By Rosie Lombardi
October 10, 2013

Doctors who make arrangements to get cardiac diagnostic tests for their patients know this is typically a lengthy process. But Burlington-based m-Health Solutions, which has developed a mobile solution, is demonstrating how quick and easy these tests can be. The Appletree Medical Group, which is comprised of about 31 clinics across Ontario and Alberta, recently adopted the technology and incorporated it in its EMR Advantage system.

One of the key features of m-Health’s 14-day cardiac system is the speed with which a test can be arranged. “If a patient goes to his doctor complaining about palpitations, we can get a kit couriered to the patient’s home or their place of work in 24 hours,” says CEO Sandy Schwenger (pictured).

The kit is comprised of a cardiac diagnostic device with electrodes, a BlackBerry smartphone, an easy instruction manual and DVD for setting up the test. Also available is a call centre to assist patients with any questions they may have. Cardiac strips are transmitted wirelessly to m-Health’s cardiac diagnostic centre and the data is compiled by cardiac technologists. When sufficient data is received, one of the 54 cardiologists currently working with the system throughout Ontario will review the results and make the diagnosis. On completion, the results are transmitted to the referring physician and the patient is contacted to put everything back in the ‘kit’ and to return it in a self-addressed envelope where it is then refurbished for the next patient.

The BlackBerry is dedicated to cardiac diagnostics only, and can’t be used for phoning or any other purpose, explains Schwenger.

“While the patient is wearing the device, the rhythm is sent from the device to the BlackBerry, and then transmitted to our Center. We received a federal government grant to develop this specialized application for the BlackBerry.”

Another key feature of m-Health’s system is that the duration of the diagnostics is longer than older, familiar cardiac dignostic tests, she says. The longer monitoring helps with stroke aversion, as it identifies atrial fibrillation.

“Historically, this type of monitoring was done with the Holter monitor. But our solution can last up to 14 days, whereas Holters typically monitor only 24 to 48 hours. There’s an enormous amount of research that supports the longer duration of monitoring because many people are symptomatic, but cardiac events are infrequent. Dr. Gladstone out of Sunnybrook Hospital has just finished a study, and he in fact believes that even longer monitoring than 14 days is important to prevent strokes.”

The system also has a feature that allows patients to manually indicate on the device when they feel an event instead of writing it in a diary, which saves cardiologists time and effort in hunting and finding the test strip that correlates with the event.

“The BlackBerry is equipped with a symptom rhythm correlation feature. When patients push the button, they can record, ‘I was walking the dog and I felt dizzy.’ That message is transmitted along with the strip to our cardiac center.”

Despite all this high-tech wizardry, Schwenger says the system is easy enough for non-tech-savvy patients to use. “Some people say, ‘Oh my gosh. An elderly patient could never use this.’ But over 5,000 patients at have been diagnosed using this technology, and research shows that they are very capable of using this type of system.”

Another feature of m-Health’s system is that it’s scaleable and can be used for a large number of patients. This feature was attractive to the Appletree Medical Group, which was looking for a way to provide a simplified cardiac monitoring solution for its 31 facilities across the GTA and Ottawa.

To make ordering the test easy for its doctors, Appletree built an interface to link its EMR Advantage system to m-Health. “Doctors order the test from their EMR system. The patient signs and consents, and the request is directly received by m-Health, who then fulfill the order. When completed, results are transmitted electronically back to us, and our doctors are notified that it’s ready for review,” says Katrina Wroblewski, director of operations at Appletree.

Over the past three years since m-Health launched the system, with Appletree coming on board, the number of GPs who are using it to provide cardiac diagnostic to their patients has grown to about 1,500 today, says Schwenger. “Right now we are focusing on Ontario, but that doesn’t mean we aren’t looking at other opportunities outside of Ontario.”

The partnership with a big player like Appletree’s EMR subsidiary Canadian Health Systems may be that opportunity, as it has been expanding outside Ontario. “There are about 2.4 million patients whose physicians use Appletree’s EMR Advantage system to manage their practice, and over half a million patients in Alberta. m-Health’s Event service right now is only being offered in Ontario, but we hope to offer it for the Alberta and the BC clinic groups we will be serving in the near future,” says Wroblewski.