The Case for Service

The past several months have brought significant changes to the software and services landscape for CIED/ILR patient management in cardiology practices nationwide. One major shift involved a recent acquisition, while another leading provider announced the discontinuation of its services, prompting healthcare organizations to reassess and accelerate their long-term strategic decisions. As many platform providers also offer support with technical analysis of remote transmissions, it is important to weigh both the software capabilities and service components when selecting a solution for your device clinic and patients.

Since the mid-1980s, dedicated software platforms for managing cardiac device patients have emerged and consistently demonstrated their value in improving clinic workflows. These platforms enhance the efficiency, accuracy, and overall quality of patient care.

According to the Time and Motion Study released in 2021, clinics using device management software spent 2.1 fewer minutes per remote transmission review compared to those without such systems (11.5 vs. 13.6 minutes). For an average clinic managing approximately 5,758 patients, this translates to an estimated 10.1 staff hours saved per day, or 50.7 hours per week—based on 171 in-clinic visits and 1,335 remote transmissions weekly. Over the course of a year, this results in approximately 2,639 hours saved, the equivalent of 1.4 full-time employees.(1)

These time savings ultimately support improved patient compliance and, most importantly, better health outcomes. While the benefits of device management software are clear, the financial commitment required may present challenges for smaller clinics. However, as the demand for efficiency and high-quality care continues to grow, investing in these platforms may prove essential for long-term sustainability and improved patient outcomes.

Reality in a Device Clinic

As long as cardiac device clinics have existed, clinicians and physicians have been responsible for caring for the programming and maintenance of these devices. These clinicians are highly knowledgeable and typically possess a cardiac background that makes them uniquely qualified for this line of work. If you are currently in the role of a device clinician or even a member of the industry, you likely learned at the hip of someone similar. This education, if done well, does not come quickly. There is no magic book or online course that will give you all that you need to be able to navigate what comes with being responsible for a device clinic. The best programs will introduce you to all the concepts. From there, it’s all about gaining as much experience in a supportive environment that preaches quality and what is best for the patient. The enemy to attaining this level of expertise is time. It can take 9 months or more for even the sharpest of clinicians to acquire all that is needed to care for a device clinic independently. Dr. James Allred’s post from last year helped to shine a light on all that is needed today for a successful device clinic.

Education – A Call for More: Transforming Device Clinic Education for a Stronger Future

Industry’s Role

It is very common these days to have industry help to offset the in-clinic work that results from these device implants. While it does not generate revenue for the office, the technical work provided by industry is not reimbursable; it addresses the most important task: caring for patients. Because the recruiting, training, and retaining of dedicated clinical staff is such a challenge to these offices, the device companies with their highly trained staff are called in to help. While this will help many clinics manage the day-to-day, it does not allow the device clinic to operate at its full potential. For that to be realized, proper attention must be given to remote monitoring and all its aspects. This includes alert protocols, management of disconnected monitors, scheduling of remote transmissions, and access to the practice’s EMR for proper assessment capabilities for patient management. The scale of the device patient population has been and will continue to grow, while the industry personnel who have been asked to help are doing the opposite. There are simply not enough industry resources to handle a device clinic’s daily patient volume. This has been mitigated by managing ‘clinic days’ for each manufacturer. Industry, being limited to providing attention to this device volume for a few days a month, missing actionable clinical data is almost inevitable.

More Patients Coming….

One reason for this expanding patient population has been the enhancements to devices such as loop recorders, which can alert at the sign of atrial fibrillation (AF). With an estimated population of 10.5 million adults in the U.S. with AF, physicians are using loop recorders to help better understand the burden of AF in their patient population. The result of these devices is the generation of a lot of episodic data, which clinicians must review to either help diagnose AF or rule out. The algorithms in most of these devices have improved their ability to detect true AF. Still, the increase in workload for these clinics has, in some cases, negated the benefit of the information for practitioners. What if there were a way to have access to this higher level of diagnostic data without the corresponding increase in workload to find actionable episodes? In the near future, these same devices will have more diagnostic information to help manage heart failure patients. This will again present a similar decision for physicians and those who care for these patients.  Heart Failure diagnostics have been used in implantable devices dating back to 2004. There is plenty of support in the literature for its use. While there is some debate over who will ultimately manage these patients, electrophysiologists/ implanters or those who manage heart failure patients, the bigger issue is that no one has the resources to assume this additional workload. What if these physicians, nurse practitioners, physician assistants and nurses had help in triaging these patients, so they only saw the patients that required intervention?

The Case for Service

As the landscape of cardiac device management continues to evolve rapidly, the growing complexity and volume of patient care demands a proactive approach. Clinics must not only consider the software platforms that streamline workflows but also the critical service components that ensure ongoing, high-quality patient management. The pressure on clinical teams will only intensify with this expanding patient base and increased diagnostic capabilities in implantable devices. Procuring support from administration to hire, taking the necessary time to train these clinicians, and the ability to retain this team for the long term are all challenges that are not likely to change in the foreseeable future. When you combine this with the diminishing ability of industry to fill this gap as they have in the past, a change is necessary in how we think about device clinics going forward. Therefore, now more than ever, it is essential for practices to partner with established service providers who can offer the technical expertise and clinical support to help manage their patients effectively. In a future where budget increases for additional FTEs are not feasible, outsourcing will become the new normal, enabling existing staff to be redeployed more effectively. By doing so, clinics will be better positioned to maintain compliance, enhance patient outcomes, and ensure sustainability in an environment that will continue to struggle for appropriate resources.

For more information about resources available through CV Remote Solutions, please reach out to us at www.cvremotesolutions.com.

 

 

 

Bibliography

1.            Seiler A, Biundo E, Di Bacco M, Rosemas S, Nicolle E, Lanctin D, Hennion J, de Melis M, Van Heel L. Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation. JMIR Cardio. 2021 Oct 15;5(2):e27720. doi: 10.2196/27720. PMID: 34156344; PMCID: PMC8556635.

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