General overview of HeRO and the value that it provides to the modern neonatal intensive care unit.

Medical Predictive Science Corporation (MPSC) is committed in the development of computational diagnostic and bioinformatic technologies for the healthcare industry. MPSC is committed to saving lives and reducing healthcare expenditures through the development of effective clinical diagnostic and decision support tools. These products use computational diagnostic methods to make the early diagnosis of clinical illness through continuous, non-invasive patient monitoring, and to provide diagnostic information as well as decision support to the physician.

HeRO is Developed specifically for the neonatal infant, the HeRO Heart Rate Observation System® represents the leading edge of what MPSC sees as a family of innovative diagnostic tools. HeRO sets the standard for which all our products will strive. HeRO has been shown through clinical evidence to support improved outcomes and reduced cost in the neonatal intensive care unit. Our research programs continue to focus on the advancement of monitoring technologies that are proven effective through evidence based medicine.

The HeRO Whiteboard

HeRO detects abnormal heart rate variability, or heart rate characteristics, among premature babies in a neonatal intensive care unit to provide clinicians with an early warning of sepsis, infection, and other forms of deterioration. The use of HeRO monitoring has been proven to reduce mortality, length of stay, cost, and even cerebral palsy in the largest randomized controlled trial ever conducted among very low birth weight NICU patients.

The abnormal heart rate characterstics (HRC) that cause HeRO Scores to rise are associated with cytokines. These mediators of the inflammatory response cause changes throughout the body, including the way that the SA node of the heart responds to the autonomic nervous system. HeRO is a real-time, non-invasive window into the inflammatory process that tells clinicians that a patient is deteriorating often before other clinical signs are present. Earlier diagnoses lead to more effective treatment and improved outcomes.

Cytokines & HRC

The links between infection, inflammation, cytokines, and abnormal heart rate variability (HRV). All of which led to development of HeRO, a system that identifies abnormal heart rate characteristics to provide an early warning of impending deterioration. The use of HeRO monitoring has been proven to reduce mortality, length of stay, cost, and even cerebral palsy in the largest randomized controlled trial ever conducted among very low birth weight NICU patients.

The abnormal heart rate characterstics (HRC) that cause HeRO Scores to rise are associated with cytokines. These mediators of the inflammatory response cause changes throughout the body, including the way that the SA node of the heart responds to the autonomic nervous system. HeRO is a real-time, non-invasive window into the inflammatory process that tells clinicians that a patient is deteriorating often before other clinical signs are present. Earlier diagnoses lead to more effective treatment and improved outcomes

Predictive Accuracy for Infection

The predictive accuracy of HeRO for infection. In the evaluation of predictive analytics or any early warning system, it is important to analyze forward looking metrics like positive predictive value, negative predictive value, and risk ratio that accurately capture the decisions a clinician must make in real-time: what is likely to happen to this patient and what actions should I take now? Many clinicians are familiar with sensitivity and specificity, but these metrics look back in time, once the status of the patient is already known.

But most importantly, any of these metrics of model performance are used to estimate the clinical impact of the model on patient outcomes when we don’t have the data. With HeRO, though, we ran the largest RCT in neonatology. So we know the impact of HeRO monitoring on outcomes: reduced mortality, length of stay, cost, and cerebral palsy.

HeRO Randomized Controlled Trial

We review the results from a very large clinical trial that evaluated outcomes for infants who were monitored by HeRO versus the control group without HeRO monitoring. This 3,003 patient clinical trial is the largest single randomized controlled trial ever conducted in neonatal medicine.

Patients randomized to HeRO display had reduced all-cause mortality, reduced mortality after infection, reduced length of stay, reduced cost, and reduced rates of severe cerebral palsy.

Neurodevelopment

The studies that investigated the neurodevelopmental outcomes of infants who were HeRO monitored during their stay in the NICU.

Elevated HeRO Scores are associated with abnormal EEG findings, abnormal MRI findings, and higher grades of IVH. Extremely Low Birthweight babies in the HeRO RCT who were randomized to HeRO display had reduced mortality at 18-22 months, a trend toward reduced mortality or neurodevelopmental impairment at 18-22 months, and reduced mortality or severe cerebral palsy at 18-22 months.

Testing and Antibiotic Stewardship

The impact of HeRO monitoring on rates of testing and antibiotics. One study found that patients randomized to HeRO monitoring had no overall increase in antibiotics. Another study separately analyzed those patients that were septic from those that remained healthy. It found septic patients were better targeted with antibiotics, and experienced reduced mortality, while healthy patients had no change in antibiotic usage. Patients that were HeRO monitored experienced more days alive, had non-significant trends toward more days alive and without antibiotics as well as more days alive and without a blood culture, and a significant improvement in days alive and without an unnecessary blood culture. Finally, a recently published abstract demonstrated that HeRO Scores in the time period after a culture was drawn for early onset infection, but before the culture result is available, have a 99% negative predictive value for the culture result; this offers a further opportunity to improve antibiotic stewardship.

Intubation / Extubation

Recent investigations have shown the utility of incorporating HeRO into clinical decision support for extubation readiness and extubation success. In this episode of the HeRO Whiteboard, we explore that literature, and show the CDS tools now available on the HeRO website (www.heroscore.com/extubation).

Product and Installation

The different forms of the HeRO product and the installation for each. HeRO solo and HeRO duet are one- and two-bed stand-alone HeRO monitors that require no IT involvement for installation. HeRO ES is a version that runs within certain Philips monitors equipped with an internal PC, or iPC. HeRO Symphony is the networked implementation, where HeRO Scores are available on central stations, any clinical workstation PC in the hospital, and can even be pushed into the EMR via HL7.

HeRO solo & HeRO duet
 

• HeRO is now available as a bedside monitor,either as a single patient solution with HeRO solo or as a two patient solution with HeRO duet.
• HeRO solo and HeRO duet have some great features:
• A stand-alone HeRO monitor for 1- or 2- NICU beds.
• Simple to install – 2 power cords and either 1 or 2 monitor connect cables.
• Available with 3 mounting options:
• Rolling stand mounted (our most popular)
• Wall mounted via a GCX rail
• Tabletop mounted on a flat surface.
• Intuitive, touchscreen monitor
• NEW – USB Data Export – an optional upgrade to export data to a USB flash drive.

HeRO Symphony
Our premium product built for modern NICUs Now deployed on over 2,500 NICU beds in 24 countries!)
 

• HeRO Symphony feature summary:
• Supports patient transfer with data continuity.
• Provides HeRO surveillance for all the beds in your NICU
• Supports HeRO central viewing stations to view HeRO data
• User access through a browser based client, works with tablets.
• Provides an HL7 data stream to export to your electronic medical records
• Archives HeRO Scores for up to one year.
• Using a virtual or physical server in the hospital data center, HeRO can monitor the entire NICU.
• HeRO Symphony can seamlessly integrate with HeRO ES to gain the advantages of a bedside view of HeRO plus all of the central monitoring functionality.
• HeRO and PHI. Please review our FAQ.