The evidence supporting the benefits of remote cardiac monitoring (RCM) of cardiac implantable electronic device patients (CIED) is overwhelming1-3. The purpose of this post is not to debate the efficacy of remote cardiac monitoring, but to explore why there is a hesitancy towards adoption. Given that the efficacy of RCM has been established in peer reviewed articles, why isn’t RCM more widely utilized?
As we explored that question through our own internal research, we found several barriers to the utilization of RCM:
- Unwillingness to grant access to a third party to monitor patients
- Insufficient access for all parties involved in RCM
- Systems are inflexible, insufficient customization opportunities
- IT Restrictions against USB usage with programmers
- False belief that Pacemaker reps are remotely monitoring patients
- Manufacturer dominance creating reliance on proprietary RCM offering
- Lack of IT resources to implement project
- Cost associated with RCM
- Resistance to workflow change by Nurses/Techs
- Resistance to workflow change by Physicians
Paul McLoughlin, the author of a study on this subject4, grouped patients reasoning for declining remote monitoring into 4 categories:
- Perspective and Perception
- Privacy and Security
- Loss of Human Contact
We can all relate to being fearful of something new or unknown. For many, it increases with age. One patient reported being stressed out about adding the new RCM routine. Another patient simply did not want to be reminded that they had a device implanted in their chest when she felt perfectly fine and had no impact on her daily life. Others perceived that they would need specific devices and to be tech savvy to utilize RCM. Patients had issues with confidentiality and security. They did not want their data hacked but were not more forthcoming. The most common reason, and it should come as no surprise, is the loss of human contact. Being able to communicate with a real person, talking to the doctor, having someplace to go and something to look forward to.
So how do we overcome a patient’s resistance to change? The author found that educating the patient overcame most concerns and objections. When the patient was informed that that they would still be able to visit the doctor, they relaxed and were willing to participate. Likewise, when patients were told that they did not need a computer or the internet to participate, they were less fearful. For those that were stressed, having staff reach out to them during RCM eased their worries. Fear of the unknown will always be a constant, but once identified, fear can be overcome by educating the patient and or their support group.
1 - 2015 HRS Expert Consensus Statement on Remote Interrogation and Monitoring for Cardiovascular Electronic Implantable Devices https://www.hrsonline.org/guidance/clinical-resources/2015-hrs-expert-consensus-statement-remote-interrogation-and-monitoring-cardiovascular-electronic
2 - Home Monitoring of Cardiac Devices in the Era of COVID-19 Jennifer C. Miller, Devin Skoll, and Leslie A. Saxon Current Cardiology Rep. 2021, 23(1), Published online 2020 Nov. 20th
3 - Editorial Commentary: Remote monitoring of cardiac implantable electronic device patients: Why is a medical necessity perceived as an unnecessary burden? Suneet Mittal. The Valley Hospital Health System, Paramus NJ PMID: 27212012 DOI: 10.1016/j.tcm.2016.04.003
4 - Understanding Patient Reluctance to the Remote Monitoring of Cardiac Implantable Electronic Devices Paul Mcloughlin* University of Ottawa Heart Institute, Ottawa, ON Canada Published date: July 10, 2018; Journal of Nursing and Care 2018 DOI: 10.4172/2167-1168.1000460