By Dr. Maninder Bedi

Here is the reality: The pandemic has forced the hands of hospitals and clinics and physicians across the country to not only find creative ways to still service patients at a high standard 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 influx of an array of cardiac remote monitoring capabilities at healthcare facilities all over the U.S. Nearly all of today’s implantable cardiac monitors, implantable cardioverter-defibrillators, pacemakers and external wearables are designed with some form of remote monitoring features, which can collect and transmit an extensive amount of data often utilized to determine a diagnosis or more frequently and actively monitor patient health.

Up until the onslaught of the pandemic, however, the widespread use of remote monitoring among general cardiologists and electrophysiologists was really only just in its infant stages, despite the benefits of cardiac remote monitoring being demonstrated in several clinical studies over the past decade-plus, 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. Additionally, the data recorded from these devices pointed to more frequent early detection, resulting in timelier interventions.

So, of course, given the opportunity for remote monitoring to potentially provide more quality care that could allow patients to lead longer and healthier lives, it was only a matter of time before physicians steadily increased the number of remote monitoring patients they would oversee. However, 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, dramatically impacting the standard of care.

Facilities, hospitals and cardiac clinics are quickly learning that the management of this data can pose massive, ongoing drawbacks if there isn’t a data management infrastructure already in place.

A few years ago, 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 to remote monitoring. Despite the aforementioned clinical benefits, the administrative burdens associated with managing this kind of data overload were plain and immediate. It was negatively impacting virtually every aspect of our work, especially the time we were able to dedicate directly to our patients.

The math just wasn’t working out in our favor: 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. The entire process carried out by our own administrative and care teams – along with thousands of other hospitals and clinics – looks something like this:

1. Contact the specific device company representative for access to all device interrogations, including any actionable or emergent alerts
2. Download the cardiac data from the device company’s secure server
3. Print the data
4. Read and review the data
5. Sign off on the data
6. Initiate any follow-up appointments or actions based on the data
7. Scan the data into EMR
8. Accurately bill for the time to Medicare and Medicaid

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 towards burnout, as every facet of our recordkeeping for cardiac patients and their device data became increasingly more tedious and was hindering our ability to provide the best possible care.

Like many clinics prior to the pandemic, we weighed several traditional options for managing everything: 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.

How were we going to move the needle forward?

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. Three primary processes were needed:

1. Consolidation of all cardiac data from each device manufacturer onto one dashboard
2. Assessment and organization of all data and device interrogations in real-time
3. 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.

And 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%.

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 management software should also allow teams to view alerts related to all standard device transmissions, patient device recalls, successful versus failed EHR 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 remote monitoring, but the reality is that it has quickly become one of the most critical components in which every cardiac remote monitoring clinic should now be investing.

About the author: Dr. Maninder Bedi is a board-certified electrophysiologist and one of the industry’s key opinion leaders on remote monitoring. He is also the founder and chief medical officer of Optimize EP, a digital health company committed to providing cardiologists and electrophysiologists with digital solutions for improving the management of cardiac device data.