Today’s implantable cardiac monitors, implantable cardioverter-defibrillators, pacemakers and external wearables are designed with remote monitoring capabilities to collect and transmit an extensive amount of data that can be used to help determine a diagnosis and monitor patient health. The benefits of remote monitoring patients are profound. In fact, the IN-TIME study demonstrated that the use of remote monitoring resulted in 50% relative risk reduction in mortality in comparison to the standard of care for heart failure patients. Additionally, the data recorded from these devices directly pointed to a boost in early detection, resulting in the initiation of timelier intervention1.
There is no question that these devices have led to more possibilities for physicians to provide greater quality of care, allowing patients to lead longer and healthier lives. However, the ongoing adoption of technological advancements has also come with steep learning curves and occasional setbacks as we integrate the daily management of cardiac patient data into our standard of care. Facilities, hospitals and cardiac clinics have quickly learned that the management of data can pose massive, ongoing drawbacks to clinicians and care teams particularly if they have yet to streamline their workload.
A few years ago, in examining the operations of our practice, Regional Cardiac Arrhythmia, it was evident that my team and I were struggling with the burden of data overload. It was negatively affecting virtually every aspect of our work, as well as office morale. With our clinic serving nearly 4,000 patients and each patient requiring an office visit every 90 days, my time was routinely allocated towards navigating page after page of device records along with assessing and approving my patients’ cardiac data. The care team was also tasked with printing this information and scanning the data into our electronic medical records while trying to accurately bill the time investment for Medicare and Medicaid reimbursements. The challenges were immense and increasing with every new Abbott, BIOTRONIK, Boston Scientific and Medtronic device implanted. To effectively use the data received through remote monitoring, we were piloting through the four vendor-specific software platforms used for the storage of device data as well as continuing our usual standard of documentation. We were experiencing burnout as every facet of record-keeping became increasingly more tedious with each new patient.
With our workflow greatly flawed, the cardiac care team at Regional Cardiac Arrhythmia was quick to notice that the complexity and challenges of managing patient data was hindering our ability to provide the best possible care and we knew that these issues were not unique to our practice. Many of my colleagues shared the same goals of increasing efficiency and accurately reporting for CMS reimbursement; we all needed to find a solution. Like many clinics, we weighed numerous potential options to simplify our operations: hiring additional members to our care and administrative teams, limiting the acceptance of new patients, or utilizing technology from only one or two manufacturers.
None of these resolutions were a viable option.
To fully meet our needs at Regional Cardiac Arrhythmia, we needed a platform that offered three major processes:
- Compilation of all cardiac data regardless of the device manufacturer.
- Assessment and organization of device interrogations to better inform the team of actionable alerts.
- Creation of simple compatibility with existing hospital and clinical billing programs to ensure appropriate revenue collection.
With no clear options available on the market, I reached out to a computer science expert to determine if my expectations for a single solution were realistic and achievable. Working together, we assessed the operations of the cardiac clinic and analyzed how to best organize the growing data and notifications coming from each device to create a solution that would be easy to use, streamline workflow and improve efficiency. Utilizing his expertise in managing and processing data along with clinical expertise from the cardiac care team, a fully functioning system that met all of our platform requirements was successfully created. Now, nearly three years later, the system we created is in place and its value proven. Our standard data management procedures have never been more efficient. We have the ability to review our patients’ data transmitted from implantable and wearable cardiac devices in a highly streamlined and structured format and continuously monitor patient device status, assess activity logs and add care notes. By simply accessing the dashboard of our cardiac data management system, we can view alerts related to standard device transmissions, patient device recalls, successful vs. failed EHR uploads, and the state of the review and billing of remote reports.
Without taking the leap and branching out of our wheelhouse to determine a solution, our ability to deliver the best possible patient care would have continued to suffer. As clinicians, we are positioned to understand obstacles and identify solutions that others cannot and likely will not recognize. We will always be at the frontlines, engaging with patients, determining treatment pathways, monitoring devices and interacting with the software systems intended to simplify processes. That is exactly why we must always help drive the creation of solutions that can truly improve care delivery and operational efforts critical to the long-term viability of cardiac practices.
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