, Dr. Merchant scans a list of several hundred patients to find the handful that need to be contacted for an office follow-up.
“Whenever there was a change in patients that require care, we would contact them either on the phone or have them come in,” Merchant told Fast Company. The patients in the control group also received sensors, but neither they nor their doctors were given access to the data. “We would see as them as usual when their symptoms were triggered or for their scheduled appointments.”

Propeller Sensor

This is one of the earliest clinical trials that will show how the so-called Internet of things--a vast array of small but interconnected devices that allow unprecedented levels of communication--could have an impact far more meaningful than automating your home lighting system. The asthma sensor is made by Propeller Health, and it recognizes what type of medication is being used, along with when and where symptoms are triggered. The data is shared with an app that tracks where and when each puff of medicine is discharged, and users can receive weekly updates via text message. It also tracks symptoms, triggers, and location, triangulating them so that you and your doctor can start to see what causes attacks. Are you in a high smog area? Is your bedroom too dusty? Do you use the rescue medication more in September when you’re burning leaves?

“The app prompts you for triggers," says Propeller's chief marketing officer Erica St. Angel. "When you use the rescue medication it sends a text, 'We see you used your rescue information. We hope you’re okay--when you’re feeling better, enter your trigger information. Like were you near a cat, was there mold, or was it cold outside?'" Over time that helps patients get smarter about when to take a preemptive puff.
Collecting and analyzing data from multiple individual asthmatics in a community unlocks another layer of potential for Propeller as well. The company partnered with the Weather Channel to monitor the air quality index in cities like Louisville, Kentucky, where they also teamed up with the city to give out free sensors to residents with asthma. “With many more users you can start to overlay other types of geospatial information, pollution, where the parks are, and create really dense and cool maps,” St. Angel says. “In Louisville you start to see time-based information--there is construction on the freeway right now, so asthma attacks are up.”

Propeller's solution works even for people without smartphones. Through a partnership with Qualcomm Life, the inhaler sensor can be paired with a hub that plugs into the wall and transmits data. Patients using the hub receive an email with updates about their health. Propeller will even mail updates to people without Internet access. "Or we do phone calls," says Propeller CEO and cofounder David Van Sickle. "We have an asthma educator on staff for that reason.”
“I can care less about the technology,” Van Sickle says. “What we care about is improving outcomes to give people more asthma-free days.”
The early results show that the sensor is having a positive effect. Dr. Merchant, who has no financial relationship to Propeller or the foundation funding the study, released the first set of findings last week. Patients using the Propeller sensor on their inhalers had slightly fewer emergency room visits than the control group (0.103 versus 0.141 per person per year), and significantly fewer inpatient days (0.087 per person versus 0.225 among the control group).

While that impact may appear to be small, it is measurable when applied to health spending, which is also being tracked historically for the test groups. The patients being monitored remotely with the Propellor sensors were on track to save nearly $700 compared to the previous year. “That was the biggest advantage,” says Merchant. “Both the hospital visits and the costs.”
The Propeller study is still young--this is the first quarter worth of results, and it doesn't wrap up until May of next year--but these are promising early results. And there's built-in incentive for doctors and hospitals to adopt the system. Regulatory changes taking effect in 2014 will, under Medicare's Hospital Readmissions Reduction Program, financially penalize hospitals that readmit patients with the chronic lung disease COPD within 30 days of their original stay. In January, Propeller is introducing a version of their sensor and app made specifically for patients suffering from COPD. “If you go to the hospital for COPD and are discharged but have to come back, there are penalties for the hospital--even if you go home stable,” says St. Angel. “This creates a driver for physicians to use the app to monitor and understand what is going on in the home environment.”

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