Practical Management of the Remote Device Clinic
Introduction
Introduction
Key Points
- Remote monitoring (RM) improves morbidity and mortality in the management of patients with cardiovascular implantable electronic devices (CIEDs).
- The number of CIEDs implanted on an annual basis has grown to approximately 1.7 million worldwide.
- This expert consensus statement provides evidence-based recommendations for all aspects of RM services.
Take-Home Messages
- For patients with CIEDs, RM is the standard of care.
- Prompt patient enrollment and maintenance of regular connectivity with long-term adherence to RM accomplished by individualized patient and caregiver education is essential to an effective RM program.
- Adequate staffing using both clinical and nonclinical personnel with appropriate patient-to-staff ratios and dedicated time to perform defined roles and responsibilities are essential for managing RM clinic workflows.
- Clinical staff in the RM clinic should be appropriately educated and/or certified and participate in ongoing quality assurance and improvement programs.
- Programming alerts specific to device type and indication with established mechanisms for promptly dealing with high-priority alerts can moderate increasing data volume and workload for RM programs.
- Communicating RM device results with patients, their health care providers, and the patient electronic medical record in a secure and confidential manner should be accomplished according to individual device clinic workflows.
- A relationship between RM clinics and device manufacturers for bidirectional exchange of ideas for staff training, patient education, patient care services, and management of safety advisories and recalls is imperative.
- Use of third-party resources may offer financial and practical benefits for dealing with increased device clinic volume.
- Pediatric patients with CIEDs on RM require scheduling similar to that for RM of adult patients but may have special needs requiring additional considerations.
- s) require immediate connectivity to RM with special programming needs based on the patient’s clinical indication for the ILR.
- Alert-based RM that relies on continuous connectivity allowing for extended time intervals between in-office device interrogations.
General Concepts
General Conce...
Table 1. Definitions Programmer - A manufac...
...onsiderations...
...nts with CIEDs, RM is recommended as part o...
...patients with CIEDs on RM, routine...
...atients with CIEDs on RM with a devic...
...ent/reimbursement models...
...the care of patients with CIEDs on RM, it is r...
Administrative and Nonclinical Staff
...ive and Nonclinical Staff...
...nrollment techniques...
...with an ILR, enrollment in an RM p...
...with a CIED, it can be beneficial t...
...updating manufacturer websites...
...he care of patients with CIEDs on RM...
...iques to optimize patient connectivity
...he care of patients with CIEDs on RM...
Staffing of Remote Monitoring Clinics
...of Remote Monitoring Clini...
...requirements for RM
...patients with CIEDs on RM, a team-based organ...
...the care of patients with CIEDs on RM, it is reco...
...care of patients with CIEDs on RM, it is reco...
...patients with CIEDs on RM, it is reasonable f...
...dentialing and qualifications for RM...
...of patients with CIEDs on RM, it is recommended...
...e care of patients with CIEDs on RM, it is...
Figure 1. Staffing Challenges With Remot...
Figure 2. 2015 HRS Expert Consensus Statement on...
Technical Considerations in Remote Monitoring
...hnical Considerations in Remote Monitoring
...Example of a Timeline for Patients With CIE...
...with noncontinuous RM...
...with CIEDs on RM in the absence of conti...
...with CIEDs on RM in the absence of continuous con...
...te-based...
...r patients with CIEDs in centers without onsit...
...patients with CIEDs in centers with onsite d...
.... Traditional Personal 1:1 vs Site-bas...
...lustrative Example of Unscheduled CIE...
Alert-based Remote Monitoring
...-based Remote Monitoring...
...t-based RM...
...tients with CIEDs and a component wit...
In patients with pacemakers (PMs) on RM with c...
...n patients with ICDs on RM with consistent...
Programming Considerations for Optimal Remote Monitoring
...gramming Considerations for Optimal Remote M...
...rer and device-specific knowledge...
...r the care of patients with CIEDs on RM...
...2. Remote Monitoring System Differences Between...
...gure 6. Alert Recommendations by Device...
...ing for clinical indications with differ...
...with CIEDs on RM, it is recommende...
...n patients with ICDs on RM, it is recomme...
...tients with CIEDs on RM, it is reaso...
...ients with CIEDs on RM with CRT, it...
...patients with CIEDs on RM with atrial arrhythmi...
...ients with ICDs on RM, it is reason...
...e of patients with CIEDs on RM, it is re...
...pecial programming considerations for ILR...
...n patients with ILRs on RM, it is recommende...
...ts with ILRs on RM, it is recommended that program...
...atients with ILRs on RM and frequent un...
...with ILRs on RM for unexplained syncope, it...
...ts with ILRs on RM for cryptogenic...
...with ILRs on RM with consistent connectivity, in-...
Managing Alerts
...aging Alert...
...d and Yellow Alerts for PMs and ICDs a Multiple...
...g high-priority alerts...
...h CIEDs on RM, it is recommended that for concerns...
...siderations to minimize inappropriate ale...
...n patients with CIEDs on RM from whom suff...
...or the care of patients with CIEDs on RM...
...re 8. Remote Monitoring Alerts That Shoul...
...recommendations for alert managemen...
...patients with CIEDs on RM, it is rec...
...zing Alerts for Nonactionable Events...