Software-as-a-Service CIED Management: Embracing the Future at the Heart & Vascular Institute of Prisma Health-Upstate

In this feature interview, EP Lab Digest speaks with Dr. Joseph Manfredi about his use of Software-as-a-Service (SaaS) cardiac implantable electronic device (CIED) management software (Murj). Dr. Manfredi is with Carolina Cardiology and the Heart & Vascular Institute of Prisma Health-Upstate in Greenville, South Carolina.  

What are some of the ways in which the Prisma Health-Upstate EP practice has kept on the cutting edge of technology and innovation?

I think we’re always looking for ways to improve our ability to provide the best medical care to our patients and our community. One contributor to innovation is the insight of peers in our southeast region. Sharing best practices keeps all of us up-to-date with any new developments, innovations, and novel approaches to improved patient care in the EP world. We welcome seeing what other facilities are doing ­— if the way they’re doing things has advantages compared to the way we’re doing it, we hope to adapt that learning and evolve our practice for the better.

Remote care is a big part of your cardiac device clinic. What clinical benefits have you seen with remote care?

We recently combined two very large implantable device clinics into one, so we’re now managing roughly 6,000 patients. Originally, we thought moving to more remote care would create an extra burden and more responsibility for our clinical staff. On the contrary, remote monitoring has played a great role in our ability to more effectively utilize the staff that we have. It has freed up office time for our staff and appointments to care for the more critical patients. With remote monitoring, we’re able to monitor our patients and catch potential issues very early on in the disease process, sometimes even before patients develop symptoms. This allows us to intervene earlier and hopefully provide better outcomes.

Have there also been economic impacts with remote care?

Absolutely. Using a remote monitoring system, such as Murj, has helped us to adopt remote monitoring as the primary standard of care. Murj’s workflow allows us to efficiently track all patients and quickly identify those who may have fallen through the cracks or missed some of their remote checks. In addition, the effectiveness of our remote monitoring program frees up staff to work on more new consults and urgent device follow-ups. For example, we recently moved from two office device checks to one office check and three remote checks. This has considerably cleared up our schedule and the ability to work in more patients that need office visits for other issues.

You adopted the Murj SaaS cardiac device management application in 2018. What was the motivation to make this change?

I think the biggest motivation was the fact that we were bringing two clinics together, and we wanted to do this as efficiently as possible. When we looked at Murj’s platform, we felt they could best provide us with efficient workflow practices to be able to make that accommodation.

What processes did you use before Murj? Were you able to keep up with the volume of transmissions?

Before Murj, we were using a competitive device monitoring system, and a lot of our remote monitoring was being done using the print-scan-process, so we’d do a remote check, print it, manually review it, and then we’d have to scan it back into our medical records system. With the help of Murj, we’re making great strides to becoming a paperless device clinic.

What benefits have you seen with this change to Murj?

Our device clinic is running more efficiently and smoothly than it ever has. Reports are being read and processed more quickly. This is a benefit to both the technicians as well as the providers. One of the unique characteristics that Murj offers is they offer incredible data insights that allow us to look for individualized patient care and practice efficiencies, and areas where we can improve. Murj allows us to see which devices we’re using most, which patients are compliant, which are not, and why they might be noncompliant. Murj has also helped us look at our own processes to see if there are things that we could be doing better. And if there is a question, whether it be clinical or more process-oriented, we’re able to query Murj and find answers quickly.

How have things changed for your clinic since Murj was adopted? Have you seen better care and reimbursements?

Yes, I think we are able to provide better care. Murj allows us to detect problems much earlier than we used to. One case in point would be a remote monitoring patient who is noted to have atrial fibrillation. They were asymptomatic, but we were able to detect it more quickly on Murj and get that patient on oral anticoagulation. Murj also helps us keep track of who is on anticoagulation, so if a patient has atrial fibrillation detected on their device, we already know whether or not if the patient is anticoagulated and it may not be such an urgent issue. From a reimbursement standpoint, it was very difficult before Murj to track who was getting their quarterly device checks and who wasn’t. Murj automatically indicates those patients due for their next device check.

What staff feedback have you received?

Our techs absolutely rave about Murj — one of the things we most often hear from them is that the support they receive from Murj has been second to none. Whenever there is a problem, our staff can quickly get in a chat room with one of the Murj techs and fix the problem immediately.

Has there been any reallocation of resources?

Yes, with improved workflow and data availability, providers are able to spend less time having one-on-one discussions with the technicians about questionable transmissions. From any computer station, providers are able to immediately pull up Murj to review the patient device detail and get a response back to the technicians. So that has absolutely given more time to our techs and providers to do other things.

How has your experience been working with Murj in regards to implementation and training, new features, and the people?

They have been very user friendly. They were readily available to us in the beginning for training, and they have always been available for any questions as well as open to feedback on what features we like and what needs improvement. From our feedback, they’ve been able to make updates to their system that have been extremely valuable to our practice. In addition, Murj provides access to all relevant CIED patient data all in one place, which has been a big benefit to our practice. Not only are we able to keep track of what medications patients are on, we are also able to see what the indications were for, and what their ejection fractions are — all of which plays a critical role in clinical decision making. One of our techs made the comment that being able to access Murj from any computer is of huge help, because if they have a question for a provider, the provider can pull it up immediately on any workstation and respond. All of these Murj capabilities have been seamless and extremely beneficial to both our staff and providers.

What tips do you have for clinics considering a change to Murj?

I think the best advice I could give is to be patient. In the beginning, change is always anxiety provoking for staff, especially when everyone is used to a certain way of doing things. However, we knew that Murj was going to be a great investment for us going forward, even though initially we had to take a little bit of extra time entering patient data to get the ball rolling. But once that data is in Murj, it’s in there forever. Change may seem daunting, but the benefits are worth the effort.

What advice do you have for other EP or cardiology clinics looking to establish themselves as a center of excellence?

My advice is to always look forward. The world of electrophysiology is constantly growing, changing, and improving, so I think the best thing you can do is to continue to learn and grow, and always keep an open mind about new technologies. 

Disclosure: Dr. Manfredi has no conflicts of interest to report regarding the content herein.