Implicity is a remote monitoring platform for patients with Cardiac Implanted Electronic Devices, an essential element in the contemporary health ecosystem at a time when there are more and more remotely monitored patients. It is above all, a high-tech device mobilizing AI in the service of health. To better understand the issues that drive this exceptional HealthTech, we interviewed Dr. Arnaud Rosier, CEO and co-founder of Implicity.
You created Implicity, how would you summarize your activity? What is the genesis of the company? What convictions drive you?
I created Implicity to tackle a problem that I used to experience daily in the care of my patients with prosthetic cardiac devices. The creation of Implicity in 2016 was the logical continuation after 10 years of experience in the medical field, remotely monitoring patients with prosthetic cardiac devices (cardiac pacemaker for example), and working on my doctorate in artificial intelligence,, applied to this type of monitoring, within an INSERM team.
My conviction, fueled by numerous clinical studies, is that the remote monitoring of patients with prosthetic cardiac devices saves lives while being one of the rare medical innovations that reduces healthcare costs. Prosthetic cardiac devices such as pacemakers and implantable defibrillators are computerized implantable devices that record all patient events and transmit this data to health professionals for fast and efficient patient management.
In France, 500.000 people are equipped with this type of devices which are produced by five manufacturers: Abbott, Biotronik, Boston Scientific, Medtronic and Microport. Each of the 5 manufacturers has its own remote monitoring platform. There was no unified platform. Developing a remote monitoring interface that aggregates all prosthetic cardiac devices on the market comes as an evidence, eagerly awaited by all. The solution monitors patients interpret adverse cardiac, and above all makes it possible to consider supporting algorithms that alone will allow scaling up data analysis. The Implicity platform, deployed in more than 60 medical centers and monitoring more than 30,000 patients, is the leading solution in Europe in this field, and one of the few in the world.
My second strong conviction is that making data available is essential to improve patient follow-up. Mass processing of health data and artificial intelligence are enabling significant progress in patient care, evaluation and choice of treatments. These algorithms not only save time for healthcare teams, but also prevent serious events by predicting them, and continuously assess what is the best treatment. By replacing in-person checkups of cardiac devices, which is normal in 99% of the case, remote monitoring allows resources to be redirected toward patients who really need them while maintaining daily vigilance over the entire population concerned.
Cardiac prostheses are incredible electronic medical devices that collect and transmit a lot of data types (heart rate, but also activity, breathing etc.). Simplifying the analysis of available data flows without overburdening the teams in charge is a growing challenge that will ultimately affect all devices that continuously generate data (implantable, but also “smart watches” and other home equipment). Filtering the relevant data to be fed back to physicians or cross-referencing this data with information from the patient record to select the right time for intervention will necessarily go through AI algorithms on which many teams, including our own, are currently working.
Implicity is the winner of the first call for projects in 2019 from the Health Data Hub providing access to a shared health database for research. Moreover, we have just obtained the final agreement from the CNIL to use this data with the purpose of developing an algorithm for diagnosing and predicting cardiac decompensation. Very soon we will be able to start working on this project, which we are excited about as it has promising outcomes for our patients.
Cardiac devices and remote monitoring: How’s the situation today in France? In the world?
In France, there has been a collective awareness of the value of remote monitoring for patients with cardiac implantable electronic devices (CIEDs) and heart failure patients with the launch of the ETAPES program (Telemedicine Experiments for the Improvement of Health Care Pathways) . France and the United States are now among the first countries to offer reimbursement for the remote monitoring of these patients.
Yet in France, only 10 – 15% of people with CIEDs benefit from the remote monitoring of their connected device, despite the scientific consensus of learned societies (2015) recommending generalized remote monitoring of these patients on the basis of significant benefits proven consistently. The initial reluctance of the CNAM caused by the fear of seeing an increase in spending may have contributed to slowing down reimbursement in France, which is only experimental. However, there is a consensus on the potential savings.
In Europe in general, several joint actions should be undertaken: Reimbursement of remote monitoring should be supported in common law, communicate to the doctors in charge of remote monitoring about the regulatory framework and the recommendations of learned societies, and finally inform patients about the benefits of remote monitoring in terms of mortality reduction in order to reduce bias in the current offer (1 in 10 patients concerned). Remote monitoring has been shown to reduce the frequency of in-person visits and care costs while improving patient satisfaction and life expectancy.
In the United States, the adoption rate is estimated to be higher than in Europe (around 30% of patients with CIEDs are monitored). Remote monitoring of CIEDs is covered by Medicare (federal health program for citizens and permanent residents over 65) and private insurances. American hospitals adopted remote monitoring as it saves time, reduces costs, and improves patient care.
The current situation highlights the value of remote monitoring: what is your analysis on the future of the practice?
In the context of Covid-19, the cardiologists who had set up an effective remote monitoring realized to what extent it made it possible to continue an optimal care at a distance, without any issue.
Patients with cardiac devices, usually elderly or heart failure sufferers, are particularly at risk from the virus. Remote monitoring (RM) allowed to maintain access to medical care for patients while providing them with high quality remote follow-up. Unfortunately, RM was limited during that period to patients already registered for remote monitoring, ie only around 10 to 15% of French patients concerned.
Learned societies around the world agree about recommending remote monitoring of cardiac implantable devices as the standard solution even outside the context of Covid-19. They encourage manufacturers and healthcare establishments to register their patients for remote monitoring. We see that doctors who are still falling behind in remote monitoring have changed their mentalities in few months regarding this innovation. It is to be hoped that they will be supported by their hospital administration and by the main national guidelines for health policy.
We are experiencing a paradigm shift. The crisis has clearly accelerated the adoption of telemedicine, telecardiology, and telemonitoring in particular. I have difficulty envisioning a step backwards, especially since these models have proven their clinical effectiveness.
The Minister of Solidarity and Health references Implicity among the remote monitoring solutions in the context of the health crisis: what message would you particularly like to convey to patients and health professionals?
The Minister of Solidarity and Health supports Implicity platform for the solutions available and references it as a remote monitoring solution in the context of Covid-19 pandemic. To contribute in the collective efforts of recent months, we made our universal solution available to unequipped health professionals free of charge during the health crisis.
This health crisis has confirmed the importance of modernizing monitoring methods. Business models must support this innovation. Doctors should commit to extending this offer to all their patients and not just a subpart. At the same time, patients should be better informed about the solutions available to them and be put in the loop of data that concerns them to gain autonomy their monitoring alongside professionals.
Finally, it is very important that health authorities promote methods of financing innovative solutions in proportion to their use, in relaying the financing of the national ETAPES program. To date Implicity represents 50% of remote monitoring patients in France and has not received any funding in this regard, which raises questions.
As remote monitoring has been proven to have positive medical outcomes for patients, save time for health professionals and be cost-efficient for the health system, there is no valid reason not to accelerate this practice!