Remote Monitoring provides timely access to clinically valuable information
Pacemakers and implantable pacemaker defibrillators (ICDs) no longer simply prevent bradycardias with brady pacing or terminate tachycardias with antitachycardia pacing or shock therapy. These devices have evolved to become valuable diagnostic devices storing clinically valuable information with regard to system integrity, atrial and ventricular arrhythmias and heart failure parameters.
Until the last few years this clinically valuable information could only be accessed with a programmer at an in-person office visit or with periodic inductive device downloads requiring patient participation. These forms of follow-up only allowed for intermittent access to the clinically valuable information stored in the devices.
The advent of wireless devices and the Internet has transformed access to the data stored in Cardiac Implantable Electronic Devices. Continuous access to the clinically valuable information stored in these devices is now possible with Remote Monitoring. CIEDs are programmed with specific ALERTS which trigger immediate downloads of clinical information to the Internet. Monitoring this data on the Internet allows for timely clinical intervention shortening the time to the detection of arrhythmias, device or lead malfunction and intervention for heart failure.
Remote Monitoring – A Workflow problem
Unfortunately, the workflow issues created by Remote Monitoring have been vastly underestimated. Patients with wireless devices pose unanticipated logistical issues to practices which for time in memoriam have dealt with patients who present to the doctor’s office or hospital in-person frequently with a referral letter in hand and an insurance card engaging the clerical staff, the physician and the billing staff. Patients with wireless devices are transmitting information to the Internet on a continuous basis and are not engaging the office staff in-person. Simply implanting a wireless device and providing the patient with a transmitter before asking the practice allied health professional to monitor the downloads on the Internet does not address the complexity of providing this service with its clinical, financial and medico-legal implications. Confronted with these issues, many practices have failed to provide a safe cost effective service or have elected not to provide this service.
ScottCare and Ambucor– Solutions to the Dilemmas of Remote Monitoring
The goal of ScottCare and Ambucor is to facilitate early access to clinically valuable information stored in CIEDS by making this information available in a timely fashion to the physician. ScottCare and Ambucor bridge the gap between the data delivered to the Internet and presenting information to the electronic medical record where it can be viewed in the context of the patient’s medical record by the physician.
There are four device companies in the USA that provide wireless CIEDs each with its own proprietary website. ScottCare provides a cloud based software package, OneView, which can accept information including electrograms from all for companies. OneView can in turn export this data to an Electronic Health Record.
Managing patients with wireless devices that are transmitting data to an Internet site without visiting the office requires a separate office structure to deal with these patients. This is not work that can easily be absorbed by the office staff. Ambucor is an insourced labor force that can be hired to provide the specialized services needed for 24/7 remote monitoring. The Ambucor team will help ensure that the patient receives a monitoring device, provide the patient a schedule for 3 monthly downloads, obtain the quarterly downloads, post them to the EHR, continuously monitor for alerts, screen data for information, provide detailed information for billing, provide continuous support line for patients to call, while providing a cost effective service.