01 | heart care redefined
Having successfully helped set up and operate independent cardiology centres in the UK and the Netherlands, we began work on a virtual service that would digitise these practices, giving patients access to quality cardiac care anywhere and anytime through a system that would be like the “Babylon of cardiology”.
“Metronome” is an on-demand subscription service that combines a medical-grade wearable, an app and a real-time virtual clinic powered by artificial intelligence.
Health-conscious trackers and a plethora of wearable devices have increased the volume of data available to consumers and patients alike. But with more data, there is increasing demand for health care professionals to make sense of it all. Metronome will provide these health analytic services 24/7 to consumers, whether they have been diagnosed with a heart condition, have presenting symptoms and are seeking a diagnosis, or are simply members of at-risk populations tracking their heart health (i.e., people who are obese, diabetic or who have hypertension/high blood pressure).
Having successfully completed the technical feasibility study for Metronome, we now have detailed plans to deliver our own proprietary wearable. And by building data bridges to existing and upcoming devices as part of the Apple Health Kit and Google Fit, Metronome will capture near-medical-grade data from a rapidly growing device community. This will make our platform device-agnostic and take our extensive in-clinic service virtually anywhere anytime continuously and on-demand. The patient will be entirely in control.
Metronome - heart care redefined.
Background interviews and feedback on Metronome from our Medical Advisory Panel (MAP) in late 2018.
02 | we care too late
We pick up on heart health too late, and the cardiovascular burden on our society continues to grow.The heart is the organ that carries most of the weight of our modern living—from the sedentary hours behind desks, to Type II diabetes and an increasing obesity epidemic. Hospitals are places we go when we are broken to seek treatment, but what if we could evolve from treatment to prevention and provide consumer-facing services to help avoid those icebergs down the track? What’s the value of being able to skip that unscheduled hospital visit?
With increasing data connectivity, mobile processing, cloud computing, machine learning, and artificial intelligence, we are able to augment our frontline services in healthcare in a significant and material way. We can focus on health and wellness services that are created purely on the basis of preventative care, and we can provide patient and healthcare interactions that go from when things are broken to before they break.
03 | wrong cars in the parking lot
I met Robin, or Dr Van Lingen as his many patients know him, a few years ago. He wore all the hallmarks of someone who went into an honourable profession (to genuinely save lives) but was scarred by the system. He could see ways to improve and empower patient well-being, but every opportunity for innovation was stymied. So, he began work on the initial concepts that we evolved into metronome – a wearable that could provide real-time connectivity and continuous monitoring for heart patients anywhere and at any time. There were immediate advantages for concerned patients who had undiagnosed symptoms such as palpitation, shortness of breath, or chest pain. The difficulty was that the heart only has three ways of communicating that something may be wrong. Many a time, these symptoms are benign, but at times they are not, and the patient has no way of differentiating between the two. Of course, as witnessed in horror by sporting fans, some very serious conditions can also be lurking asymptomatically in the healthiest of athletes.
The challenge is clear – if we could pre-sort the cars parked outside of Robin’s cardiology practice between those with an underlying condition requiring urgent treatment, and those with a benign symptom that needs to be reassured, Robin would use the same limited slots in the day saving more lives. This, he explains to me, is why he became a cardiologist. This is not to suggest that alleviating the concern of those symptomatic patients is not valuable. It is simply a recognition that patients are beginning to die on NHS waiting lists, deaths that could be prevented with better detection and earlier intervention.
With waiting lists that are burgeoning above 12 months for a referral to be seen and in some cases patients dying on the waiting line, we feel passionately that there is a better way of screening and diagnosing symptoms to improve the outcome. After many months of listening to Robin, and our medical advisory panel formed of other cardiologists, cardiac nurses, and technicians and GPs, we increasingly grew convinced that there was an opportunity to leverage our technology capabilities to do a better job. This will not only to help those with a critical underlying condition waiting for a diagnosis, but also the much larger at-risk population from tracking and improving their quality of life.
So, in 2018, we officially formed the project and began to look at the technical feasibility of the metronome. But what we discovered in the process of testing 37 vector points across the body for a medical grade ECG, PPG, heart rate, respiratory rate, and oxygen saturation levels suggested that we may be looking at an even greater opportunity than we had considered before – triangulating changes in blood pressure throughout the day not just as a static reading when a cuff inflates at homes or in a hospital setting, but on the go as our metronome customers would go about their lives. That is when we started to feel that we were catching a glimpse of something bigger than our initial ideas.
04 | but what about AI?
Not even the most sophisticated, empathic, human-scripted, neural-network-empowered artificially intelligent algorithm will provide the empathy of a cardiac nurse. The business of health and wellness will always be defined by the quality of care and empathy at the individual patient level. Tools to decode very large data sets and recognise patterns have a critical role in providing better health services. At Metronome, our purposes in enabling AI are to help review and sift through the large volume of medical-grade data, to listen and learn from our virtual clinic of cardiac nurses and cardiologists, and to look for patterns and connections beyond symptomatic snippets of ECG. The aim is to identify early markers of cardiovascular wellness—both healthy and unhealthy states—so that we can help our customers to recognise early warning signals as early as possible and guide them away from a course that could result in them becoming cardiac patients in a hospital.
Our systems will never use AI to diagnose or inform of a diagnosis. We will always use cardiac nurses and, in fact, offer our customers the opportunity to request that all follow-ups be with the same cardiac nurse to perpetuate the continuity of care. We use technology to ensure that our human care is better and more accurate in its predictions, works from anywhere, and is available on demand and at any time by our customers. We will never use AI to chatbot health care. We are in the business of caring, empathy, and human health. We use technology to make that promise more accessible to more people more of the time and more effectively.