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Health care executive Chris Darland discusses their article “Why remote patient monitoring needs a preventive shift.” Chris explains that remote patient monitoring is currently too reactive, functioning as a safety net that tracks problems rather than preventing them. He suggests that technology should shift toward a proactive approach where data is collected before routine visits to provide a real life snapshot of heart performance. Chris describes how advanced signal processing tools, similar to those used by NASA, can now capture high-fidelity cardiac signals over several days while patients live their normal lives. By using AI to turn raw data into actionable insights, health care teams can detect subtle trends and make small adjustments before emergencies occur. This new approach moves beyond simply turning homes into hospitals and instead focuses on building a digital model of whole body health. Find out how listening to the heart’s hidden clues can help clinicians see ahead to what might become a problem.
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Transcript
Kevin Pho: Hi and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Chris Darland. He is the president and CEO of Peerbridge Health. Today’s KevinMD article is “Why remote patient monitoring needs a preventative shift.” Chris, welcome to the show.
Chris Darland: Thank you for having me. It is great to be here.
Kevin Pho: All right, so tell us what led you to write this article, and then tell us about the article itself for those that didn’t get a chance to read it.
Chris Darland: Sure. All my family is from rural Kentucky. Some live outside of Louisville, and some live outside of Lexington. My experience with health care growing up was largely in the ED. It was my grandfather who was in and out of the ED for all sorts of cardiac issues, which at least felt like every 18 months almost like clockwork. What was interesting to me as I reflect on it is that every time my grandpa would leave alive, it felt like a miracle to him. The cardiologists were performing miracles, whether it was placing a pacemaker or treating an MI. He always came home alive, which was fantastic.
But I think there was an underappreciation for the anxiety that puts on the whole family. My mom had to leave school and sit with him at the hospital. I can picture dinner tables full of bills and pills, and constantly asking if he took his medication or not. Although I am super thankful for all the cardiologists who saved his life, in my head, I always thought there has to be a better way. There has to be a way to prevent this so it is not an ED visit that keeps him going, but a way that you catch it early. That is pretty deeply embedded in me and my family. My dad still lives in the middle of Kentucky by himself at the end of a long gravel driveway. There are tens of millions of people just like my dad. I don’t think we are any better off now than we were 30 years ago when I experienced this with my grandpa. So it feels like the time for the shift is now, and I am pretty optimistic actually today.
Kevin Pho: All right. You said that we aren’t better off now than we were 30 years ago despite the advent of all this technology. We are going to talk about some technological options. Why do you say that even though we have 30 years of technology that is in front of us?
Chris Darland: Good question. I think you might argue outcomes are a little better. A lot of the investment is going into figuring out how to save lives when people are already sick, and you know they are sick. Heart pumps are fantastic. Pacemakers have made giant leaps and bounds. I would definitely say people are living longer than they were. But when I say we are not better, I mean we are still not catching problems earlier. We are just better at treating them after it is too late.
Truthfully, I think it is really just in the last three or four years that we have seen this combination of better hardware that can get you out of the hospital. The reality is you could do preventative screening for everybody in the country if you got everybody into a hospital to do echoes and cardiac MRIs. There is not a lot of mystery left in cardiac care, so you could find almost everything. But of course, that is not economically feasible, and it is not logistically feasible. There are not enough echo techs in the country to even come close to that. You need hardware that can get out of the hospital. I think there have been leaps and bounds of improvements in technology.
The touch of this AI wave has brought costs down significantly. You can start to layer on interesting signal processing tools, and now you can analyze this data without rooms full of servers. It is somewhat like this LLM push of ChatGPT and Claude has brought costs down for the way we use AI, which isn’t necessarily new since it has been around for 25 years. But now you can do it in a cost-effective way, which then opens it up to everybody in a meaningful way. It feels like, not due to lack of effort or caring, we are at this very interesting inflection point where lots of technologies are coming together at one time. This will fundamentally shift how we can treat preventative care.
Kevin Pho: So one of the things that you wrote in your article is that we want to transform that paradigm from a more reactive stance to a more preventive stance. Just tell us some examples of what that may look like.
Chris Darland: What it looks like is based on our experience out at a health system in San Diego last week. They have a couple of problems that they were asking for our help with. One was that they end up as a cardiology department seeing a lot of patients that don’t really need them after all. Patients were just alarmed by maybe a wearable or something that brought them in there, which of course isn’t a great use of their time.
As we walked down the hall, they said their other problem is that they have a gigantic line of people in the ED waiting to get admitted or not. They don’t have a super thoughtful way to say if someone with chest pain just pulled a muscle working out or if it is a cardiac issue and they need a bed. I think what they are looking for broadly is not only rapid assessments of cardiac stability, but just as importantly, a layer of intelligence on top that says why it matters. There are lots of tools coming, and we certainly do not have a data shortage problem in health care. In fact, we probably have more data than we know what to do with.
The challenge is taking all this data and making it actionable. For example, our device can get to a hundred indications, which is fine, but that is not actionable. What they want us to tell them is whether the patient needs a bed or not and why we came to that conclusion. If we can give that to them in a paragraph, that is everything. They don’t want us to show them layers and layers of technology or how smart our technical team is. They just want the answer.
For the cardiology department, they want to see patients that have specific criteria because those are the patients they can help. If patients don’t have those specific things, then the primary care doctor is completely fine, and they want instructions they should give them. It is all about limited time. Take this powerful tool that we are working on, and the output has to be as simple as humanly possible. Don’t tell them anything more than they need to know so that they can make their next decision, which is either to admit, titrate drugs, or move to a procedure.
A lot of the doctors I talk to still only have seven minutes per patient. No matter how advanced a tool is, if you are going to make them spend another 20 minutes, they just can’t use it. It is not a pragmatic tool for them. They need a really rapid, succinct look at 20 or 30 years of medical history to identify the next step. That is what they need, and that is at least what we are working towards.
Kevin Pho: And that is what the beauty of AI and large language models is, right? It can distill huge amounts of data and just give an answer to a simple question. That really is the appeal of these large language models.
Chris Darland: That is exactly right. The way we view it is that if we gave all the raw data to a cardiologist, they would definitely come to the right conclusion if they had a week to look through all these research reports and really study the patient. But they don’t have that time. So we can take ACC guidelines, HRS guidelines, and American Heart Association guidelines and do that same week’s worth of work in 10 seconds. Most importantly, we can explain why we came to the conclusion and what we are referencing. That shortcut, which they can then reconcile with their 15 years of education, is a big leg up compared to even two or three years ago.
Kevin Pho: Let’s take that example you were saying about the evaluation in the emergency department and sending data to the cardiologist to determine whether that patient needs to be admitted or not. What kind of information can be transmitted remotely?
Chris Darland: It is a great question. We have one device right now that the FDA is reviewing which has a cellular chip in it. Effectively, we collect ECG data, data from an accelerometer, and some impedance data, which then gets transmitted. Everything sits in Google Cloud, in our case, where the compute happens. Part of what we are doing is pulling the data off the device, which can go over cellular. It can also go through a hospital’s internet network, but that can usually be a little bit tricky for the IT team.
Let’s say we pull it over cellular, we do the compute, and we understand everything we can about the context of the patient. Then it all gets transmitted essentially as drops into the EMR. What is interesting is that context matters. So what might get dropped to the ED doctor is going to look wildly different than what the cardiologist needs to see. The clinical question the ED doctor is trying to answer is whether the patient needs a bed. The cardiologist wants to see that the report said they need to be in a bed, but wants to understand why. Is there a structural abnormality found? Do I need to do a follow-up echo? Is there some kind of hemodynamic stability issue where they may need to roll them down the hall because they could be decompensating?
Every person in the hospital who will interact with this patient is answering a different question, and it all needs to be caught and transmitted in that way. The ED is a good example, but it doesn’t need to be in the ED. It could be in the ambulance on the way to the hospital, or more importantly, what I hope with this preventative shift is that it is actually at my dad’s house. He puts it on at his house and wears it for five to 10 minutes. He takes it off, and either his primary care doctor or his cardiologist at the University of Kentucky looks at it really quickly. They might say that everything looks good and he needs to wear it again next year. Or they might say they have identified stenosis and if he comes to the University of Kentucky, they can do a TAVR procedure to give him a new valve. It is minimally invasive, and he is home the next day.
My bet would be that if I told my dad that he had an issue and needed a procedure, he would actually take the two-hour drive to Lexington. If I simply told him he is high risk and should go see a doctor at the University of Kentucky, the chances of him going are pretty much zero. So ideally this is all remote and it happens before you are even showing up in the ED, even if that is the use case that the San Diego clinic was interested in. For us to be effective, it has to be remote.
Kevin Pho: So from the patient standpoint, what exactly would that look like? What would the device look like, and what is the patient experience like?
Chris Darland: Good question. I have one right here. The device is just a wearable that you put right on the center of your chest. For different things, you will need different amounts of time. We are working on getting FDA clearance to do a home sleep test. If you wanted to do that, you would wear it overnight for one or two nights to get data. But if you just wanted a quick cardiac assessment, our goal is to do that in five minutes.
You pull it out, there is an adhesive you take off, and you put it onto your chest. The new device that the FDA is reviewing has a mobile app on your phone where you will start the study. You take the device off after five or 10 minutes, or the next day if you are doing a home sleep test. In most cases, it is going to get mailed back to us where we will clean it off and make sure it is disinfected for the next patient. Some customers actually say they would rather keep it at the primary care office or at the hospital.
Importantly, we are not sending anything to the patient. It is still a prescription device. My fear is always that it can be quite overwhelming what the patient might see, and then they might go into a panic or a tailspin over something that might be benign. You really want the clinician to come with a plan to say what they saw and what can be done. All of our reports, although they may look different for a primary care doctor versus a cardiologist, start with the clinician to synthesize that data.
We have someone really smart on our team who leads commercial growth named Leah. She made the point, which I think is exactly right, that good monitoring finds everything, but that doesn’t mean everything matters. There are all kinds of false alarms and scares in the industry today, so we really want to make sure the doctor’s eyes are on the data. They are the experts who know the patient context. They know if the patient just got laid off and might be under high stress, or if there is something going on in their life that might be causing an irregularity. All that is important to get to the clinical decision. We feel pretty strongly that the clinicians stay at the center of everything.
Kevin Pho: So do you have any outcomes data in terms of some of these remote interventions and how it can benefit patients and clinicians as well?
Chris Darland: Very soon, I promise. We just opened a 15,000-patient trial where we are running these full panels on patients anywhere. We are doing some patients for a 15-minute sitting, some for a full 24 hours, and some that actually go seven days so you can pick up arrhythmia data and a few other things. We are enrolling patients right now as we speak and hope to have some results a little bit later this year. We feel pretty encouraged based on the roughly 150 who have enrolled to date that we are making an impact.
Kevin Pho: So in your ideal world, assuming everything gets approved by the FDA and the data looks good, what will your ideal world look like? What would an ideal scenario that uses your technology look like?
Chris Darland: If I could have it my way, this would be sent out to every rural American proactively. I say that because that is my personal background and what I am passionate about. But the reality is that even in urban settings, it is hard to get cardiology appointments. Our goal is to get the cost down for this device to $25. You put it on really quickly, and for $25 we can find everything we need to say whether you need to go to the University of Kentucky or you don’t, as in the case of my dad. It is all done proactively.
The reality is heart disease progresses a little bit every year until it becomes an emergency. It is very slow and then all at once. The data will guide us a little bit, but let’s say the data tells us that it really picks up at 60 or 65. Every year you would wear this. The more people we can reach, the less expensive we can make it, which is super important to us to reach scale. This should be the super tool that buys clinicians a whole lot more time and gets the people who need to see them in front of them.
I am optimistic that payers will be excited about it because we should hopefully be able to remove a significant amount of readmissions and ED visits by catching things early. Patients should be really excited because the reality is if you catch disease early, you can treat it with generic pharmaceuticals and you are not going in for surgeries. For those that end up needing help, if I went to Denny’s right now with my dad, of the 10 guys he is with, there are probably four or five people that could use help from a cardiologist. Now the University of Kentucky could look at the data and say they can help those five guys. We could proactively bring them in, which means they are doing the procedures that they want to be doing and making the impact they want to make. I think being proactive and getting this into people’s hands should benefit everybody who touches the health care system. That is what I am fighting like heck to do, not just to be a hospital monitoring tool, but really getting it into people’s hands early.
Kevin Pho: We are talking to Chris Darland. He is the president and CEO of Peerbridge Health. Today’s KevinMD article is “Why remote patient monitoring needs a preventative shift.” Chris, let’s end with take-home messages that you want to leave with the KevinMD audience.
Chris Darland: I have three kids. I think they will grow up in a wildly different health care space than I did, and for sure than my grandpa did. I think we are at a really interesting spot. The message I give to clinicians is to be demanding. There are a lot of tools out there. A mistake I probably made earlier was trying to create point solutions to solve little things as opposed to being the tool that can amplify you. Clinicians do have to remain at the center of all things in care. But be demanding, be open, and let’s try some new things. Like I said, I am wildly optimistic. This is a hugely complicated place to do business, but it really does feel like we are on the brink of something special.
Kevin Pho: Chris, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
Chris Darland: Thank you.
