I am a clinical cardiac electrophysiologist — an electrical engineer for the heart. I studied electrical engineering and digital signal processing before I studied medicine, and electrophysiology turned out to be where those two things actually meet: treating the electrical issues that govern how the heart beats and circulates blood, from rhythms that are too fast to rhythms that are too slow to the nerve signals that regulate heart rate and blood pressure. All of it, as it turns out, is electricity.
As part of treatment, many people need an implanted cardiac device — a pacemaker, defibrillator, resynchronization device, loop recorder, or one of a growing number of newer implants. Nearly 4 million people in the US have some form of a cardiac implantable electronic device (CIED), with roughly 300,000 pacemakers and defibrillators implanted every year. These devices sit under the skin of the upper chest for the life of the device, often for decades, continuously collecting more than a thousand data elements: heart rate trends, lead impedance, current drain, battery voltage, rhythm changes, heart sounds, heart rate variability.
For most implanting physicians, this is a one-and-done event — the procedure, then confirming the site is healing. For patients, it's a very different relationship. For them, one question stays unanswered for the lifetime of the device and their own: what is my device seeing and reporting about my heart, right now?
There's a cognitive dissonance in having a device implanted in your chest, wired directly into your heart — something your own biology first treats as a foreign body, then absorbs as a permanent part of you — mechanically and electrically interacting with your heart, continuously reading out data about it, and yet you don't know what it's finding. That's made stark by not being able to access that data yourself: not knowing whether an unusual sensation in your chest is the device, or something the device already detected, or nothing at all.
What's worse is that the data is available. It's collected continuously, but the analysis is intermittent — every few months, gated by billing and reimbursement requirements, not by anything clinical. And when we do explain it, the explanation can land as dismissive without meaning to. "Looks good. Nothing to worry about. We'll just keep watching it." That's the substance of the conversation something like 70–80% of the time. Watch what, exactly? I don't feel good. I'm worried. That's the uncertainty script running in a lot of patients' minds while they're being told everything is fine.
Now imagine instead if patients could see their own device data whenever they wanted, with real resources to help them understand it — and through that, could understand themselves and make better decisions about their health and their life. That's the idea behind Open Heart / Open Access, and it's the reason The Generator exists as a venture rather than staying a private frustration. Sophisticated medical knowledge — including the knowledge already living inside your own chest — shouldn't require a medical degree to access.
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