James Byrne hadn’t been out of the hospital for long when a call came in after midnight. He answered to the voice of a triage nurse asking him how he was feeling. He was pretty tired, actually, having been through radiation treatment and chemotherapy designed to eradicate his acute myeloid leukemia and then an allogeneic bone marrow transplant (his son Logan had been the key donor; his cells were augmented with donated umbilical-cord stem cells). That and having been asleep until his cell phone rang. But otherwise, just fine, he said.
Good to hear, the nurse said – because Byrne’s body temperature had just jumped to 98.9 degrees. While that’s just a shade higher than the standard 98.6 degrees, his temperature had been hanging around 97 degrees, so what would otherwise seem normal might instead have been an indication of a brewing infection. Given that his immune system had been wiped out and was just starting to rebuild itself, an infection would pose a serious risk to the 45-year-old resident of Albuquerque, N.M. This was, fortunately, a red flag that could be safely lowered again.
Byrne would have had a hard time taking his own temperature while sound asleep. A three-inch by one-inch, U.S. Food and Drug Administration-approved medical device called a BioSticker had done that and much more.
Biosticker as an early warning system
Before Byrne left UCHealth University of Colorado Hospital on the Anschutz Medical Campus, the UCHealth and University of Colorado School of Medicine advanced practice practitioner leading the study, Glen Peterson, had asked him if he might be interested in joining one of two cancer-related clinical trials using the remote-monitoring gadget developed by Golden-based BioIntelliSense. This one would involve sticking the BioSticker to his upper chest and largely forgetting about it for 30 days. The BioSticker would collect a steady stream of his vital signs – body temperature, respiratory rate, resting heart rate, skin temperature, gait, body position and more – and transmit it to UCHealth providers via a wireless hub and Reimagine Care, a startup focused on home cancer care. The goal would be to spot emerging health problems before Byrne himself did.
It’s not the first work UCHealth has done with BioIntelliSense. Their collaborations through the UCHealth CARE Innovation Center have most notably involved remote monitoring of high-risk COVID-19 patients. But Dr. Richard Zane, UCHealth’s chief innovation officer and chair of the CU School of Medicine’s Department of Emergency Medicine, says the technology could apply to a wide range of health conditions.
“It’s about bringing remote patient monitoring to wherever the patient is, understanding how to ingest key vital signs, and building predictive and prescriptive algorithms on top of those data so that we can intervene before we otherwise would have,” Zane said.
BioSticker establishes a baseline to judge abnormalities
Technologies such as BioIntelliSense’s BioSticker and the recently announced BioButton – an even-smaller stick-on medical device that captures much of the same data as its predecessor – have the potential to supplant “an outdated system” of discharged patients self-reporting their own health status, as Dr. Clay Smith, director of the UCHealth Blood Disorders and Cell Therapies Center and associate chief of the CU School of medicine’s Division of Hematology, put it.
Byrne’s example of having a lower-than-usual body temperature is a case in point. The typical approach of having people take their temperature a couple of times a day and report fevers to caregivers assumes 98.6 as the “normal” temperature. But it can vary from person to person, as it did with Byrne; it can be lowered by medications; it can go up on a hot day or even when wearing a hat. A long-term monitoring device such as the BioSticker, which captures and transmits 1,440 measurements every 24 hours, day and night, can establish baselines from which to judge abnormalities.
“We see people who are quite ill who have a ‘normal’ temperature and those with a higher temperature who are fine,” Smith said.
Help with more than fevers
The second UCHealth-BioIntelliSense study also relates to body temperature. That study, which Peterson also leads, involves cancer patients whose chemotherapy has left them with low numbers of white blood cells called neutrophils that help fight infections. These patients are susceptible to febrile neutropenia – a fever caused by an infection that exploits the weakened immune system. Febrile neutropenia cases account for about 5% of all adult cancer-related hospitalizations in the United States, with an average stay of more than eight days.
The sooner one can spot a fever or other signs of nascent illness, the faster the patient can get treatment.
“We know that, the longer you wait from the time infection starts, the worse the outcomes,” Smith said. “It’s important to detect it as soon as possible, figure out what type of infection it is, and start antibiotics.”
Fevers are only the beginning, Smith says. He sees technologies such as the BioSticker feeding diverse readings into artificial-intelligence-powered systems capable of synthesizing body temperature, heart rate, respiratory rate, movement characteristics, and other factors to “detect a whole range of problems and alert health care providers to nip health problems in the bud.”
Zane says BioIntelliSense’s work with UCHealth is already moving in that direction. They’ve identified patterns in the data that seem to predict fevers while a patient’s temperature is still normal. Such insight could one day let providers prescribe antibiotic pills for patients at home to beat back infections before they’re serious, thereby avoiding hospitalization for intravenous antibiotics.
James Byrne’s BioSticker has triggered a few calls over the month he has worn it, he says. One involved a 3:30 a.m. call from a nurse practitioner triggered by a change in his breathing patterns – and indeed, he had been coughing for much of the night. The nurse had him check his pulse oxygen level; it was normal.
Another had to do with a leap in his heart rate. He happened to have been walking around quite a bit at the time, he says, and he isn’t in the best shape of his life for obvious reasons. The triage nurse explained why she was calling and asked, “You doing alright?”
“I’m doing just fine,” he answered.
But it was nice to get that call.