Medly heart monitoring enters commercialization through Vitall

The commercialization of Medly, a universally acclaimed remote monitoring technology for heart failure patients developed by Toronto’s University Health Network (UHN), has been entrusted to Vitall Intelligence Inc., a member of the Blyth Group of companies headed by serial entrepreneur Don Simmonds.

Invented by Dr. Heather Ross, head of cardiology at the UHN’s Peter Munk Cardiac Centre and Dr. Joseph Cafazzo, the hospital’s director of biomedical engineering, Medly is a smartphone-based system that collects and interprets daily health data from Bluetooth enabled weigh scales and blood pressure monitors.

The system uses an algorithm that detects the risk of decompensation and keeps patients out of hospital.

Medly has expanded from a single site in 2016 to five Toronto area hospitals. It is also being used to monitor heart failure patients in remote Indigenous communities in Northern Ontario, preventing unnecessary medivacs.

Based on data and studies from eight to 10 years of use, Medly keeps heart failure patients stable and results in a 50 percent reduction in heart failure-related hospitalizations.

Vitall, which describes itself as a digital health information utility, is transitioning Medly from its current on-premise deployments to a cloud-based infrastructure that makes it scalable and affordable for expansion across Canada and beyond.

Vitall business development lead Kirk Fergusson is aware of the odds he’s up against, acknowledging that, “Hospitals are struggling financially and don’t have a lot of disposable cash sitting around for innovations even if there’s compelling ROI story behind it.”

The problem, said Vitall chairman and CEO Simmonds, is that “Hospitals aren’t necessarily reimbursed for keeping people out of hospital. If they invest in Medly, it doesn’t change the economics of the hospital at all. That’s a fault of the system.”

He explained that we should be incentivizing hospitals to take care of patients so they’re not re-hospitalized. We don’t yet do that well here in Canada.

Nevertheless, Medly helps hospitals function more efficiently, reducing costs in a broader context.

“Medly benefits the entire healthcare system,” said Fergusson, “because it strategically cares for a group of very high users of the system’s resources. It keeps them out of hospital, and that unclogs a lot of capacity. Hospital CEOs have been dealing with supply side remedies to meet increasing demand, so more beds, more clinicians, more capacity. What Medly does is reduce demand, so the resources they have can be used for other patients.

“If you deal with the sickest heart failure patients by giving them better care at home, monitoring and responding to their situation every day, they have fewer situations of decompensation. This means they don’t show up at the ER and don’t get re-hospitalized. That reduces stress on the system, since the average stay is 10 days.”

Patients on the Medly program receive notification on their cellphones every morning asking them a series of five questions.

Their weight, blood pressure and heart rate are entered into the app manually or automatically if they are using Bluetooth enabled devices.

An algorithm instantly interprets the data and responds to the patient. Eighty percent of the time, patients are told, “Have a nice day. See you tomorrow.” Only 20 percent of the time is there an issue requiring a nurse to get back to the patient by text or phone call through the app. In the few cases of a red alert, there is comfort knowing the challenge has been reported for an immediate response.

If the patient’s weight is elevated and there’s a risk of edema, the nurse can ask for a photo of their swollen ankle and either advise the patient to take an extra dose of Lasix or reduce salt intake. Only when necessary will nurses refer patients to their cardiologist.

According to Fergusson, Medly is significantly more effective and less onerous on staffing than traditional remote monitoring programs because of the algorithm that automatically interprets patient data.

In traditional remote monitoring programs, nurses have to review and interpret the data themselves and usually aren’t able to oversee more than 50 patients.

Because the algorithm does so much of the work for them, nurses using the Medly program can handle anywhere from 200 to 250 patients.

Medly includes a dashboard that displays the pertinent patient data for nurses and cardiologists, allowing them to see the trajectory of a patient’s disease. It advises them during a virtual appointment on the appropriate course of action, hopefully avoiding an ER visit or re-hospitalization.

Heart failure patients on the Medly program have the potential to live longer because they can get to guideline-directed medical therapy in a shorter timeframe.

“There are four primary drugs that in combination help heart failure patients,” said Simmonds. “But everyone’s different, so you can’t just say, ‘take these four medications in these dosages.’ It’s a process of titration.

“Because we have a shortage of cardiologists, most Canadians with heart failure are not optimized and, in some ways, we shortchange them of lifespan because it’s proven that an optimized combination of these drugs will extend their life.”

He added, “That’s an important side benefit for the patient. Medly supplies the data that speeds the optimization of the titration process.”

Vitall will continue pitching Medly to individual hospitals but also plans to persuade provincial and territorial health ministries to take the lead in rolling it out across the country.