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Bringing Cardio Device Data Out of the Cloud and Putting It in Physicians’ Hands

8 Oct 2014 by Stephen Siciliano

Reducing emergency room wait times for cardiac patients with pacemakers or implantable devices can be achieved through technology that brings data down “out of the cloud” and into the hands of emergency room physicians.

That’s what a recent pilot study at University of California San Diego (UCSD) confirmed when the application of a “cardiac device data management suite” yielded a reduction in average emergency room wait times.

The past two decades have seen a significant increase in the number of patients with pacemakers or implantable cardiovascular/defibrillator devices (PM/ICD). These patients often endure prolonged lengths of stay due, in part, to the time it takes device manufacturer sales representatives to be contacted and arrive at emergency rooms.

UCSD researchers James Killeen, Jesse Brennan, Gary Vilke and Ted Chan set out to assess the effect of real-time PM/ICD “interrogation” by emergency department staff on wait time for patients with the devices.

The before/after study compared interrogation times done by device company reps with those clocked by emergency department staff using what the researchers called an, “innovative cart containing interrogation devices from four major PM/ICD manufacturers” for their patients.

The researchers’ suppositions proved correct, as the in-house interrogations reduced average wait times by 92 minutes at UCSD Medical Center’s Hillcrest and Thornton emergency departments.

“Using Geneva Healthcare’s technology platform, we have been able to quickly train our emergency department staff on how to collect information about a patient’s device regardless of the device manufacturer or type of device,” said Dr. Theodore Chan, UCSD chair of emergency medicine. “We do not have to rely on each manufacturer’s device representative or on different proprietary reporting systems.”

“We’re the first ones to really demonstrate how medical device interoperability saves healthcare dollars,” said Dr. Gilanthony Ungab, Geneva Healthcare’s chief medical officer.

Ungab, a cardiologist specializing in arrhythmia cases with pacemakers and defibrillators, said he and another Geneva co-founder started looking at data from devices and trying to improve overall care by making that information accessible and useful to emergency room physicians.

“We started a data analytics company based on the fact that, as healthcare reform is evolving, we need to leverage technology and data to improve the quality of care,” explained Ungab. “We wanted a company that would be a platform to enable device data to be actionable and accessible to physicians to make their lives a little bit easier in managing patients.”

He explained how the four major pacemaker companies (Medtronics, Boston Scientific, Biotronics and St. Jude’s) have traditionally given patients home-use monitors that collected data and stored it in the cloud.

“Somehow, down the line, that information would be accessible to clinicians for use in treating patients,” continued Ungab. “But we found that, while the data is very valuable, the cloud itself was an obstacle to access.”

Geneva convinced the device manufacturers to let it take collected data and unify it under one dashboard display that caregivers could access without going to the cloud.

“With almost three million patients out there with devices, and a sales force that has to run to every ER visit, patients can wait two to six hours for a sales rep to come in,” said Ungab.

Geneva’s suite represents a clinical decision support tool that takes traditionally complex data generated by cardiac devices and places them on a simple, color-coded dashboard (red for problem, green for everything is fine) that any member of a patient’s care team can read.

This eliminates the middle man — the company rep — and lightens the cost-of-service burden for the device manufacturers.

“Now, a patient can come into emergency room triage and the nurse can ask ‘Why are you here?’ and the patient can say, ‘I’m feeling dizzy.’ The nurse asks if they have a device and, if so, that leads to an interrogation of that device. From there, an EKG tech can pull that information so that we can determine whether a patient needs immediate care or can wait.”

In the health care reform universe where everybody ostensibly has insurance, emergency rooms will be packed, and the ability to screen information from a device and prioritize the cases on hand will prove a boon, according to Ungab.

“It’s a different approach to patient population management than how we do it today, which is mostly taking billing records and seeing how well the patient is being managed retroactively,” he explained. “We’re taking real physiologic data from someone’s device inside their body and then making it actionable within minutes to determine who is the sickest and who needs treatment right away.”

Ungab is of the opinion that this will result in a huge impact on healthcare quality and cost. In the end, he noted, someone waiting on a sales rep to come and decipher his or her device is taking up a bed that could be open for another.

“If you’re the person who is having a heart attack and that hospital’s full, they have to drive you further distance to find you that bed,” he said.

The study was published in “Academic Emergency Medicine Journal.”