Using the EMR to Monitor Pacemakers, EICDs

System alerts to problems, stores data for research

Many cardiologists monitor pacemakers and other cardiovascular implantable electronic devices (CIEDs) remotely. Forward-thinking practices are now integrating their monitoring software into their electronic medical records system (EMR). The system automatically collects and downloads data, alerts personnel to problems and stores information in a database that facilitates retrieval.

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“When you have a large number of patients, it’s more efficient to move from monitoring individual patients to monitoring your patient population,” says Bruce Wilkoff, MD, Director of Cardiac Pacing and Tachyarrythmia Devices and Medical Information Officer for the Sydell and Arnold Miller Family Heart and Vascular Institute.

Cleveland Clinic electrophysiologists (EPs), who follow more than 60,000 patients on five continents with CIEDs, find the integrated system indispensible. In 2013, over half of their device evaluations were performed while the patients were asleep at home.

“On any given day, a battery will wear down, a lead will have a problem or a patient will have an event. Instead of having the patient return to the clinic, the device alerts us, and we can decide whether the patient needs to be seen here, in the ER, by their primary physician—or at all,” says Dr. Wilkoff.

Advancing technology to fill a gap

When Cleveland Clinic adopted the EPIC medical records system in 2005, Dr. Wilkoff immediately sensed an advantage to integrating their pacemaker database system into the EMR.  At that time, lack of a standard computer interface made connectability difficult, but he persisted.

His struggle underscored the need for a standard interface that allows information from one computer to be used in another context. Dr. Wilkoff is currently working with other EPs who are interested in health information technology to develop national standards that will make all types of health information systems compatible.

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“The key phrase is ‘medical interoperability.’ “The only way it will work is if device manufacturers, governments, societies, engineering organizations, standards organizations, electronic medical records companies—everyone with a stake—shares what they know. It is in their best interest to do so,” he says.

Advantage for patient care and research

Cleveland Clinic’s integrated system is programmed to check a device automatically during the night. When a problem is detected, the system sends an alert to the pacemaker database at Cleveland Clinic’s Pacemaker & Device Clinic, where it is read by an arrhythmia specialist. The information is then sent to the patient’s EMR, where it may be viewed by the patient and his or her physicians.

If the issue needs attention, the patient is called. Otherwise, the patient simply receives an email saying the device has been checked, and the report is available in their EMR.

According to Dr. Wilkoff, a major advantage of having an integrated system is the ability to build a database of patients that can be used to measure quality of care. It can also be tapped when any subset needs to be contacted—for example, when a device is recalled.

A boon for any practice

Although the Cleveland Clinic’ interest in this system was driven by the necessity of monitoring a staggering number of patients, an integrated system can be a boon for any practice already using remote-monitoring software, says Dr. Wilkoff.

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He advises EPs who purchase or install device database software to specify the need to interface their pacemaker follow-up system with their hospital’s EMR system. For assistance, he recommends contacting the Health Information Technology Committee at the Heart Rhythm Society at www.hrsonline.org.

Dr. Wilkoff also invites any EP with a serious interest in medical interoperability of health information technology to join the Heart Rhythm Society’s efforts to coordinate input from industry, government agencies, physicians and hospitals.

“You will be in a select group of people who are trying to figure out how to make sure the information you need is where you need it at the moment you need it, and is communicated to others who need it,” he says. “This is no longer theory. We are making it reality for EPs.”