Add ‘cardiac monitoring’ to the ever increasing list of services your iPhone can offer.  Last year, the FDA approved AliveCor’s heart monitor which records and ECG from your iPhone.  Although a technologically savvy invention, this high tech tool carries potential burden for you as a medical provider.  

Easy to operate, users of AliveCor’s ECG program simply place electrodes on the back of their iPhone, rest the electrodes on fingers from each hand and the handy app records a rhythm strip.  ECG’s are stored in the program for review.  Thanks to this technological advancement, you and your patients can now evaluate their heart’s rate and rhythm anytime and anywhere.  AliveCor’s website suggests that the app may be most useful following cardiac surgery, for long-tern Afib monitoring, medication-induced long QT duration response monitoring and multi-specialty care integration.  This device cannot be downloaded to a patient’s phone without a prescription.  Although this gadget is a notable, convenient technological advancement, what implications does it carry for you as a medical provider?

Dr. Westby Fisher (aka Dr. Wes) internist, cardiologist and cardiac electrophysiologist, voices concerns about this new app.  He acknowledges it’s potential to help patients conveniently monitor cardiac conditions but worries about some unaddressed issues posed by AliveCor’s app.  First, there is the concern of liability.  Physicians and nurse practitioners cannot check their iPhones constantly, waiting to see if a patient has uploaded an ECG.  Should an ECG indicating an acute cardiac abnormality be uploaded and not read by the provider for hours this could pose serious health consequences for the patient and legal consequences for the provider.  AliveCor notes it is not responsible for ECG interpretation, this is the sole responsibility of the prescribing physician.

Secondly, medical culture has not yet adapted to the realm of at-home diagnostic testing.  Insurers such as Medicare do not pay providers to interpret ECG’s from services such as AliveCor’s app.  Providers prescribing this handy app will not be compensated for their 24/7 ECG interpretation services.  At-home diagnostic testing can potentially encroach on the private lives of providers forcing them to be constantly in tune to the readings their patients take- and, for now, without pay.

AliveCor’s Heart Monitor is one of many mobile diagnostic tools entering the medical market.  As a nurse practitioner, take caution in advocating these tools as they carry legal and personal implications for providers.  Before blindly prescribing cool, new medical gadgets such as the heart monitor to your patients, carefully weight the legal and personal risks of assuming 24/7 care for your patients.

In what ways to do think medicine will change to accommodate at-home diagnostic tools in the coming years?  Are you concerned about the legal implications of these types of devices?


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