Remote Monitoring of Implanted Cardiac Devices by linxiaoqin

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									  Remote Monitoring of
Implanted Cardiac Devices

             By
      Susan Leraris, RN
           Learning Objectives
   Define remote monitoring of implanted
    electronic cardiac devices (IECDs)
   Identify the patient and clinic hardware
   Describe software platform
   Describe the role of RN in remote device clinic
   Identify legal/ethical issues with remote
    monitoring
   Describe advantages/disadvantages with remote
    monitoring
        Current Device Monitoring
   Transtelephonic monitoring (TTM)
       Performed in patient’s home at scheduled
        intervals
       Provides device battery status
   In person interrogations
       Performed in clinic setting
       Provides detailed device and patient
        information

                                           (Chen 2008)
       Remote IECD Monitoring

   Performed hands-free from patient’s home
    or other remote location (“How the
    Latitude” 2010)
   Transmitted via the internet to the device
    clinic
   Provides the same detailed information as
    an in person interrogation (Chen,et al.,
    2008)
                          Hardware

   Patient
       Implanted                     Radiofrequency
        pacemaker/defibrillator      communicator




        (St. Jude Medical, 2010)     (Medtronic, 2010)
                    Hardware

   Healthcare Provider
       Personal computer or hand held device with
        internet access
       Trained medical staff



                                 (Boston Scientific
                                 Corporation, 2010)
      Wireless Communicator


                           Medtronic®
   Standard phone line and power outlet
        Cellular accessory available from
         Medtronic®
   Radiofrequency technology
   Hands-free data transmission to a secure
    server
                       Software

   Copyrighted by each device manufacturer
       Medtronic® - Carelink Network TM
       Boston Scientific® - Latitude Patient
        Management system TM
       St. Jude Medical® - Merlin.net TM
                              (Burri, H., & Senouf, D., 2009)
               Software Application

   Diagnostic reports on device status
       Battery status
       Lead integrity
   Diagnostic reports on patient health
       Heart rate histograms
       Atrial fibrillation burden
                 Usability

   Manufacturer specific software

   Designed with clinicians

   Software upgrades
             Information System

   Clinical information system
       Collect device data
       Stores device information
       Transfers device information to the clinician
       Scheduling
   Communication system
       Device and patient alerts
       Missed transmission notification
       Patient initiated transmissions
        Review of Information System
   Clinical informtion system
       Patient care information system
   Physicians, Nurses and clinical staff
   Functions
       Device information
       Health management
       Scheduling
                                (How   Latitude, 2010)
    Review of Information System
   Configuration
       IECD – microprocessor
       Web based secure server
   HL7 and HIPAA standards
   ICD-9 (International Classification of
    Diseases 9th) codes for billing remote IECD
    follow up
   Advocate the use of this technology
                Advantages

   Timely device and patient status
    information

   Increased patient follow up compliance

   Decreased cost to the health care system
              Disadvantages


   Less face to face with the patient

   Patient problems/fears implementing
    technology
            Ethical/Legal Issues

   Malicious attacks to radiofrequency IECD

   Information available 24/7/365
       Whose responsible and when
      Informatics Competencies

   Computer literacy



   IECD device literacy
    Functions and Responsibilities

   Accessing device information on line

   Evaluation and triage of information

   Dissemination of information

   Scheduling routine follow up
                     Summary
   Remote IECD follow up
       At home monitor
       Internet platform
   RN staffed clinic
   Legal issues to resolve
   Ethical/safety issues to resolve
   Advantages/disadvantages
                   References

Boston Scientific. (2010). Boston Scientific announces FDA
   approval for LATITUDE® patient management system
   software upgrade. Retrieved from http://bostonscientific.
   mediaroom.com/index.php?s=43&item=919


Boston Scientific. (2010). EMR integration. Retrieved
   July 7, 2010 from http://www.aboutlatitude.com/how-
   latitude-works/emr-intergration.html


Boston Scientific. (2010). How latitude works. Retrieved
   June 6, 2010 from http://www.aboutlatitude.com/how-
   latitude-works/patient-management.html
                   References
Burri, H., & Senour, D. (2009) Remote monitoring and
   follow-up of pacemakers and implantable cardioverter
   defibrillators. Europace, 11(6), 701-709. Retrieved from
   http://www.mcbi.nlm.nih.gov/pmc/articles/PMC2686319/

Centers for Medicare & Medicaid Services. (2010).
   Physician fee schedule. Retrieved July 27,2010 from
   http://www.cms.gov/pfslookup/02_PFSsearch.asp
                     References

Chen, J., Wilkoff, B., Choucair, W., Cohen, T., Crossley, G.,
   Johnson, W., Mongeon, L., Serwer, G., Sherfesee, L.
   (2008). Design of the Pacemaker REmote Follow-up
   and Evaluation and Review (PREFER) trial to assess the
   clinical value of the remote pacemaker interrogation
   management of pacemaker patients. Trials. 9(18).
   doi:10.1186/1745-6215-9-18
                     References
Halperin, D., Heydt-Benjamin, T., Ransford, B., Clark, S.,
   Defend, B., Morgan, W., Fu, K., Kohno, T., Maisel, W.
   (2008). Pacemakers and implantable cardiac
   defibrillators: Software radio attacks and zero-power
   defenses. Retrieved July 10, 2010 from
   http://www.secure-medicine.org/icd-study.pdf

Joglar, J. (2010). Remote monitoring of cardiovascular
   implantable electronic devices: New questions raised.
   Pacing and Clinical Electrophysiology, 32(12):1489-1491
   Retrieved from http://www.medscape.com/view/article/
   715215
                      References
Jung, W., Rillig, A., Giremeyer, R., Miljak, T., Meyerfeldt, U.
   (2008). Advances in remote monitoring of implantable
   pacemakers, cardioverter defibrillators and cardiac
   resynchronization therapy systems. Journal of
   Interventional Cardiac Electrophysiology. 23:73-85.
   doi:10.1007/s10810-008-9311-5

Medtronic. (2010). 2010 CPT codes for cardiac device
  monitoring. Retrieved from http://www.Medtronic.com/
  wcm/groups/mdtcom_sg/@mdt/@crdm/documents/
  documents/2010cpt-codes.pdf
                      References
Medtronic. (2010). Metronic CareLink® remote monitor.
  Image retrieved June 27, 2010 from
  wwwp.medtronic.com/mdtConnectPortal/photoalbum/150


Medtronic. (2005). Medtronic CareLink® network reaches
   significant patient milestones: First internet-based
   system to better manage chronic cardiovascular disease
   patients with implanted devices enrolls 50,000 patients
   in just three years. (November 14, 2005). Retrieved from
   http://www.thefreelibrary.com/Medtronic+CareLink%28
   R%29+Network+Reaches+Significant+Patient+
   Milestones%3B…-a0138650312
                   References
Medtronic. (2010). Medtonic launches new cellular
   accessory for the Medtronic CareLink® Network.
   (May 10,2010). Retrieved June 27, 2010 from
   http://wwwp.medtronic.com/Newsroom/NewsRelease
   Details.do?itemId-1273496329472&format&=printlang
   =eng_US
                    References
Medtronic (n.d.). Facilitating information flow through
   multiple offices. Clinic case study: Iowa Heart Center
   Des Moines, Iowa. Retrieved July 17, 2010 from
   http://www.medtronic.com/wcm/groups/mdtcom_sg/@
   met/@crdm/documents/documents/iowaheartstudy_rev
   ised.pdf
                     References
St. Jude Medical. (2010). Image retrieved June27, 2010 from
    http://www.sjmprofessional.com/Products/US/Pacing-
    systems/Accent-Pacemaker.aspx

								
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