New oximetry app may promote home monitoring, cut cost, empower patients

Although not yet approved for medical use, the oximetry app from Masimo is an interesting tool with promise to empower patients through home monitoring. It has the potential to replace costly procedures and is another step towards the creative destruction of medicine.

Disclosure:

Dr Topol has no conflicts of interest relevant to this digital technology

See also:

• Masimo
• The Creative Destruction of Medicine

Transcript:

It's time for a new segment on Topolog. We're going to get into an interesting gadget. Before I do that, I want to thank you for all the comments on how to help my mother-in-law with the stroke that she had while unanticoagulated. She's doing very well, and we got a lot of varied input. It was I think a record number of comments—well over 40!—thank you for that.

Now let's get into the digital world. Here's a gadget that I just got a hold of recently; it's an oxygen sensor (oximeter) that connects to the iPhone. It's a pretty nice device, I've been trying it out, and I have to say it's very smooth.

This is my iPhone, I just basically take the oximeter and put it on my finger, and then I call up the app. This is actually a Masimo app—a company that makes oximetry equipment, which is used widely.

I get the SpO₂, and then you'll see it start calibrating my oxygen saturation pretty quickly, and—watch this—you have the sound of each heartbeat. There's a perfusion index, which is pretty much meaningless. I've never had 100% sat before (that's interesting!), and my heart rate is 44.

Why is this such an advance of really marked utility? 

While it's not at this point approved for medical use—and I'm not sure how much it will be used for cocktail party chatter!—but nonetheless, this has a lot of potential. You can then turn this "to history," turn off the sound, and now I have a sleep study in the making. All you have to do is tape my finger so this oximetry [gauge] doesn't come off. I've tried it on many fingers and get the same reading (so that's not an issue). You tape the finger and then can get many hours of oxygen saturation and heart rate.

Now that's the beginning of a sleep study, which is terrific because if you do that in a hospital setting it costs $3000 (reimbursed by Medicare). But if you do it at home with this device, it's essentially free, because this is a reusable device. Beyond that, you could add things, like a Band Aid that collects respiratory rate and confirms heart rate—or even potentially heart rhythm—and you could even add a brain-wave sensor. You could take it to an extreme, getting a lot of data beyond just oxygen saturation and heart rate. It would be nice to know respiratory rate.

I would be interested in your thoughts on this. I think it's a neat new addition to the iPhone. These "add-out combinations" really bring enormous potential for changing medicine as I try to advance in the creative destruction of medicine. They are just coming alive one after the other. This one awaits FDA medical approval, but it's out there and can be ordered and has some interesting potential utility in the future.

I'll be interested in your thoughts about how this can be applied to help patients to reduce costs and catch the value of oximetry.

Thanks a lot for your attention to this segment.

Your comments

	New oximetry app may promote home monitoring, cut cost, empower patients
	# 1 of 12	January 24, 2013 08:29 (EST)
	Richard Heilman MD	Devices described are not easily found. The I Phone ECG and the Maximo oximeter, are touted (rightly, I believe) as innovative and promising devices; but I cannot find anywhere how to find or price either. Even Google has let me down. Is there a way to make it easier to learn more about the devices showcased on Topolog without being accused of shilling for the companies? The forum is terrific by the way. Author's disclosure (Jan 24, 2013) I have no relevant disclosures to make in connection with this topic.
	# 2 of 12	January 24, 2013 04:09 (EST)
	Bob Stelloh	precision counts with google; DIY testing google fixes some spellings errors but not all - in this case search for iphone masimo oximeter and get lots of info (note: not maximo and not ecg and not i phone) Perhaps the major value of this and other such DIY devices being developed is to increase the frequency and reliability of DIY testing and transmitting it to the doctor rather than having to go to the doctor's office. Author's disclosure (Jan 24, 2013) I have no relevant disclosures to make in connection with this topic.
	# 3 of 12	January 25, 2013 04:57 (EST)
	David Richardson	iPhone oximetry How can I buy one of these applications, for iPhone oximetry? Masimo's website doesn't list it, and as mentioned above, Google can't find it. Author's disclosure (Jan 25, 2013) I have no relevant disclosures to make in connection with this topic.
	# 4 of 12	January 25, 2013 05:04 (EST)
	David Richardson	iPhone oximetry Google does find it, on Amazon Author's disclosure (Jan 25, 2013) I have no relevant disclosures to make in connection with this topic.
	# 5 of 12	January 28, 2013 03:32 (EST)
	Marsha Reda	iPhone oximetry I would love to know if the probes vary in size to include pediatric/infant? This device would be great in the pediatric home care arena considering NY medicaid will only grant a pulse ox to those on O2 leaving a wide array of patients without this useful tool. Author's disclosure (Jan 28, 2013) I have no relevant disclosures to make in connection with this topic.
	# 6 of 12	January 28, 2013 11:33 (EST)
	dr vipul desai	iPhone Oximetry This sounds very interesting but since the probe is to be bought by the phone user-its price may prohibit patients from buying it-It may be a very handy information for physicians in patient management Author's disclosure (Jan 28, 2013) I have no relevant disclosures to make in connection with this topic.
	# 7 of 12	January 31, 2013 06:35 (EST)
	alistair begg	exciting potential This is just the beginning of what we can hope to achieve with smartphone technology..the challenge will be refining the technology and making it accessible to a wide range of individuals..but this will happen..and it is up to the Cardiology community to take this further.. Author's disclosure (Jan 31, 2013) I have no relevant disclosures to make in connection with this topic.
	# 8 of 12	February 7, 2013 02:40 (EST)
	Rajesh Gupta	Utility limited due to approval conditions a. Pulse oximeters are inexpensive and commonly available, so it is really data recording and availability on iphone platform that has some value; b. more important meters such as AliveCor's ECG are available only to physicians. That is braindead: why would a physician need to worry about a 2-lead iphone addon? It is really the patient/consumer who needs to be educated and have access to readily available monitoring. What is FDA thinking: a patient will harm himself or herself by in-home ECG monitoring? Rajesh Author's disclosure (Feb 7, 2013) I have no relevant disclosures to make in connection with this topic.
	# 9 of 12	February 7, 2013 11:06 (EST)
	Lyn Po	Some of us with sleep apnea sleep with recording oximeters My APAP therapy is about as good as it gets but I still have occasional events that cause O2 desats. Seeing how short these are, to what % my sat O2 drops with associate pule rate info assures me that my therapy really is effective/does't need adjustment. I also can set it to alarm if my sat level reaches the % I set...I figure this is a secondary backup for sleeping during a power outage, first is my GoalZero Solar rechargeable battery. At just under $200, my CMS oximeter is a bargain,plus it runs on 2 AAs, so no worry about recharging. And, if we just had a reliable recording sleep stage meter that wasn't outrageously expensive, we would have close to a home sleep study. If this was for my Android phone and provided more value than what I have now, I'd be interested. Author's disclosure (Feb 7, 2013) I have no relevant disclosures to make in connection with this topic.
	# 10 of 12	February 8, 2013 05:31 (EST)
	william reichert	new apps These apps may generate some interesting data. I wonder who is going to decide what to do with the data. The O2 sat dropped last night. Ok now what?. Did the mask come off, the oxygen tubing disconnect. Did that patient have a coughing attack? Is he in going into heart failure? In my experience often if a patient calls in "data", the doctor is otherwise occupied, the nurse takes the call and if the patient is concerned suggests the patient go to the ER . This is what I see with home health visits. The BP is a little high or low....... go to the ER. Be interesting to see how this turns out. Author's disclosure (Feb 8, 2013) I have no relevant disclosures to make in connection with this topic.
	# 11 of 12	April 4, 2013 08:01 (EDT)
	Chimdindu Osuagwu	OXYMETERS IN DEVELOPMENT STUDIES IPhone or any functional, cheap, and durable and mobile oxymeter will be useful in development work, especially in developing countries where respiratory conditions is a major problem. It does not have to be for hospital diagnoses, knowing that one's oxygen saturation parameters is below optimum can enable later intervention plans. I will be very happy to receive even used ones sent to here in Nogeria, to complement the respiration meter that we use for health assessment in the field. Knowledge of the mean oxygen saturation parameter for a local population can help to inform nutritional interventions, such as lowering daily carbohydrate and fat calorie consumption. What your take on this: chimdindu@yahoo.com (Development Management Consultant) Author's disclosure (Apr 4, 2013) I have no relevant disclosures to make in connection with this topic.
	# 12 of 12	May 9, 2013 05:50 (EDT)
	Judith Currier	Recording pulse ox does the same thing I have a recording pulse ox which I bought from CMS for under $100. It does a great job of recording heart rate and saturations during the night. You can then run them through your computer and get graphs and charts which you can share with your doctor. It has helped a lot to ease concerns about whether my apnea has resurfaced, my oxygen is not high enough, etc. One thought on all these techie things, do they work on the iPad also, or preferably the mini-iPad? Author's disclosure (May 9, 2013) I have no relevant disclosures to make in connection with this topic.

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