In his letter to the editor, Sterpetti1 highlighted that patient adherence to preoperative aneurysm surveillance, which has been persistently suboptimal, deteriorated even further during the COVID-19 pandemic. In addition to exposing the fragility of our global systems of healthcare, the pandemic has also set into motion technological innovations in digital medicine and telehealth that will continue to evolve and profoundly affect the practice of medicine.
Sterpetti1 suggested patient self-administration of ultrasound examinations through a personal device to improve compliance with aneurysm surveillance. In 1918, Elliott Joslin2 was among the first to advocate placing patients at the center of the management of their disease by encouraging frequent home urine testing for those patients with diabetes. Empowering patients to autonomously administer self-care has been an initiative supported by the Food and Drug Administration and has been associated with significant cost savings,3 with home healthcare equipment such as glucometers, infusion pumps, peritoneal dialysis machines, and vacuum-assisted wound closure devices. Spurred by the COVID-19 pandemic, a recent transition has occurred to customer-initiated at-home diagnostic testing kits by companies such as LetsGetChecked (available at: www.letsgetchecked.com) and Everlywell (available at: www.everlywell.com) for the diagnosis of COVID-19, sexually transmitted diseases, and Lyme disease, in addition to celiac disease, prostate and colon cancer, and the evaluation of testosterone, thyroid, liver, and cortisol levels, among other home testing kits.
The adoption of at-home diagnostic devices, whether the Apple Watch for the detection of atrial fibrillation or an ultrasound device, has been associated with a number of unique challenges. Ensuring device reliability, robustness, resilience to cyber-physical or other misuse, establishing the security of the data transfer and consistency of data interpretation, either algorithmically or through a healthcare provider represent only a few of the critical issues. More importantly, the limited ability of racial and ethnic minorities and underserved communities to have access to such technologies or the internet connectivity necessary to stream information to a healthcare unit will only exacerbate pre-existing healthcare disparities.4
In thoughtfully augmenting consumer at-home technologies that places patients at the center of their care, the potential exists to not only regain lost ground in disease surveillance, but also to progress toward a durable change in community health and wellness that achieves consistent and accessible healthcare of the highest quality.
References
- 1.Sterpetti A.V. Telemedicine for screening and follow-up of abdominal aortic aneurysm. J Vasc Surg. 2022;74:1497. doi: 10.1016/j.jvs.2021.11.080. [DOI] [PMC free article] [PubMed] [Google Scholar]
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- 3.US Food and Drug Administration Center for Devices and Radiological Health. Medical Device Home Use Initiative, 2010. 2010. https://www.fda.gov/media/78647/download Available at:
- 4.Rokosh R.S., Lewis W.C., II, Chaikof E.L., Kavraki L.E. How should we prepare for the post-pandemic world of telehealth and digital medicine? NAM Perspectives. Commentary, National Academy of Medicine, Washington, DC. 2021. Available at: [DOI] [PMC free article] [PubMed]