Remote monitoring helps an older patient only when her reading arrives without help and a nurse has time to act on it, so I design for those two people before anything else.
I am the chief product officer of Ardenwick Health, a fictional company in Columbus, Ohio, that monitors adults with chronic disease at home on behalf of the health systems and medical groups that treat them. At the end of 2025 we were monitoring 118,000 patients for 214 customers in 31 states: 58,000 with high blood pressure, 33,000 with heart failure, 22,000 with type 2 diabetes and 5,000 with COPD. Their median age is 73. We supply cellular scales, cuffs and meters, the software their clinicians use and, for customers who want it, a team of 180 monitoring nurses who work under the practices' clinical direction. Revenue was US$171 million in 2025.
I came to product work from the bedside. I spent eight years as a nurse on a cardiac step-down unit in Cleveland, where I taught heart-failure patients to weigh themselves every morning and then rarely learnt what the scale said. Since then I have implemented barcode medication administration at a community hospital system, designed nursing software for small hospitals and run product for the remote monitoring of implanted cardiac devices at a listed device maker. I joined Ardenwick in March 2021.
Most of my decisions at Ardenwick have made something smaller before they made it better: fewer alerts, fewer steps between the box and the first reading, a slower route to market for our heart-failure risk score and a nine-month pause before we entered COPD. Each had a cost that our board, our customers or our sales team felt first, and these pages record who disagreed and what we gave up.
First readings within a month, from 68 to 90 per cent
After cellular kits replaced phone pairing as our default in 2022, nine in ten new patients sent a reading within thirty days of delivery, and 87 per cent of those aged 75 or over did. We absorbed a kit cost that rose from US$88 to US$154 rather than pass it to practices.
Heart-failure alerts down from 74 to 31 a week per 100 patients
Personal baselines and three priority tiers, released in April 2023, took monitoring time from 34 to 21 minutes per patient a month. Our clinical team examines every admission that no alert preceded, every month, and publishes the list to customers.
A risk score taken through the FDA
Our heart-failure risk score received FDA marketing authorisation in September 2025 after a 2,900-patient study at four health systems, together with a plan governing how the model may be retrained. Two customers worth US$3.6 million a year left while we waited.
COPD released after a pilot, not before
A 2024 pilot with 640 patients found that only 9 per cent of oximetry alerts changed anyone's care. The symptom-led programme we released in March 2025 had 5,000 patients by December, and 31 per cent of its alerts led to a change in treatment or follow-up.
Current focus
I am preparing the evidence plan for our next regulated feature, which will help clinicians adjust blood pressure medication between visits and which we are treating as device software from the first prototype. I am also revising our fees for patients on reduced reading schedules, so that a clinically sensible schedule never becomes the expensive choice for a practice.
Conversations I welcome
I am not looking to leave Ardenwick. I would consider one independent directorship at a listed medical device, diagnostics or home-care company, or at a not-for-profit health system that does not buy from us, joining its quality or technology committee. I can give about twenty-four days a year, with the agreement of our chief executive and board. I also accept a small number of invitations to speak to nursing informatics and product audiences.