Uday Kumar

"When I was a cardiology fellow at UCSF, I spent time at San Francisco General Hospital, which is the main county hospital in the city. Fellows love this experience because it’s 'real' medicine on the front lines, with patients from all socioeconomic strata and many with limited English language skills. I remember some of these patients being prescribed a Holter monitor, a portable recording device with wires and electrodes you attach to your skin, to diagnose suspected cardiac arrhythmias. But Holter monitors are archaic. They’re complicated to use and have to be returned to the hospital. The technology really didn’t work very well for this population, which meant that many didn’t get monitored. Later, as a Biodesign Innovation Fellow, I saw this problem again at the Stanford Hospital. This time, we were dealing with typically more well-to-do patients. But the Holter monitor, which can’t be worn during exercise or showering, still provided a suboptimal solution. So focusing on a better way to detect potential rhythm disturbances in non-hospitalized patients seemed like broad and important need. Interestingly, as we developed our solution, we were encouraged to design the highest tech product possible. Wireless technologies with real-time data transmission capabilities were becoming more feasible so people kept urging us to incorporate this technology into our solution. But the experience I had with patients at the county hospital led us to make different decisions. For example, if we had built in real-time data transmission at that time, the product would have been too expensive to use on most patients. Instead, we designed the device to store the diagnostic data locally and then the patient could use the postal service to return it to us – everyone knows how to drop something in the mailbox. In addition, we intentionally opted not to make the interface too complicated or add too many features. Otherwise, people who are older or compromised in some way wouldn’t be comfortable wearing the device. The key was to get patients diagnosed reliably in a cost-effective way that worked for them. In the end, we came up with a solution that’s inexpensive and simple enough that it doesn’t have to be prescribed by a specialist, and it can be given to patients in the emergency room or at their primary care physician’s office. As a result, the technology has helped hundreds of thousands of patients over the past few years. We’re currently adding wireless capabilities to some versions of the product to address the much smaller population of high-risk patients that need real-time data transmission. But this makes sense now because it can be done more cost-effectively, and it can be appropriately limited to those with the need. Just because you can make something more technologically advanced, doesn’t always mean you should. It’s more important to focus on the patients you’re trying to help and then create something that solves their need in the most cost-effective way possible."