This is a presentation from 2011 highlighting the possibilities of IT in private cardiology practice. It is of historical value but touches on early fundamental concepts of digitalization of a private practice in the field of cardiology.
The Electronic Health Record:Using It Effectively & with Meaning
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IT in Private Cardiology Practice, 2011
1. The Role of Advanced Technology In the Office-
Based Medical Practice (Or Practical IT: IT in
Practice)
David Lee Scher, MD, FACP, FACC, FESC, FHRS
Twitter: @dlschermd
dlschermd@gmail.com
May, 2011
2. “The most valuable commodity
that I know of is information”.
-Gordon Gekko
7. The Benefits Of Health Information Technology: A
Review Of The Recent Literature Shows Predominantly
Positive Results
Health Aff March 2011 30:3464-471
• Meta analysis July 2007-Feb
2010
• 278 outcome measures were
evaluated across all studies
included in final sample.
• 62% found positive results.
• 30% found mixed,
predominantly positive results.
• 8% found negative or mixed, but
predominantly negative results
Health Aff March 2011 30:3464-471
8. EHRs
• The Health Information Technology for
Economic and Clinical Health Act (HITECH)
• The Electronic Health Record (EHR) is a longitudinal
electronic record of patient health information
generated by one or more encounters in any care
delivery setting.
– Important: EHR is not EMR: an EHR is an EMR with
interoperability (i.e. integration to other providers’
systems).
9. HIT and Government :ONC Releases Five Year
Strategic Plan
1.Achieve adoption and
information exchange through
Meaningful Use of health IT.
2.Improve care, improve
population health, and reduce
health care costs.
3.Inspire confidence and trust in
health IT (Privacy /Security).
4.Empower individuals with health
IT (PHR).
5.Achieve rapid learning and
technological advancement.
10. What Electronic Healthcare Records
Do and Don’t Do
International Healthcare Technology News:
Healthcare IT and Technology News Blog
FRIDAY, 22 JULY 2011 20:56
David Lee Scher, MD, FACP, FACC, FESC, FHRS
http://healthcaretechnologymagazine.com/blogs
11. Ten Ways Healthcare Providers Can
Get the Most out of EHRs
Theehrproject.com
14. The Ideal Office IT Network
• Inexpensive.
• Shallow learning curve.
• No dedicated personnel required, easy maintenance.
• Eternally guaranteed and secure.
• Includes medical records, office clinical and
administrative operations, and communication network.
• Interacts seamlessly with hospital, government agencies,
outside labs, referral physician EMRs, and device
company remote monitoring systems.
• Mhealth accessible (mobile communications).
15. Clinical Benefits of an IT Network
– Facilitates better patient coordination/management
among office staff and providers.
– Easier access to health information exchanges (HIEs).
– Facilitates clinical research (patient recruitment,
follow-up, outcomes).
– Better and more efficient implantable device follow-up/
management.
– Working data base (able to be mined).
19. Arrhythmia Monitoring: Clinical Implications
• Ventricular arrhythmias
– Reprogramming of ICD
– Therapeutic changes
• Electrolyte monitoring
• Adjuvant AA drug therapy/ablation
• Atrial arrhythmias
– Anticoagulation?
– AA drug therapy
– Ablation
20. Advantages of Remote F/U
Safety alert notification
Arrhythmia detection
Integration with electronic health records
Cost savings
Secondary utilization of data
21. Patient Follow-Up Compliance
• Randomization gp 3mo 6mo 9mo 12mo
• Remote (%) 88 90 88 84
• Conventional F/U(%) 91 78 73 65
TRUST Study: Varma N, et al. AHA 2008
22. The Clinical Evaluation of Remote NotificatioN to
REduCe Time to Clinical Decision (CONNECT)
Trial: The Value of Remote Monitoring
Crossley G, Boyle A, et al Am Heart J 2008:156;840-6
23. Time from Event to Decision by Alert Type
(median days)
Device Event
No. of Events
(No. of Patients)
No. of Days from Event
Onset To Clinical Decision
Median (Interquartile
Range)
Remote In-office Remote In-office
AT/AF burden at least 12 hrs 437 (107) 280 (105) 3 (1, 15) 24 (7, 57)
Fast V rate at least 120 bpm
41 (26) 47 (37) 4 (2, 13) 23 (5, 40)
during at least 6 hrs AT/AF
At least 2 shocks delivered in
an episode
44 (35) 32 (23) 0 (0, 1.5) 0 (0, 2)
Lead impedances out of range 26 (18) 12 (6) 0 (0, 9) 17 (5.5, 45)
All therapies in a zone
16 (12) 11 (6) 0 (0, 1) 9 (0, 36)
exhausted for an episode
VF detection/therapy off 10 (10) 8 (8) 0 (0, 0) 0 (0, 84)
Low battery 1 (1) 1 (1) 30 0
Total 575 (172) 391 (145) 3 (0, 13) 20 (4, 52)
27. Randomized Multicenter Comparison of Home
Monitoring vs Regular F/U in MADIT II Pts
• 115 pts, 110 single chamber, 5 dual chamber ICDS
• Randomized after 3 months to 1 office f/u with HM
or Q 3 month office f/u with HM
• Endpoints:
– primary-number of unplanned visits
– Secondary- total costs, QOL, total mortality
Elsner CH et al. Proceedings Computers Cardiology 2006;33:241-244
28. Randomized Multicenter Comparison of Home
Monitoring vs Regular F/U in MADIT II Pts:
Results
• Mean F/U time 117 days (23-513)
• No significant difference in hospitalization or
mortality rates.
33. Economic Advantages of Remote
Monitoring
• Provider:
– Reduced office utilization
– Increased Reimbursement
• Patient: Reduce patient visits
– Travel costs
– Eliminates of patient loss of work costs
• CRM Company:
– Personnel for office follow-ups and troubleshooting
34. The Ideal Patient for Remote Monitoring
• Single chamber ICD for primary prevention.
• NO ICD shocks or arrhythmias first three months
post implant.
• Rare or controlled atrial fibrillation.
• Clinically stable CHF and coronary artery disease.
35. In Office Follow-up
• Frequent nonsustained VT.
• AF with many high ventricular rate episodes.
• Unstable or changing impedances and/or
thresholds.
• CHF with associated arrhythmias.
• Multiple ICD shocks or inappropriate shock.
• After changes in AA drugs.
36. Interoperability of Remote Monitoring
Data With EMRs
• A natural progression of technology.
• Both shown to increase efficiency, eliminate paper,
improve patient management, and outcomes.
• “Obstacles”:
Cost to companies:
• A: Cost of doing business, both standard of care in
2010.
Proprietary nomenclature
• A: Most device features now equivalent, addressed by
IDCO (Implantable Device-Cardiac Observation)
“Not enough demand from customers”
37. Ideal IT Cardiac Implantable Electronic Device
Management
• Incorporates remote monitoring data and in-office
data.
• Easily viewed settings, arrhythmias, and therapies
delivered.
• Clinical and device data on same screen.
42. SUMMARY
• EHRs are the hub of office IT.
– May incorporate EHR, practice management tools.
• Remote monitoring of CRM devices is economically
and clinically beneficial.
• Interoperability of CRM devices and EHRs still
challenged but will happen seamlessly.
• Get with both programs: they’re here to stay and are
standards of care!
43. “If you ask me a question I don’t know,
I’m not going to answer”
------Yogi Berra