A PaceMate Case Study: Genesis Healthcare System Experience With Adopting a Software-Only Remote Monitoring Solution to Optimize CIED Patient Management

The Genesis Heart & Vascular Institute is a hospital-based practice located in Zanesville, Ohio, and part of the Genesis Healthcare System. Genesis Healthcare System is a 298-bed facility serving 7 counties within a 50-mile radius of the hospital. Genesis Heart & Vascular Group consists of 3 electrophysiologists, 4 interventional cardiologists, 9 general cardiologists, 15 advanced practice providers, 5 dedicated device clinic registered nurses (RNs), and 3 medical assistants. This team follows over 3100 cardiovascular implantable electronic device (CIED) patients representing all the major CIED vendors, and the number of CIED patients continues to grow. CIED remote monitoring services are centralized in Genesis’ main location. In-clinic CIED interrogation and programming services are performed at the main clinic in Zanesville as well as 2 satellite office locations. The Genesis dedicated device clinical team has an average of 5.5 years of device experience and 12.5 years of pertinent health care experience. One of their device specialists is an RN and certified as a Cardiac Device Specialist (CCDS) through the International Board of Heart Rhythm Examiners (IBHRE).

PaceMate account manager Jennifer Brehm interviewed key stakeholders at Genesis Healthcare System and asked them to share their experiences relative to all facets of the selection, planning, integration, and onboarding process with PaceMate’s software-only remote monitoring platform solution. The following captures the perspectives of those who led the initiative on behalf of device clinicians, electrophysiology (EP) physicians, and information technology (IT) partners.  

Alaina Mathers, BSN, RN, CCDS, device clinic charge nurse explains the clinic’s experience with the PaceMate software solution.

(JB) Why did the clinic begin the search for a software partner?

(AM) As the clinic grew, the devices became more advanced, and patients’ overall health status seemed to be more complex. As the medical world advanced, it became increasingly obvious that we needed a better way to collect, manage, share, and store information from the devices for each patient. We also needed to best utilize the current staffing and resources available to become more efficient and cost-effective. We also wanted to decrease the human error factor during data processing and increase our revenue capture. Finally, with advancement in technology comes the increased potential for device advisories and recalls and/or potential issues. Our practice wanted to find an avenue that would increase our patient safety by better identifying and tracking the affected devices.

(JB) Will you describe your pre-onboarding experience with PaceMate?

(AM) Pre-onboarding with PaceMate consisted of scheduled virtual meetings with the PaceMate staff to establish an Epic integration and clinical training plan. Meeting participants included the PaceMate and Genesis project managers, Genesis IT department and PaceMate’s integrations director, our billing department representative, Genesis Heart & Vascular practice manager, Genesis device clinic director, and the device clinic charge nurse. PaceMate began by gathering current state workflow information from our clinical practice and IT teams to best prepare an Epic integration plan specific to our facility. The IT departments from both PaceMate and Genesis then met regularly to set up and test PaceMate’s Epic App Orchard integration for clinical documentation and claims creation. Clinical project milestones were also tracked during weekly 30-minute virtual sessions. These sessions were led by the PaceMate account manager and included the Genesis clinical device staff and practice manager. Once the software was set up to receive remote vendor transmissions, glimpses of the future state workflow were given first in demo sessions, then in live practice sessions prior to Go Live. The Genesis staff felt included and updated throughout the process. The PaceMate project managers were very responsive to answering questions and resolving any potential issues before they became a problem. 

(JB) Please tell me about your onboarding experience.

(AM) Genesis Heart & Vascular hosted onsite Go Live support with the PaceMate staff for 3 training days. Genesis IT dedicated personnel to be stationed within the clinic to work as a team with the clinical staff to troubleshoot any unforeseen integration issues. Day 1 was dedicated software “playground” time to educate and train the clinical staff on the new workflow. Day 2 consisted of PaceMate staff working side-by-side with the clinical team as we ended the playground sessions and started working in the live environment to work through remote transmissions and in-clinic device interrogations from active patients. Day 3 was dedicated to post-Go Live question and answer support to help solidify our training process before leaving us onsite and switching to virtual support to help us navigate our new software journey. Regular post-launch huddle virtual sessions were scheduled between the PaceMate and Genesis staff. The dedicated PaceMate staff was available via software support requests, phone calls, texts, or emails to assist us with any difficulties or questions that arose between the planned huddle sessions.

(JB) How was the learning curve post-Go Live? How much time did it take the team to feel proficient using the PaceMate software system?

(AM) If I am going to be totally honest, post-Go Live was a little tense and stressful for about the first 3 weeks. This is to be expected with any major workflow process and/or software change. You could have heard a pin drop in our work area, as we were all so concentrated and focused on working on the new software system. My secret was a bin of candy snacks, which staff could grab during any stressed-out moments. By week 6, the staff had begun to accept this as the “new normal” for their daily routines and processes, and little by little, conversations returned as we settled into the workflow. PaceMate became an accepted part of our workday, and not the primary focus. After 8 weeks in, we were beginning to feel confident in the software and liked it as much as we had hoped. We are now about 3 and a half months into using PaceMate, and although I do not know that we are “expert,” I do know that we are very comfortable and proficient with the software and our need to reach out to PaceMate support has become a rarity. In many instances, we can navigate the software and find the solution on our own. We have now transitioned to contacting them with suggestions for possible enhancements. We have developed a “wish list” of ideas to be added, and they have been very receptive to listening and have followed up with our team with potential future developments.

(JB) Please explain how the PaceMate’s software platform changed your workflow and efficiency.

(AM) Our workflow and efficiency have changed greatly. I have found that we are:

·       Using far fewer physical resources (paper, ink).

·       Decreasing the physical labor involved in creating a report (no more printing, scanning, hand entering data, etc), which has optimized our current staffing to allow for further growth.

·       Shortening the turnover time from receiving the remote to having it completed for the provider to over-read.

·       Having PaceMate’s cloud-based software solution has created a potential future opportunity that would allow nurses to work from home remotely vs being tied to a physical office.

·       Decreasing the human error factor by reducing the amount of hand-entered data.

·       Improving the flexibility to cross over and work on all vendor reports in one dashboard.

·       Streamlining the process for reports to be posted into the Epic chart for clinical documentation.

·       Optimizing and auto-generating billing with the appropriate coding to process through insurance with the least number of rejections and/or denials.

·       Greatly reduced the data mining time on advisory and recall devices/leads because PaceMate monitors each identified vendor issue and prominently displays these on each unified report.

·       Allowing for the opportunity to generate specific patient population reports to assess for factors that may help identify patients that may benefit from such things as device upgrades (ie, high percentage right ventricular pacing, low ejection fraction).

·       Creating a professional, well-put-together report, which contains all basic device data and the interpretation note on a cover page, which also displays the time-stamped e-sign from the provider and their notes/attestations if so desired. The entire vendor PDF is then added to each cover page for complete clinical documentation.

(JB) What impact has PaceMate’s software solution had on patient care?

(AM) Some of the biggest benefits to patient care that we have identified are:

·       Getting the alert/report to the provider faster with the shortened turnover time. Possible clinical issues are quickly and easily identified by severity flag (red, yellow, green).

·       Greatly increasing our patient safety by having the ability to identify and monitor advisory and recall devices. Once identified, the report carries an “Advisory” or “Recall” notation on it for all future transmissions. In addition, it allows our staff to use easy-access hyperlinks that directly connect to the vendor recall for specific information and details.

·       Having the ability to insert hyperlinks within the interpretation note and/or bolding a portion of the interpretation note is a great benefit when trying to direct the provider’s eyes to specific details, decreasing the number of acute items that could be inadvertently overlooked.

·       We are also building our heart failure (HF) clinic and are beginning to use the device data for assessing fluid monitoring status. We hope to fully integrate PaceMate into the HF clinic as well as monitor metrics for identified HF patients.

(JB) What are some of your favorite PaceMate software features?

(AM) We have several favorite features:

·       The overall streamlining of the entire interrogation report process. Everything is in one place and integrates with Epic beautifully.

·       Having software that is physician-friendly. The provider can easily find, review, and sign the report.

·       Automated billing with associated codes has both simplified and optimized the revenue capture and decreased insurance claim rejections.

·       Having a system that aids in identifying and monitoring advisory/recalls is a huge patient safety bonus. We feel much more comfortable with these scenarios now.

·       We have the option to add other devices into our PaceMate software (ie, insertable cardiac monitors, wearables), and this will allow physicians to be able to go to one site for all their over-reads and results.

·       The “Tech Support” tab within PaceMate is a great feature. They have always responded in a timely manner with assistance.

Jim Walter, Genesis Healthcare IT project manager, provides his perspective on the Genesis/PaceMate Epic integration project.

(JB) What is your opinion of the PaceMate/Epic App Orchard FHIR capabilities?

(JW) Our PaceMate integration into Epic was with the most recent PaceMate-Epic App Orchard version. It was released just prior to our April 2022 PaceMate/Epic Go Live.

(JB) Please describe your experience with the PaceMate interface build. How long did it take from start to finish?

(JW) Our PaceMate-Epic integration was guided by PaceMate’s director of integrations. She developed a very detailed plan that kept the integration on track. We were able to complete each milestone and the project was completed before the established target for Go Live.  The Epic App Orchard integration process was completed in 8 weeks.

(JB) Please describe your experience during the Go Live week with PaceMate. What went well and what challenges were overcome at the time of Go Live?

(JW) Our PaceMate Go Live support team included 2 onsite PaceMate representatives and 1 virtual support person, including members from the PaceMate technical solutions team, account management team, and integrations team. PaceMate provided a very complete Go Live plan for onsite training sessions with the device nurses and physicians. While we did encounter a few minor integration issues, they were quickly and easily resolved in real time. These issues did not affect the clinical training process or stall project milestones—for example, compressing the captures before uploading for clinical documentation as well as some HL7 display issues. 

(JB) Please describe your experience post-Epic App Orchard integration with PaceMate. Can you describe any challenges that were overcome at the time of Go Live, and how has your experience been with post-Go Live support?

(JW) Our clinical team has been very pleased with the PaceMate workflow, as it has made following their device patients more complete. The documentation and integration information that is stored in Epic has improved patient care. We were able to implement automated billing from PaceMate. This has ensured that we are compliant with the Centers for Medicare & Medicaid Services (CMS) rules involving cardiac device management and follow-up. Before PaceMate, we used a manual process. Since going live, we have occasionally found some Epic/PaceMate interface errors. The Genesis team has continued to work with PaceMate support, who has been very helpful in helping us correct those errors. Our clinical team continues to learn ways to prevent errors, such as correcting misspelled or mismatched names due to manual entry during device implant. As our clinical team has become more aware of what causes Epic/PaceMate errors, this process has also simplified. 

(JB) What is your favorite PaceMate software feature?

(JW) In my opinion, the best part of this project has been the acceptance and ease of use for our staff. The need for continued IT support since Go Live has been minimal. Our lead device nurse has become a champion for the staff and helps with any new physician training. This has improved the device clinic efficiency.