The benefits of cardiac remote monitoring have been demonstrated in several clinical studies over the past two decades, including IN-TIME. The data are very clear: The use of remote monitoring resulted in 50% relative risk reduction in mortality in comparison to the standard of care for heart failure patients.1 Additionally, the data recorded from these devices pointed to more frequent early detection, resulting in timelier interventions.1
Nearly all of today’s implantable cardiac monitors, implantable cardioverter-defibrillators, pacemakers, and external wearables are designed with some kind of remote monitoring features that can collect and transmit an extensive amount of data often utilized to determine a diagnosis or to actively monitor patient health. And given the opportunity for remote monitoring to potentially usher in more quality care that could allow patients to lead longer and healthier lives, physicians were steadily trending toward increasing the number of remote monitoring patients they would oversee.
The widespread use of remote monitoring to manage cardiac device patients among general cardiologists and electrophysiologists was still only in its infant stages up until about two years ago, when the pandemic forced the hands of hospitals and clinics and physicians across the country to not only find creative ways to still service patients at high standards but also implement and adopt what used to be very specific forms of technology as more of the rules and not the exceptions. This has never been more apparent than with the sudden surge of cardiac remote monitoring capabilities being implemented at healthcare facilities all over the U.S.
But the rapid adoption and necessity of remote monitoring clinics during the pandemic has—not surprisingly—come with steep learning curves and occasional setbacks as the daily management of cardiac device data has suddenly gone from perhaps a few hundred patients to sometimes thousands of patients in a very short span of time, negatively impacting the standard of care and offsetting the benefits of remote monitoring.
Facilities, hospitals, and cardiac clinics are quickly learning that the management of this amount of data can pose massive, ongoing drawbacks—both to their own teams and their patients.
About two years prior to the pandemic, my team and I decided—in the best interest of our more than 4,000 cardiac device patients—that we would transition all of them fully to remote monitoring. Despite the aforementioned clinical benefits, which was the primary driver behind our decision, the administrative burdens associated with managing the immense amount of patient data were plain and immediate. It was adversely affecting virtually every aspect of our work, especially the time we were able to dedicate directly to treating our patients and their conditions.
The math wasn’t working out in our favor at all: 4,000-plus patients requiring an office visit and device check every 90 days meant more than 360,000 reviews of 6-10 pages of cardiac data and alerts. On average, I and the two other physicians in our practice each spent five hours every week assessing and approving these device reports, which was nothing compared to the hours being put in by our care teams to handle the important administrative tasks that both precede and follow our data reviews. The entire process, when carried out beginning to end, looks something like this:
- Contact the specific device company representative for access to all device interrogations, including any actionable or emergent alerts
- Download the cardiac data from the device company’s secure server
- Print the data
- Read and review the data
- Sign off on the data
- Initiate any immediate actions or follow-up appointments based on the data
- Scan the data into EMR
- Accurately bill for the time to Medicare and Medicaid
Furthermore, we were constantly navigating four different vendor-specific software platforms—Abbott, BIOTRONIK, Boston Scientific, and Medtronic—and sometimes a fifth—iRhythm. This was leading steadily to burnout, as every facet of our recordkeeping for cardiac patients and their devices became increasingly more tedious and was hindering our ability to provide the best possible care. It was also wreaking havoc on our team and their day-to-day workflow.
Like innumerable other clinics are now currently doing, we weighed several traditional options for managing the sudden shift brought about by transitioning fully to remote monitoring: hiring additional members to our care and administrative teams, limiting the acceptance of new patients, or even utilizing devices from only one or two manufacturers. But none of those were viable solutions if we wanted to maintain differentiated and quality patient care across the board.
Unique health IT software became the answer—a digital solution capable of housing a robust data management platform that was scalable and configurable and created more workflow efficiency while offering a variety of integrated and automated features.
There were three primary processes that we absolutely needed:
- Consolidation of all cardiac data from each device manufacturer onto one user-friendly digital dashboard
- Digital assessment and organization of all data and device interrogations in real-time
- Full compatibility with existing EPM, EMR and billing programs
And to make certain that each of these boxes was checked and adhered to our specific quality standards, our practice took an unconventional approach—we built our own software.
In 2019, we piloted our platform’s data management infrastructure and capabilities with our 4,000-plus device patient population. During that year, we increased our billing proficiency by nearly 50% and reduced workloads related directly to remote monitoring for our administrative and care teams, on average, by almost 90%. It became an immediate tool for promoting our clinic’s sustainability.
And now, with remote monitoring clinics emerging out of necessity in rural and urban areas all over the country as a result of the pandemic, the key to the success of those clinics and the continued wellbeing of their patients is going to be the integration of a device data management platform designed specifically to meet their needs.
Ideally, remote monitoring data management software should streamline data and alerts from multiple manufacturers onto one unified dashboard so that care teams can continuously monitor patient device statuses from any mobile device, assess activity logs, and add care notes without having to toggle between manufacturer databases and varying user interfaces. The software should also allow teams to view alerts related to all standard device transmissions, patient device recalls, successful versus failed EMR uploads, and the status of the review and billing of all remote reports.
The importance of the software’s scalability, configurability, and workflow efficiency cannot be understated here. Those three key features alone provide clinicians and care teams with the opportunity to implement digital management platforms that cater precisely to their practice sizes and patient populations, and it even affords research and academic teams embarking on clinical studies with new opportunities to collect and collate cardiac device data more easily and efficiently.
A few short years ago, data management software was slowly emerging as an interesting future possibility for those physicians embracing remote monitoring, but the reality is that it has quickly become one of the most critical components in which every cardiac remote monitoring clinic in the U.S. should now be investing.
- Hindricks G, et al; IN-TIME study group*. Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet. 2014 Aug 16;384(9943):583-590. doi: 10.1016/S0140-6736(14)61176-4. PMID: 25131977.