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Remote Monitoring Alert Burden Reduction With PaceMate™LIVE Technology
Understanding Alert Burden
Remote monitoring (RM) is a Class 1A recommendation for the management of cardiovascular implantable electronic devices (CIEDs).1 But with this standard of care has come an overwhelming volume of RM alerts for clinics of all sizes to manage.
Alert burden is a multifactorial issue. Approximately 95% of devices on RM are now wireless devices that connect via Bluetooth or radiofrequency-enabled technology. The result of this “hyperconnectivity” means clinics receive CIED alerts 24/7/365, with approximately 74% of those alerts received after 5:00 PM and before 9:00 AM.2
The most significant contributor to alert burden is the growing number of implants—especially insertable loop recorders (ILRs). O’Shea et al3 describes how ILRs contribute excessively to overall alert burden. In this observational study, though ILRs represented only 18.8% of the total device patient population, ILRs accounted for just over half of all alerts in a >26,000 CIED-patient population.
Another factor within alert burden is the significant population increase of persons eligible for device implants. Increasingly more baby boomers are reaching retirement age, and cardiac devices become faster, easier, and safer to implant. Additionally, many clinicians are leaving the traditional practice setting in favor of retirement, remote work, or other nontraditional roles. Perhaps because of the COVID-19 pandemic, aging population, or growth in the telehealth field, device clinics are facing critical staffing challenges in an area of practice where recruitment of experienced staff is already problematic.
Solutions to Alert Burden Challenges
Increased transmission volume, emerging indications, and reduced clinic support staff have created the perfect storm. Clinics have sought to address this burden by hiring additional staff, contracting with third-party RM companies or developing dedicated RM services within their clinics. But these solutions have proven to be exceedingly difficult to scale and are typically unsustainable. Methodic, standardized alert management can be improved through protocolized programming. However, device-based alerts vary by vendor and are not always remotely programmable.
Additional staffing, either internal or outsourced, is also not a scalable solution. The struggle to recruit, train, and onboard device clinicians is a well-known pain point for almost all device clinics. Variability of alert types and programming methods results in fragmented processes and contributes to alert management challenges, inefficiencies, and overutilization of resources.
The Power of Customized, Prioritized Alerts
Cloud-native technology—that is dynamically connected to the electronic health record (EHR) with Fast Health Interoperability Resources (FHIR®) Application Programming Interfaces (APIs)—presents the most scalable solution for RM alert burden.
In order to provide the most optimal care, physicians and their device team need timely notification of the most clinically relevant findings. PaceMate™’s software-based alerts allow users to customize and prioritize alerts beyond device and vendor-site settings. With the capability to dynamically push and pull EHR data in real-time, the proprietary clinical alerts engine embedded in the PaceMate™LIVE software platform allows for unprecedented time-to-patient-care savings.
PaceMate™ leverages the discrete HL7® device data along with the discrete EHR data to automatically identify and classify alerts at the physician, practice, subgroup, or patient level. PaceMate™ also assists device clinics in configuring the alerts that are most important to them and most significant for their patients’ care. All alerts, regardless of device vendor, are prioritized by the degree of urgency on the PaceMate™LIVE dashboard, with the reason for each alert condition documented as well.
EHR Integration, Medication Lists, and Analytics
PaceMate™’s memberships in the Epic App Orchard, Cerner CODE program, and athenahealth Marketplace provide the unique ability to pull in discrete EHR data via FHIR® APIs. Data from the EHR—including medications with doses and dates, diagnoses, hospitalizations, and care team—informs our alerts engine and is part of the logic behind alert categorization. PaceMate™’s unique alerts architecture interface provides specificity to the alerts physicians want prioritized.
Medication lists and diagnosis data specifically support the PaceMate™ digital health platform to optimize alerts related to atrial fibrillation (AF). PaceMate™’s AF “rate versus rhythm” rules allow clinicians to select the pathway for which they would like to be alerted for specific AF occurrences. For example, with a rhythm strategy, the presence of an AF diagnosis code in the EHR problem list stratifies an event as “new onset” versus “recurring.”
PaceMate™ is also able to identify, via the EHR medications list, whether a patient is on an anticoagulant. This degree of design delivers any alert at the urgency level customized by the physician to new-onset AF versus recurring AF without anticoagulation. PaceMate™ also provides data options to identify patients with left atrial appendage occlusion (LAAO) devices, which applies the same logic to an AF event as the presence of anticoagulation.
PaceMate™’s data analytics platform is a valuable tool to support identification of patients with frequent and repetitive unnecessary alerts. Available to all PaceMate™ customers, this data analytics tool provides nurses and clinicians with granular population health data to identify, mitigate, and monitor alert burden trends. These analytics provide users with a deep dive into alerts classified by device, manufacturer, alert type, and much more. PaceMate™ consultative expertise can offer clinics targeted action plans to address patients disproportionately impacting alert burden.
Alert fatigue can negatively impact CIED patient management and clinician engagement. PaceMate™’s dynamic, software-embedded alerts engine is the only technology available to address this gap.
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This article is published with support from PaceMate™.
References
1. Slotwiner D, Varma N, Akar, JG, et al. HRS Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices. Heart Rhythm. 2015;12(7):e69-e100. doi:10.1016/j.hrthm.2015.05.008
2. PaceMate™ internal data.
3. O’Shea CJ, Middeldorp ME, Hendriks JM, et al. Remote monitoring alert burden: an analysis of transmission in >26,000 patients. JACC: Clinical Electrophysiol. 2021;7(2):226-234. https://www.ahajournals.org/doi/10.1161/CIRCEP.121.009635
