"Still, there’s often confusion about who is caring for the patient ... " Playing off of Jimmy the Greek's comment,…
As the healthcare industry begins to shift more towards telehealth and non-office-based management strategies, there’s a greater need for devices that patients can use at home or on the go. I’ve long been a fan of my Garmin watch, which tracks my daily steps, maps my runs, and reminds me to get moving when I’ve been sitting too long. Beyond that, I’ve not gotten too deep into the quantified self movement. I’m more motivated by being able to watch frivolous Netflix on the treadmill than I am by tracking performance numbers, so I haven’t needed that external reinforcement.
At a recent medical visit, I had an uncharacteristically high blood pressure reading, which I mostly attributed to the fact that I was about to be stuck with a bunch of needles. However, as a student of data and given my family history, I figured it might be time to invest in my own home blood pressure monitor to make sure nothing more sinister was going on. Plus, as a physician practicing telehealth and relying on patients providing their own data, it would give me some visibility into the experiences my patients might be having.
A couple of my physician friends have hypertension and monitor themselves religiously, so I asked around the virtual physician lounge for recommendations. Nearly everyone recommended the Withings BPM Connect, which is supposed to be easy to use and compact. It also supports both Bluetooth and Wi-Fi connectivity. I’ve had some experience with the Withings scales as part of a congestive heart failure project I did for a health system client, so decided to take their recommendation. Through the wonders of internet commerce, I was able to have one delivered to my home quickly and was eager to get it up and running. Since I was evaluating the device from different perspectives – patient, clinician, and informaticist – I had a lot of different elements I wanted to look at.
The first challenge with the device was the printed instructions that came with it. The user manual appeared to be printed on environmentally friendly brown paper. Although it’s a good idea from a sustainability standpoint, for users of a certain age where contrast is important for printed materials, it was a bust. I became one of those folks that uses the flashlight function on their phone just to read it, which made one of the younger members of my household laugh. Rather than watch me struggle with it, he proceeded to take the manual and read the German version to me, seeing if I could figure it out from the bits and pieces of the language that I understand. Based on that experience, I can see how the written documentation alone would be challenging to older users or those with low vision.
Eventually I got to the point where I needed to pair it with my phone, which was an adventure in itself. I downloaded the app easily and followed the instructions to connect. That’s where things started heading downhill. After what seemed like an interminably long “trying to connect” screen, it failed to connect. I repeated the process multiple times with the same results. Even though my phone identified the cuff as an available device from within the phone’s connectivity settings, it wouldn’t connect. In true IT fashion, I rebooted the phone and tried again.
This time I was able to get it to connect, and a firmware upgrade was applied to the cuff. Unfortunately, it immediately disconnected and wouldn’t reconnect. Multiple trips through the “trying to connect” screen and a couple more reboots later, I finally got it to connect to the phone. Eventually it also allowed me to connect the cuff to my home Wi-Fi network and I was ready to try to take an actual blood pressure reading. By this point, though, I had a fairly ripping headache and was a bit frustrating, so I expected a less-than-perfect result. The cuff itself is fairly easy to put on and take off, although patients with less dexterity in their arms or hands might benefit from having some assistance.
The Withings Health Mate app has a helpful video for those who have never taken a blood pressure that explains how you should sit quietly for five minutes and make sure your arm is supported at the level of your heart prior to taking a reading. As a matter of logistics, these steps are almost never followed at medical offices, which re-emphasizes the role home monitoring devices might play in helping patients and physicians obtain accurate results. The cuff itself has two modes – one where a single blood pressure is taken, and one that takes three blood pressures over a short period of time and then averages the results. I decided three data points were better than one and gave it a whirl. The LED display was easy to read and includes your name in the final display, which is helpful since the device will support up to eight users.
The Health Mate app does a nice job of graphing your results as well as displaying your latest measurements and highest and lowest values. I found it annoying, though, that it keeps asking me to connect to Google Fit, which I have no desire to do. There didn’t seem to be a way to get it the reminder to snooze, so we’ll have to see if it keeps coming back. The app offers functionality to send patient data to the physician, but I haven’t experimented with that yet. The device advertises six months of use on a single charge (via USB), but doesn’t specify whether that’s one person checking blood pressure daily, or some other combination of variables. As a physician, the timeframe we recommend for BP checks varies from person to person, and sometimes it’s not ideal for patients to check it too often. The app does offer patient-facing reminders to encourage regular measurements.
Withings advertises the BPM Connect as “travel friendly” and I agree it’s rather compact – the cuff wraps tightly around the display unit and it’s about the same diameter as a flat iron used for hairstyling, although much shorter. The company also sells a protective travel case for $29.95 but I don’t think it’s necessary, unless you’re tossing it in a gym bag where it might come into contact with sweaty or dirty clothes or where it might be rattling around with something that might catch on the Velcro.
I got a kick out of reading some of the reviews on the Withings website. One noted that the device “feels like a premium home health product with soft, heathered fabric around the outside and a soft-touch plastic to the tube…” I guess I didn’t think much about the fabric or the feel of the plastic since I’m used to conventional nylon office-style blood pressure cuffs, but that might be an important aesthetic for some users. My absolute favorite customer review was a product manager’s wildest dream, stating, “I never thought I’d buy into the ecosystem so much, but they are *genuinely* delighting me with their user experience.”
My initial user experience was less than delightful, and had I been someone who was less tech savvy, I might have given up. It definitely felt like one of those moments where people call their grandchildren and ask them for help. Fortunately, even with the aggravation with the connectivity, my blood pressure wasn’t all that exciting and I’m glad to know I still have a resting heart rate that borders on being abnormally slow. We’ll have to see how it performs over the next several months and whether the old adage about what gets measured gets managed applies.
What’s your favorite piece of home monitoring equipment? Leave a comment or email me.
Email Dr. Jayne.