The Number One Remote Monitoring Problem to Solve: Patient Connectivity

Why the Current and Long-term Success of a Remote Monitoring Program Hinges on Patient Engagement

Introduction

Remote patient monitoring and interrogation of cardiac implantable electronic devices (CIEDs) dates to the early 1970s. In 2015, the Heart Rhythm Society (HRS) convened a multidisciplinary team to develop a consensus statement regarding best practices for remote monitoring programs, centering around patient engagement and education as strategies for success. The consensus statement provided detailed guidance for managing patient expectations as part of the initial patient education and patient agreement/contract.¹

Modern remote cardiac monitoring remains a class 1A recommendation, and it is now considered the standard of care for managing CIEDs across all major device manufacturers. With this growing adoption, clinics have experienced drastic changes in their device management workflows, requiring the implementation of new processes to develop a successful program now and for the future of remote monitoring.

Benefits and Challenges of Remote Monitoring for Clinics

Clinics that have invested in remote monitoring programs have benefited from numerous improved outcomes. These include lower rates of readmission and hospitalization, better detection of heart failure (HF) and other major cardiac conditions, and fewer in-person visits, leading to greater clinical efficiencies and improved patient outcomes.

Despite remote monitoring for cardiac devices as the standard of care, a considerable gap remains in patient compliance prohibiting the success of remote monitoring programs. According to a recent study, 88.2% of survey respondents strongly or somewhat agreed that connectivity was a major concern and that it is the number one challenge in managing patients with remote monitoring.²

Strategies for Keeping Patients Connected and Engaged

To ensure the overall success of a cardiac monitoring program, it is critical for patients to understand their role in transmitting their data in a consistent and timely fashion. Engagement is vital in overall patient safety and health. With remote monitoring, maintaining an active connection is essential to care delivery, as you cannot treat those that are not connected.

A recent industry benchmark estimated that 45% of remote transmissions are never sent due to improper setup and lack of ongoing collaboration with patients.³ This underscores the importance of patient engagement and education during both onboarding and ongoing follow-up to help drive adoption.

Another study of over 118,000 patients found only 21% patient compliance over a 14-month period.⁴ Reasons included patient demographics (eg, patients aged 80 years and older were associated with poorer compliance), systems-based challenges (eg, increased enrollment at a clinic site was associated with improved compliance at the patient level), and device-related reasons (eg, patients with wireless devices had better compliance compared with those requiring use of a device interrogation wand).

Patient connectivity is an important aspect that all cardiology clinics must consider when managing remote patients. When device data is more regularly transmitted for clinical review, it can result in improved patient safety and well-being. With the proper mechanisms in place, a well-engaged and active population can expect to have a 90% or more rate of connectivity.

Clinic staff are then able to focus their efforts on patient care by reducing administrative overhead through the use of technology. To ensure best results at scale, a remote monitoring program should consider best practices through alternative communication channels, such as text-based or email outreach as a supplement to regular in-person consultation.

Key Benefits When Actively Engaging With Patients

As CIEDs and remote monitoring technologies continue to advance, the need to systematically manage patients to keep up with the influx of data also increases. Simple, yet sophisticated patient engagement strategies come with several immediate benefits:

1. Optimized care and value to patients

2. Increased efficiency (both clinical and administrative)

3. Improved staff satisfaction and reduced burnout

4. Increased revenue opportunity

Each of these benefits can be transformative to a clinical practice and easily support the investment, regardless of whether the program is managed in-house or with a third-party partnership. Clinics that do leverage a remote monitoring vendor with patient connectivity capabilities can experience greater clinic productivity than those who do not. (Figure 1)

Figure 1. Patient connectivity is vital to the success of a remote monitoring clinic. Leveraging a third-party solution with patient engagement capabilities relieves burden from clinic staff and leads to greater clinic productivity.⁶

Informed Patients Are Motivated Patients

An informed patient experiences a greater rate of satisfaction and adherence. Initial education, ongoing help, and reminders about a scheduled transmission are simple tools that can easily be forgotten in a busy clinic. Device clinics can expect to see connectivity rates increase when patients are routinely engaged in their care and their needs and expectations are met.

To improve rates of connectivity, patients need to have a clear understanding of when and why they should be regularly transmitting their device data. Patients should also have the resources available to understand how to transmit data.

In addition, patients should know how to communicate issues about their cardiac device and how to seek additional resources or information. If patients feel responsible for participating in their care, they will take action and get the necessary support.

Financial Implications: A Closer Look

There is the potential for substantial revenue when performing routine monitoring every 31/91 days. To grow practice revenue, patient engagement is key, as missed transmissions will result in lost billing and revenue.

Strategies such as sending out reminders, proactively scheduling days for data transmission, and regularly following up on device connectivity status will all result in improved revenue.

Reducing Noise and Focusing on What Is Most Important

CIED monitoring can be noisy—for example, in one study, 60% of all loop recorder alerts were false positives.⁵ A successful program must consider strategies to quickly detect, analyze, and process all transmissions, while focusing on clinically critical information. Defining a clinic’s protocol to triage, assess, and prioritize transmissions is the first step in building out a CIED program. While all patients should be regularly transmitting data, success lies in ensuring whether action is necessary and quickly processing a transmission that does not warrant further intervention or coding. When critical events do occur, a precise set of guidelines ensures that technicians are consistently reviewing that data and accurately taking follow-up action with patients. Once a clinic’s protocol is defined, systems and technology can be put in place to manage transmissions in an effective, consistent, and timely manner.

Strategies for Improving Patient Engagement

Device clinics looking to improve patient connectivity and engagement can rely on technology, services, or a combination of both.

Software can be used to detect and identify patient connectivity status so technicians can take proactive steps to ensure timely transmissions occur. Some tools can also be programmed to automate connectivity workflows and contact patients in the event that they become disconnected or do not transmit on time. Such communications may take the form of automated emails, SMS communications, or phone calls to remind the patient and offer a resource to get them back on track.

Figure 2. Clinics that work with a remote monitoring partner demonstrate a higher level of program success and satisfaction. This is due to a number of benefits, including being able to offload nonclinical tasks such as patient follow-up for connectivity reminders and missed transmissions.⁶

A more hands-on approach can also be achieved using supplemental services focused solely on getting patients onboarded, engaged, and regularly transmitting. Such services are often fully outsourced and provided on an intermittent basis when connectivity rates begin to drop. Some third-party remote monitoring solutions, such as the Vector Patient Care Platform, offer these services to device clinics and their patients. (Figure 2)

The Future of Remote Monitoring

CIED remote monitoring is the cornerstone of cardiac rhythm management, with proven benefits for both clinics and patients. Maximizing those benefits is crucial for an efficient and profitable practice with optimal patient outcomes.

The future of remote monitoring includes a comprehensive approach to leverage all cardiac data. Successful CIED remote monitoring programs have even expanded their practice to include remote vitals monitoring (eg, blood pressure and weight scales) to manage heart failure and hypertension. This requires a robust patient engagement strategy to ensure data is appropriately captured and managed.

These advancements help clinics focus on value-based care and clinical outcomes. Leveraging vitals data for preventative care can reduce hospital admissions and be a step forward in improving patient care.

Summary

Patient engagement and connectivity are the primary challenges that device clinics face today. They are the key components of a successful CIED program and set the foundation for long-term success. It is also one of the most pervasive challenges that device clinics currently face. Best practices can be implemented for optimizing patient engagement:

• Setting patients up for long-term success as they are onboarded within the clinic
• Taking proactive steps to understand where there are gaps in connectivity
• Reducing the chatter and focusing on the most critical information needed for care
• Leveraging a combination of technology and services to get patients back online
• Meeting patients where they are and motivating them to play an active role in their health care

About Vector Remote Care

Vector Remote Care is a leader in providing solutions for the cardiac device clinic, with services ranging from simple data management software to clinical device experts and electronic health record (EHR) integrations. Vector is the only third-party vendor that offers the combination of software-empowered and live support patient engagement to realize these benefits.

Founded in 2014, Vector is a complete cardiac digital health solution that makes it simple for care teams to accurately capture, manage, analyze, and act on remote cardiac data. Vector helps monitor and manage the entire cardiac remote monitoring lifecycle—from patient setup and data transmission to analysis and billing—so teams stay focused on what matters most: delivering the best care to patients. 

To learn more about Vector Remote Care, visit: vectorremote.com/EP

This article was published with support from Vector Remote Care, LLC.

References

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2. Harvey M, Seiler A. Challenges in managing a remote monitoring device clinic. Heart Rhythm O2. 2022;3(1):3-7. doi:10.1016/j.hroo.2021.12.002

3. Zeitler EP, Piccini JP. Remote monitoring of cardiac implantable electronic devices (CIED). Trends Cardiovasc Med. 2016;26(6):568-577. doi:10.1016/j.tcm.2016.03.012

4. Rosenfeld LE, Patel AS, Ajmani VB, Holbrook RW, Brand TA. Compliance with remote monitoring of ICDS/CRTDS in a real-world population. Pacing Clin Electrophysiol. 2014;37(7):820-827. doi:10.1111/pace.12358

5. O’Shea, Middeldorp ME, Hendriks JM, et al. Remote monitoring of implantable loop recorders: false-positive alert episode burden. Circ Arrhythm Electrophysiol. 2021;14(11):e009635. doi:10.1161/CIRCEP.121.009635

6. Porterfield C, Stitt K. Struggling to connect: 2021 state of remote monitoring report. Vector Remote Care.