In the summer of 2018, VitalConnect launched the VistaTablet as an extension to their FDA-approved biosensor, the VitalPatch, which measures eight vital parameters. We have previously covered the VitalPatch and the launch of the VistaTablet, but we recently had the chance to check them out first-hand. The following is a review of this editor’s experience and impressions.
A slim and light gadget sitting at a width of <4cm, length of <12cm, and about half as thick as a standard wrist watch, the patch gives an unfortunate first impression: flimsy and cheaply-made. Perhaps this was a conscious design decision, given that the patch is meant to be disposable and used for only a five-day stretch. Or maybe it’s a consequence of other design features, such as the breathable foam-like material it’s made of, or the inherent flexibility that allows it to bend and twist with natural body movement. But don’t let the first impressions fool you – this impressive piece of technology is capable of pulling some really high-quality data!
Consisting of two oval-shaped sensor areas to enable the placement of two ECG/EKG leads, the patch could be positioned in one of two locations on the torso, one of which is favoured for obese patients. For those of us with… more masculine features – you may be dismayed to learn that installing this patch requires either of the two locations for patch placement to be cleanly-shaven. This is to ensure there is no interference with the sensor’s function or the adhesive’s lifetime.
Set-up is fairly simple: upon cleaning (or shaving) the area of application, the adhesives are uncovered, and the patch is firmly pressed into place. A button is pressed, and a hidden LED indicator verifies that the patch is on. Each patch comes with an identifying code, which is used to connect the VitalPatch with the VistaTablet via Bluetooth. Once successfully connected, the patient or caregiver is prompted to calibrate the patch by choosing the patch’s location on the body and the body’s posture (upright vs supine). The patch then immediately begins recording eight measurements in a continuous manner.
Once installed, it is easy to forget the patch’s presence as one proceeds with their day. The only limitations when wearing the patch are to avoid swimming and direct exposure to water when showering. The patch is meant to remain on throughout the five-day period of data recording, as repeatedly removing it drastically compromises the adhesive. While the adhesive could probably hold out for an additional two or three days if left untouched, the data quality may be compromised as direct contact with the skin is essential. The patch’s area did get itchy after a few days – probably amplified by repeated applications and removals.
The VistaTablet is a Samsung tablet with locked features, restricting the user’s access to the VistaPoint application (for monitoring measurements), a select few settings, and a help option. A rigid plastic casing is provided for easier handling by clinicians at the bedside, or to serve as a stand for the tablet.
In addition to serving as an easily accessible monitor for real-time vitals data at the point-of-care, the VistaTablet serves as a connection point between the VitalPatch and the Cloud. The tablet connects to VistaCloud, VitalConnect’s online server, over WiFi or through a cellular connection. While the cellular option was not available when we tried it, a sim card would presumably be supplied by the healthcare provider along with the tablet. However, a steady internet connection at all hours of the day is not a requirement, since the patch is capable of storing up to ten hours worth of vitals data, then offloading to the tablet (and hence, Cloud) when a connection is available. For the same reasons, the tablet does not need to be within Bluetooth range at all times – I left the tablet at home on many days while I head off to work. Since the tablet’s Bluetooth is always on (as far as we could tell, the user cannot turn it off), the tablet does need to be charged at least once a day.
The VistaPoint application’s data view consists of seven tiles for presenting a live-feed of measured data. While the company markets the patch’s ability to measure eight vital signs, only seven measurements are accessible through the tablet: respiratory and heart rates, ECG, skin temperature, activity (in the form of a pedometer), body posture (a choice of laying down, leaning, upright, walking, or running), and fall detection. The eighth measurement is heart-rate variability, which is only accessible with the historical data via VistaCloud. Along with the data presentation, the tablet monitors the patch’s life (percentage left of the five days), enables recalibration of posture sensing, and acknowledgement of fall detection alerts.
The VistaCloud is accessible online, providing a dashboard view for nurses and clinicians to monitor the live data stream for multiple patients at a time. It serves as the control center for all of the patches. Organized in a tile format, it affords an easy overview of each patient-patch duo. Each tile provides a summary of the patient’s current vitals (leaving out the temperature, ECG, and heart-rate variability), along with the patch’s remaining life and any notifications that may have been set off. The user can elect to view all patches commission by the care center, or a subset thereof (e.g. ones with unacknowledged notifications or with a low battery).
Upon selecting a given patient, the caregiver is able to set notifications if any of the measured vitals departs a predefined range – one that could be individualized to each patient. There is an additional option of linking these notifications (or the fall detection notifications) to a phone number for SMS alerts.
Within each patient view, the user can view and clear previously set notifications, as well as access the patient’s historical vitals data. In this option, the user can choose any time point and any duration during the five-day life of the patch to examine. With a choice between heart rate, respiratory rate, ECG, steps, skin temperature, and RR interval (a measure of heart-rate variability), there is a wealth of continuous data to choose from. The user can modify the data view to focus on as short as a minute (not very useful) or as long as 24 hours (too much data), and the entire dataset can be downloaded in CSV format. It’s a dream-come-true for physiology researchers and quantified-selfers alike!
Scrolling through my historical data, it was noted that near the end of a patch’s life, there seemed to be more frequent data interruptions, particularly during heavy exercise or while sleeping (I tend to sleep face-down) – which justifies the decision to limit the patch’s life to five days.
I was impressed by the system’s remarkable ability to detect falls. Testing its sensitivity, I ran through multiple scenarios and found that the patch could differentiate between slowly lying down, getting down to ground quickly, and actually falling (onto some pillows!). However, there were two instances during my 10-day usage periods where a false “fall detected” alert was recognized. These notifications were easily acknowledged from the tablet. I suppose it’s better to err on the side of caution with fall detection – particularly since the product is advertised as a monitoring system for at-home patients, a majority of whom are elderly.
To further test the system’s accuracy, a side-by-side comparison of pedometer data from the patch over my ten-day usage period was evaluated against my smartwatch’s average count for that same month. Surprisingly, there was only a 5% discrepancy between the two counts – lending some confidence to both measurement devices. I additionally sampled my heart-rate variability data, looking at the RR intervals averaged for the same durations pictured above, or as I slept earlier on the same day. While typical RR intervals range from 600 to 1200 milliseconds, higher variability reflects a healthier and more relaxed physiology. My baseline value during sleep sat at almost 1100 milliseconds, which was significantly higher than my awake and resting value of about 800 milliseconds, and my light exercise average of about 675 milliseconds!
- High-quality continuous data
- Easily integrates into daily routine
- Elegantly designed system
- Patch area can get itchy
- Cheap-looking patch
- Historical data inaccessible via tablet
- VistaCenter could be more user-friendly
Overall, this was a great experience! VitalConnect has put together a well-designed solution for remote patient monitoring that very smoothly integrates into one’s daily activities. The quality of the collected data was truly impressive, and the historical view has helped me be more mindful of my body. While it is unclear why a tablet is a necessary part of implementing at-home monitoring (would be nice to just download the VistaPoint application to patient smartphones), it is a nice complimentary gadget and serves a real purpose in the bed-side scenario.
More info: VitalConnect website…