Real-World Experience With a Cloud-Based Virtual EP Office

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EP LAB DIGEST. 2023;23(12):16-17.

Dragos D Turturica, MD; Elizabeth Pottanat, BS; Todd J Cohen, MD; New York Institute of Technology College of Osteopathic Medicine, Department of Clinical Specialties, Old Westbury, New York

In 2019, we described a new paradigm in cardiac electrophysiology (EP) office-based practice using a cloud-based computing platform.¹ This article discussed the digital organization and components used by the Long Island Heart Rhythm Center (LIHRC). Specifically, we utilized a HIPAA-compliant electronic health record (EHR), integrated electronic fax (eFax) system, and remote cardiac device monitoring systems for pacemakers, implantable cardioverter-defibrillators, and implantable loop recorders.¹ This paper provides an update on our experience with the virtual medical office (VMO) model.

Components of the LIHRC Model

The minimum needs for a VMO include computer-based access to the cloud via Wi-Fi, stethoscope, exam room, blood pressure cuff, electrocardiography (ECG), cloud-based EHR and HIPAA-compliant eFax, and remote device monitoring systems.¹ The EHR used is Practice Fusion, which is available via the web for medical charting, e-prescribing, online scheduling, and billing, as well as for communicating with other physicians and health care testing facilities. Figure 1 shows a screenshot of the EHR system, which integrates with an eFax (Updox), which connects directly into Practice Fusion (Figure 2A). Telehealth visits are incorporated within the Practice Fusion/Updox system and accessible directly from the EHR (Figure 1). Figure 2B demonstrates the eFax user interface, which facilitates the transmission and reception of electronic documents among various health care practices, facilities, and services.

Telehealth

During the COVID-19 pandemic, the use of telehealth increased significantly, underscoring the vital role of virtual EP visits as an urgent necessity. The Updox Telehealth system, launchable from Practice Fusion, allows for remote communication with patients in a secure environment, enabling capture of patient images for inclusion in the EHR and the ability to store information on doctor-patient interactions.

Medical Education and Clinical Exposure During the Pandemic

Using a method called TeleMedstudent, 2 video platforms are combined with screen-sharing, allowing for medical students to be virtually taught during live remote patient visits (Figure 3).² This system was especially useful during the lockdown phase of the pandemic and allowed medical education to continue at a large medical school.² Additionally, the system allows patients’ family members to remotely participate in their medical encounters. Versions of this system have been developed for those in medical training (TeleFellow).

Advantages and Disadvantages of the VMO System

The Table outlines the real-world advantages and disadvantages of the EP VMO system, which has been utilized at LIHRC since October 2018, with additional components added in early 2019. Feedback on the VMO from the operating physician (Todd Cohen, MD), VMO staff, billers, and medical students is that the system is easy to use, portable (mobile), and accessible from any computerized electronic device, including cell phones and tablets. The system has helped the LIHRC to complete, store, and send thousands of medical reports, including patient evaluations, device interrogations, EP and other cardiac and medical procedural reports, medication prescriptions, laboratory tests and results, and medical referrals.

Additionally, the cloud-based EHR system has helped facilitate research. The system can create reports based on patient demographics and diagnoses. Retrospective, de-identified observational research by LIHRC has been deemed exempt by the New York Institute of Technology College of Osteopathic Medicine (NYITCOM) Institutional Review Board. This has permitted Dr Cohen and the medical students at NYITCOM to complete a myriad of observational clinical and research studies, resulting in at least 50 presentations/publications using the EP VMO. In addition, the EP VMO has served as a useful tool for medical education as well as introducing students to telehealth and research. The system has been cost-effective and has very little downtime.

There are few disadvantages, which include limited administrative tools and inability to track efficiency and turnover times at large medical practices. The latter may be facilitated by larger, more complex EHR systems such as Epic. Technical support for the cloud-based EHR is also online only, requiring the operator to independently learn and troubleshoot the system, which may be different from larger EHR systems that provide in-person or onsite information technology support (including reports and templates construction).

Summary

The LIHRC’s real-world experience with this cloud-based EP EHR system has demonstrated its ease of use in a variety of settings, including the home, office, and hospital. It is simple, cost-effective, and multifunctional (eg, billing, sending and receiving labs, and corresponding medical information). Integrated telehealth solutions have been adapted to this EHR system that provided virtual health care to EP patients during the COVID-19 pandemic. Additionally, the system has been adapted to a TeleMedstudent application, which allowed medical students to continue their clinical medical education during the pandemic. This cloud-based system’s versatility can also be used to screen athletes, firefighters, and other occupational workers for cardiac or arrhythmia-related conditions. Use of this VMO system is helpful for private practice or educational institutions. 

For more information, please contact Dr Cohen at toddcohenmd@gmail.com, or learn more at

www.liheartrhythmcenter.com.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. They report no conflicts of interest regarding the content herein.

References

1. Cohen TJ, Needleman BS, Harper B, Balentine J. The Long Island Heart Rhythm Center: using digital health innovation to create a new paradigm in the EP office-based practice. EP Lab Digest. 2019;19(3):27-29.

2. Cooper Z, Hunzeker N, Hubley R, Gitelman S, Cohen TJ. Implementation of a novel dual video telehealth platform during a cardiology clerkship during COVID-19 pandemic: TeleMedstudent (abstract). J Am Osteopath Assoc. 2020;120(12):e41-e42.