Dr Robert Fearn

One year ago, I stood up at the New Technologies Symposium at ASCRS. The American Colorectal Society and introduced the Alfred Alert Sensor. A flexible metal strip attached to the outside of an ostomy and provided both patient full-bag alerts and overall stoma losses.

The significance of this innovation cannot be understated. This was the first time patients with a stoma had any kind of biofeedback about their instantaneous and cumulative output for an issue that is problematic for this group of patients. Furthermore, it was designed by a patient from his hospital bed. It was developed from a hack to an FDA approved marketable product by patients, clinicians, engineers, and developers working together towards a common goal. The technology was well-received, but it was limited. Stoma bags are complex, dynamic structures moving constantly, and this produces a great deal of noise on a flexible sensor. Although in ideal conditions the measurement of output was accurate, the experience was not good enough. The benefit was not immediate enough for patients to want to use it each day over the critical early postoperative period.

Fast forward to a year later. We have totally transformed our approach and our technology. The same team of patients, clinicians, engineers, and developers have designed and built the world’s first smart stoma bag from the ground up. Using cutting edge temperature and moisture sensors both in the bag and against the skin and machine learning techniques, we can track output in more detail and accuracy than ever before. We have demonstrated an association of skin temperature with peristomal skin complaints and now have thousands of bag-hours of data providing insights that have never been previously possible. Furthermore, we have a platform of care including peer support and telehealth nursing providing tangible benefits to patients that complement and enhance the technology.

Over the past two months, we have had opportunities to showcase our data to the clinical community through abstracts accepted at this year’s SAGES, DDW, and ASCRS conferences. The breadth of topics we were presenting on are also heartening. At SAGES, we demonstrated validation of our hardware and algorithms. At DDW, we presented data from a collaboration with Cleveland Clinic. It was an analysis of tens of thousands of patients’ data collected through the NSQIP program demonstrating consistently higher readmission, surgical site infection, acute kidney injury and readmission in ostomates compared to a matched group of colorectal patients when surgery did not result in a stoma. At ASCRS, we presented the collaborative approach used to design the whole care pathway, integrating smart monitors, peer support, and telehealth. In separate presentations, we were able to show our findings associating thermal imaging techniques with peri stomal skin problems. The benefits of the Patient Coach Program were shown in numbers (the uptake and durability of peer delivered coaching) and outcomes (patients are reporting quality of life benefits). From the podium, we also showed our data on the growth of access and patient reported benefits of our social media education and coach program.

The crowning glory at ASCRS was returning to the New Technologies Symposium. Dr. Sam Eisenstein, a colorectal surgeon piloting our product at the University of California San Diego, walked the audience through the technological developments, the care program, and the benefits they are seeing with no readmissions for dehydration in the cohort that has used the service. Making this work at UCSD was more than just providing the technology and hoping for the best. At the heart of our innovation are empathy and human endeavor. The healthcare assistants and surgeons were all on board and pulling in the same direction meaning that patients were motivated and enthusiastic to use the service. Possibly the most important link in the chain are the Wound Ostomy Care Nurses. They are the patient’s best source of knowledge and experience in learning to come to terms with their new anatomy. At our most successful sites, the WOCN understands that the Alfred SmartCare Platform can be an enabler and an extension of their management allowing them to care for their patients better and more efficiently. The results speak for themselves, and we are excited to bring these findings to a whole new audience at WOCNext in Nashville next week. The data we have recently presented is just the tip of the iceberg. Come and join us on this exciting journey!

Dr Robert Fearn is a gastroenterologist in the English National Health Service and is the Medical Director of 11 Health.

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