Tuesday, June 12, 2012

Data data everywhere: A day in a device clinic

A few weeks back, I visited a pacemaker/defibrillator device clinic. During this visit, I was able to observe how in-clinic and remote device checks are conducted.

Device checks are conducted after implanting a cardiac device in the patient, to assess the status of the patient and the device. These can be done in the clinic and remotely. In-clinic device checks are conducted with a computer system (referred to as a Programmer; see the picture below) that communicates with the implantable device in the patient. This system allows a clinician to monitor as well as make changes to device settings without having to re-operate. Remote follow-ups, on the other hand, are conducted via a secure website that allows clinicians to remotely assess the status of the patients who are at their homes.  

Medtronic Programmer

The frequency of these device checks is dependent on the device type, the clinic and the geography. For example, a clinic could perform in-clinic device checks for pacemaker patients once a year and could perform remote checks every 3 months. Typically, in-clinic device checks are conducted more frequently for defibrillators than for pacemakers.

During an in-clinic device check, a nurse interviews the patient, conducts tests (e.g., sensing, threshold, impedance), and makes changes to the device settings if necessary. On a given day, a nurse sees patients who have implantable devices from different vendors, which means that they have to switch between various Programmer systems when conducting the different device checks. There are a lot of variations between these systems – the nomenclature of key parameters, data representation, navigation paths, the way tests are conducted, and so on. Further, each manufacturer has different device and lead models that also contributes to complexity. The same variation holds true for remote monitoring systems as well – each manufacturer has their own unique, remote monitoring website.

In addition, a device nurse on a given day also interacts with multiple systems such as a scheduling system (for scheduling patients for device checks), a billing system, an Electronic Medical Records (EMR) system, and a database management system (that archives data from cardiac devices across manufacturers). Last but not the least, several clinics still maintain paper records of device checks.  

To conclude:
  • The diversity of systems that the nurses interact with in a day and the amount of data entry that occurs is enormous. Standardization (in terms of displaying the key parameters in the Programmers and remote monitoring websites) by device manufacturers has great potential for enhancing clinical efficiency - though this is easier said than done.
  • Better data flow between the different systems ( e.g, EMR, scheduling, billing) will also help streamline the clinical workflow. 

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