scholarly journals Clinic time required to manage remote monitoring of cardiac implantable electronic devices: impact of outsourcing initial data review and triage

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
E Nicolle ◽  
D Lanctin ◽  
S Rosemas ◽  
M De Melis
Keyword(s):  
Initial Data ◽  
Remote Monitoring ◽  
Staff Time ◽  
Clinic Staff ◽  
Remote Transmission ◽  
External Monitoring ◽  
Time Savings ◽  
Monitoring Center ◽  
Time Required ◽  
Monitoring Service

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Medtronic Background Remote monitoring is guideline-recommended to manage cardiac implantable electronic device (CIED) patients. With the continuous growth of implanted patients, clinic workload to review transmissions is increasing. Outsourcing initial data review and triage to an external monitoring center could be a valuable option for more efficient allocation of staff time, as high-skilled healthcare professionals can focus on patients in need rather than non-actionable data. Purpose The objective was to estimate the potential clinic staff time saved when outsourcing part of remote transmission review. Methods A previous time and motion evaluation described workflow tasks and time required for remote transmission review (4 EU sites, 674 observations). From real-world experience with a third-party monitoring service, the steps that can be outsourced were determined considering existing clinic-driven protocols for triage and transmission escalation. Staff time required with and without the monitoring service was thus modeled and compared. Results Outsourcing to an external monitoring center can reduce clinic staff time between 77.4% and 84.7% depending on device type. Absolute time savings range from 32.7 to 82.6 hours per year per 100 patients for therapeutic devices, and 301.3 hours for insertable cardiac monitor (ICM) patients, due to the higher frequency of transmissions in diagnostic devices. Conclusion Time to review remote transmissions can become overwhelming for clinics as growing CIED population often outpaces available staffing resources. Outsourcing initial review and triage to an external monitoring center (ensuring quality and regulatory compliance) can be an efficient option to save dedicated staff and facility time for other crucial healthcare activities. Clinic Staff Time Savings Per YearPacemakerICDCRTICMTRANSMISSIONS PER PATIENT PER YEARGreen (no further review required when outsourcing)3.04.35.020.8Yellow/Red (medical action/decision required)0.60.80.93.8ANNUAL STAFF TIME PER PATIENT, minutesNo outsourcing25.346.658.5219.7Outsourcing to monitoring center5.77.78.938.9ANNUAL STAFF TIME PER 100 PATIENTS, hoursNo outsourcing42.277.697.4366.2Outsourcing to monitoring center9.612.914.964.8TIME SAVED PER 100 PATIENTS, hours (%)32.7 (77.4%)64.7 (83.4%)82.6 (84.7%)301.3 (82.3%)Abstract Figure. Outsourcing Remote Transmission Review

Abstract 287: Vendor-neutral Clinic Management Software Use Is Associated With Time Savings For Remote Monitoring

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Eliana Biundo ◽  
David Lanctin ◽  
Sarah C Rosemas ◽  
Emmanuelle Nicolle ◽  
Alan Burke
Keyword(s):  
Remote Monitoring ◽  
Full Time ◽  
Staff Time ◽  
Cardiac Device ◽  
Review Time ◽  
Management Software ◽  
Clinic Management ◽  
Remote Transmission ◽  
Cardiac Devices ◽  
Time Savings

Background: As cardiac implantable electronic devices (CIEDs) have increased in complexity and sophistication, a transition from in-person follow-up to remote device management has taken place. The amount of information collected via cardiac devices has also increased, making the development of efficient workflows necessary for operational sustainability. Vendor-neutral clinic management software organizes patient, device, and programmer information, and thus has potential to improve remote monitoring workflow and data management. This study sought to examine whether management software use is associated with reduced time to review manage remote transmissions. Methods: A time and motion workflow analysis was performed in 6 U.S. cardiac device clinics, 3 of which use management software (Medtronic Paceart Optima™). Participating sites had an average size of 4,217 (range of 870 to 10,336) CIED patients managed. Each step involved in remote transmission review (including all clinical and administrative tasks, such as chart documentation and billing) was repeatedly timed, for all device models/manufacturers, during one business week (5 days) of observation at each clinic. The time to review an average remote transmission was calculated based on the mean time to perform each step as well as published literature, and stratified by sites with or without management software. Annual staff time required for remote monitoring was modeled by multiplying the average remote transmission review time by the average number of annual transmissions per patient across the 6 sites: 16.1 transmissions/year, representing a weighted average of therapeutic cardiac devices (4.2 transmissions/year) and insertable cardiac monitors (38.9 transmissions/year). Results: A total of 1,290 remote transmission review activities (725 with management software; 565 without management software) were observed and measured during 6 weeks of data collection. On average, the total staff time to review a remote transmission was 2.1 minutes lower at sites with management software (13.6 vs. 11.5 minutes). Extrapolated to the average clinic size of 4,217 patients, this translates into a potential annual time savings of 2,329 hours for sites with management software (13,026 vs. 15,355 hours of total transmission review time). This represents collective time savings across all clinical and administrative staff, and equates to 1.24 annual full-time equivalents (6.9 vs. 8.2 full-time equivalents). Conclusion: Remote monitoring of CIED patients requires significant staff time in cardiac device clinics. Management software is an effective tool in optimizing management of remotely monitored patients, and these benefits may translate into time savings for cardiac device clinics.

Abstract 14046: An International Assessment of the Clinic Staff Time Required to Manage Cardiac Device Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Eliana Biundo ◽  
Juliette Hennion ◽  
Sarah C Rosemas ◽  
David Lanctin ◽  
Emmanuelle Nicolle
Keyword(s):  
Electronic Device ◽  
Standard Of Care ◽  
Clinic Visit ◽  
Staff Time ◽  
Cardiac Device ◽  
Clinic Staff ◽  
Remote Transmission ◽  
Time And Motion ◽  
Time Required

Introduction: Remote monitoring (RM) of cardiac implantable electronic device (CIED) patients is guideline-recommended standard of care alongside in-office follow-up. However, overall workload requirements for device management are not well understood, which may hinder implementation of optimal follow-up strategies including remote solutions. This study sought to characterize processes and clinic staff time required for remote and in-person device follow-up of a CIED patient. Methods: A time and motion workflow evaluation was performed in 11 CIED clinics: 6 US; 5 Europe (UK, France, Germany). Participating clinics manage an average of 5,758 (range: 870-22,000) CIED patients. The duration of each CIED management task was repeatedly timed during 1 business week (5 days) of observation at each clinic. All device models/manufacturers were included. Mean staff time for a remote transmission and an in-person clinic visit were calculated, including clinical and administrative tasks. Annual staff time for follow-up of 1 CIED patient was modeled using data on CIED transmission volume, clinical guidelines, and published literature. Results: A total of 276 in-person clinic visits and 2,173 RM activities were observed. Mean staff time required per remote transmission ranged from 9.4-13.5 minutes for therapeutic devices, and 11.3-12.9 mins for insertable cardiac monitors (ICMs), while staff time per in-person visit ranged from 37.8-51.0 mins and 39.9-45.8 mins, respectively (Table 1). The estimated annual time to manage one therapeutic device patient was lower (1.6-2.4 hours) than an ICM patient (7.7-9.3 hours), due to fewer device follow-ups. Conclusions: RM allows for efficient and continuous care as a complement to in-person follow-up. However, overall CIED patient follow-up requires considerable staff time. These data should be considered in addressing barriers to RM adoption, such as challenges in workflow implementation and inconsistent reimbursement.

scholarly journals Clinic time required to manage cardiac implantable electronic device patients: a time and motion workflow evaluation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Biundo ◽  
A Burke ◽  
S Rosemas ◽  
D Lanctin ◽  
E Nicolle
Keyword(s):  
Remote Monitoring ◽  
Electronic Device ◽  
Future Research ◽  
Funding Source ◽  
Staff Time ◽  
Private Company ◽  
Remote Transmission ◽  
Time And Motion ◽  
Time Required

Abstract Background The population with cardiac implantable electronic devices (CIEDs) is growing, creating workload for device clinics to manage these patients. However, the CIED follow-up workflow is poorly understood. This study sought to characterize the workflow and staff time for CIED patient management. Methods A time and motion workflow evaluation was performed in 6 U.S. CIED clinics, which manage an average of 4,217 patients. Each task involved in CIED management was repeatedly timed, including all manufacturers, during 1 business week at each clinic. Mean staff time for a remote transmission and an in-person visit were calculated, including all clinical and administrative (e.g: scheduling, documentation) activities related to the encounter. Annual staff time for follow-up of 1 patient was modeled using CIED transmission data for the 6 clinics, guidelines for CIED follow-up, and published literature. Results 124 clinic visits and 1,374 remote monitoring activities were observed. Staff time required per remote transmission ranged from 12.1–13.4 minutes (depending on the CIED type), and time per visit was 43.4–51.0 minutes. Including all remote and in-person follow-ups, the estimated total staff time per year to manage one pacemaker, ICD, CRT, and ICM patient was 2.3, 2.4, 2.4, and 9.3 hours, respectively (Table 1). Conclusion CIED clinic workflow is complex and requires significant staff time. Remote monitoring is an efficient complement to in-office visits, allowing for continuous follow-up of patients. Future research should examine heterogeneity in clinic processes to identify the most efficient workflow. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic

Abstract 286: Clinic Time Required To Manage Cardiac Implantable Electronic Device Patients: A Time And Motion Workflow Evaluation

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Eliana Biundo ◽  
Alan Burke ◽  
Sarah C Rosemas ◽  
David Lanctin ◽  
Emmanuelle Nicolle
Keyword(s):  
Remote Monitoring ◽  
Patient Management ◽  
Electronic Device ◽  
Future Research ◽  
Staff Time ◽  
Remote Transmission ◽  
Time And Motion ◽  
Number Of Patients ◽  
Time Required

Background: The number of patients with cardiac implantable electronic devices (CIEDs) is growing, creating workload for device clinics to manage this population. Remote monitoring of CIED patients is a guidelines-recommended method for optimizing treatment in CIED patients in combination with in-person follow-up. However, the specific steps involved in CIED management, as well as the HCP time required for these activities, are not well understood. The aim of this study was to quantify the clinic staff time requirements associated with the remote and in-person management of CIED patients. Methods: A time and motion workflow evaluation was performed in 6 U.S. CIED clinics. Participating clinics manage an average of 4,217 (range: 870-10,336) CIED patients. The duration of each task involved in CIED management was repeatedly timed, for all device models/manufacturers, during one business week (5 days) of observation at each clinic. Mean time for review of a remote transmission and for an in-person clinic visit were calculated, including all clinical and administrative (e.g., scheduling, documentation) activities related to the encounter. Annual staff time (inclusive of all clinical and administrative staff) for follow-up of 1 CIED patient was modeled using device transmission data for the 6 clinics, clinical guidelines for CIED follow-up, and published literature (Table 1). Results: During 6 total weeks of data collection, 124 in-person clinic visits and 1,374 remote transmission review activities were observed and measured. On average, the total staff time required per remote transmission ranged from 11.9-13.5 minutes (depending on the CIED type), and time per in-person visit ranged from 43.4-51.0 minutes. Including all remote and in-person follow-ups, the estimated total staff time per year to manage one Pacemaker, ICD, CRT, and ICM patient was 2.3, 2.4, 2.4, and 9.3 hours, respectively. Conclusion: CIED patient management workflow is complex and requires significant staff time in cardiac device clinics. Remote monitoring is an efficient complement for in-office visits, allowing for continuous follow-up of patients with reduced staff time required per device check. Future research should examine heterogeneity in patient management processes to identify the most efficient workflow.

scholarly journals A Remote Monitoring System of Logistics Carrier Based on Wireless Sensor Network

2018 ◽  
Vol 14 (01) ◽  
pp. 4
Author(s):  
Wang Weidong
Keyword(s):  
Wireless Sensor Network ◽  
Real Time ◽  
Sensor Network ◽  
Monitoring System ◽  
Remote Monitoring ◽  
Monitoring Network ◽  
Sensor Nodes ◽  
Wireless Sensor ◽  
Remote Monitoring System ◽  
Monitoring Center

To improve the efficiency of the remote monitoring system for logistics transportation, we proposed a remote monitoring system based on wireless sensor network and GPRS communication. The system can collect information from the wireless sensor network and transmit the information to the ZigBee interpreter. The monitoring system mainly includes the following parts: Car terminal, GPRS transmission network and monitoring center. Car terminal mainly consists by the Zigbee microcontroller and peripherals, wireless sensor nodes, RFID reader, GPRS wireless communication module composed of a micro-wireless monitoring network. The information collected by the sensor communicates through the GPRS and the monitoring center on the network coordinator, sends the collected information to the monitoring center, and the monitoring center realizes the information of the logistics vehicle in real time. The system has high applicability, meets the design requirements in the real-time acquisition and information transmission of the information of the logistics transport vehicles and goods, and realizes the function of remote monitoring.

Clinic Time Required for Remote and In-person Management of Cardiac Device Patients: A Time and Motion Workflow Evaluation (Preprint)

2021 ◽  
Author(s):  
David Lanctin ◽  
Eliana Biundo ◽  
Marco Di Bacco ◽  
Sarah Rosemas ◽  
Emmanuelle Nicolle ◽  
...  
Keyword(s):  
Patient Management ◽  
Clinic Visit ◽  
Future Research ◽  
Staff Time ◽  
Cardiac Device ◽  
Cardiac Implantable Electronic Devices ◽  
Time And Motion ◽  
Number Of Patients ◽  
Time Requirements ◽  
Time Required

BACKGROUND The number of patients with cardiac implantable electronic devices (CIEDs) is growing, creating substantial workload for device clinics. OBJECTIVE This study aimed to characterize the workflow and quantify clinic staff time requirements to manage CIED patients. METHODS A time and motion workflow evaluation was performed in 11 US and European CIED clinics. Workflow tasks were repeatedly timed during one business week of observation at each clinic. Observations were inclusive of all device models/manufacturers present. Mean cumulative staff time required to review a Remote device transmission and for an In-person clinic visit were calculated, including all necessary clinical and administrative tasks. Annual staff time for follow-up of 1 CIED patient was modeled using CIED transmission volumes, clinical guidelines, and published literature. RESULTS A total of 276 in-person clinic visits and 2,173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4-13.5 minutes for therapeutic devices (pacemaker, ICD, CRT) and 11.3-12.9 mins for diagnostic devices (insertable cardiac monitors (ICMs)). Mean staff time per in-person visit ranged from 37.8-51.0 mins and 39.9-45.8 mins, for therapeutic devices and ICMs respectively. Including all remote and in-person follow-ups, the estimated annual time to manage one CIED patient ranged from 1.6-2.4 hours for therapeutic devices and 7.7-9.3 hours for ICMs. CONCLUSIONS CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs implementation of efficiency improvements, including remote solutions. Future research should examine the heterogeneity in patient management processes to identify the most efficient workflows.

scholarly journals Deploying a new realtime XRootD-v5 based monitoring framework for GridPP

2021 ◽  
Vol 251 ◽  
pp. 02052
Author(s):  
Robert Currie ◽  
Wenlong Yuan
Keyword(s):  
Remote Monitoring ◽  
Storage Systems ◽  
Remote Site ◽  
Site Administrators ◽  
Distributed Caching ◽  
Monitoring Framework ◽  
The Uk ◽  
A Site ◽  
Monitoring Service ◽  
New Framework

To optimise the performance of distributed compute, smaller lightweight storage caches are needed which integrate with existing grid computing workflows. A good solution to provide lightweight storage caches is to use an XRootD-proxy cache. To support distributed lightweight XRootD proxy services across GridPP we have developed a centralised monitoring framework. With the v5 release of XRootD it is possible to build a monitoring framework which collects distributed caching metadata broadcast from multiple sites. To provide the best support for these distributed caches we have built a centralised monitoring service for XRootD storage instances within GridPP. This monitoring solution is built upon experiences presented by CMS in setting up a similar service as part of their AAA system. This new framework is designed to provide remote monitoring of the behaviour, performance, and reliability of distributed XRootD services across the UK. Effort has been made to simplify ease of deployment by remote site administrators. The result of this work is an interactive dashboard system which enables administrators to access real-time metrics on the performance of their lightweight storage systems. This monitoring framework is intended to supplement existing functionality and availability testing metrics by providing detailed information and logging from a site perspective.

scholarly journals Prospects for Blood Pressure Remote Monitoring in Hypertensive Patients in the Ryazan Region

2020 ◽  
Vol 15 (6) ◽  
pp. 795-801
Author(s):  
N. V. Aksenova ◽  
A. A. Nizov ◽  
O. N. Selyavina ◽  
E. I. Suchkova ◽  
E. V. Filippov
Keyword(s):  
Blood Pressure ◽  
Remote Monitoring ◽  
Medical Professional ◽  
Automatic Data ◽  
Hardware Complex ◽  
Software And Hardware ◽  
Monitoring Center ◽  
Clinically Significant ◽  
High Level ◽  
Attending Physician

Aim. To study the effectiveness and benefits of blood pressure (BP) remote monitoring in outpatients with hypertension.Material and methods. The study included 100 patients with a verified diagnosis of hypertension, who didn’t achieve target BP pressure levels. The patients measured their BP twice a day over 6 months with facilities with automatic data transmission over GSM-channel to a remote monitoring center. BP parameters were being transmitted online to the remote monitoring center, where they were being processed and transferred to the personal account planner (created by the Web interface based on the software and hardware complex) of the attending physician and operator of the remote monitoring center. It is important that doctor received information only on clinically significant measurement results, based on which he determined the urgency of contact with the patient and the further tactics of his management.Results. No malfunctions in the work of communication facilities, technical failures in the software and hardware complex were registered over the entire period of the study. After 6 months of the monitoring it was possible to achieve target BP levels less than 135/85 mm Hg in 70% of patients. The proportion of patients with a high level of normal BP increased from 10% to 19%, while the proportion of patients with grade 1 and 2 of hypertension decreased significantly (from 33% to 7% and from 54% to 3%, respectively). At the beginning of telemedicine monitoring 3% of patients had stage 3 of hypertension, at the end of the study – 1%.Conclusion. The technology of telemedicine monitoring has shown itself as a simple, affordable and reliable way of management of outpatients with hypertension in conditions of real clinical practice. It was possible to achieve BP levels less than 135/85 mm Hg in 70% of patients by the method of remote outpatient monitoring. BP remote monitoring changed fundamentally the decision-making strategy of the patients management: it was not the patient who independently determined the need for consultation with a medical professional, but the attending physician made a decision on the method and urgency of contact with the patient on the basis of the data of objective monitoring indicators.

scholarly journals P227 Remote monitoring of patients with RA: a user-centred design approach

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Melanie J Martin ◽  
Nora Ng ◽  
Laura Blackler ◽  
Toby Garrood
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Remote Monitoring ◽  
Design Approach ◽  
Free Text ◽  
Remote Consultation ◽  
Low Disease Activity ◽  
Disease Flare ◽  
User Centred Design ◽  
Monitoring Service

Abstract Background Patients with rheumatoid arthritis are generally seen at arbitrary intervals in secondary care. Patients with active disease may not always be seen at the most appropriate time and those with low disease activity may be seen more frequently than necessary. The NHS Long Term Plan expects outpatient appointments to be reduced by up to a third, with digital transformation a key enabler. The remote capture of patient-reported outcome measures (PROMs) has the potential to facilitate more flexible and responsive outpatient services. Methods This project aimed to design a digital remote monitoring platform to test the hypothesis that PROMs can be used to proactively monitor and trigger consultations when patients need them most. The Rheumatoid Arthritis Impact of Disease (RAID) questionnaire, a validated multidimensional PROM, was used. Waiting room testing with patients informed the design of an acceptable mobile device format of the RAID. Recruitment criteria and acceptable cut-offs for defining flare were agreed by the rheumatology multidisciplinary team. Patients in low disease activity or remission (DAS <3.2) were invited to the service via SMS. All patients were informed regarding the governance of handling patient data and an opt-out option was offered. Patients were sent an automated monthly SMS with a PROM link and weekly reminder SMS if required. They also had the option to send in SMS messages at other times or add free text comments. Patients submitting a RAID score of ≥ 4 received a SMS with a link to the rheumatology advice service advising a remote consultation. The SMS-based service went live in January 2019 and all incoming communication was monitored on a daily basis. Results 104 RA patients are currently using the remote monitoring service with 10.3% (13/117) opting-out. 847 monthly PROMs have been sent via SMS. The PROM completion rate has been 68.9% (range 59.0-85.1%). 120 RAID (21.8%) scored 2-≤4 indicating low disease activity and 136 RAID (24.7%) ≤ 2 indicating disease remission. 480 SMS have been sent manually to patients who have engaged in two-way communication or returned a RAID score ≥4. 44 telephone advice appointments were triggered through the remote monitoring service by patients in disease flare. 80% (35/44) of remote consultation were considered to have to have averted a face to face consultation with the remaining 20% providing advice alone. Interviews have been conducted with PROM ‘non-completers’ to learn and inform further service design. Conclusion This project has demonstrated how a user-centred design approach to utilising technology can support access to rheumatology care when patients need it most, such as disease flare. The identification of patients self-reporting low disease activity using multidimensional PROMs may enable more efficient utilisation of clinical capacity through patient-initiated appointment deferment and lead to improved patient-centred care. Disclosures M.J. Martin: Honoraria; Novartis, Abbvie. Grants/research support; National Ankylosing Spondylitis Society. N. Ng None. L. Blackler None. T. Garrood None.

Design and Implementation of Multi-Master GPRS Transparent Transmission Module

2015 ◽  
Vol 713-715 ◽  
pp. 1317-1321
Author(s):  
Fu Dong Wang ◽  
Zhong Feng Wang ◽  
Ji Bin Fan ◽  
Jian Long Huang ◽  
Li Gang Li
Keyword(s):  
Monitoring System ◽  
Experimental Verification ◽  
Remote Monitoring ◽  
Remote Monitoring System ◽  
Remote Transmission ◽  
Design And Implementation ◽  
The Stability

GPRS data transparent transmission modules are increasingly applied in different remote transmission occasions. With the development of remote monitoring system, there are some deficiencies need to be improved. This paper realizes a design of GPRS transparent transmission modules with multi-master communications function, the module integrates RS232 interface and supports UDP protocol. After experimental verification, the stability and practicability of the design is superior.

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