Optimizing Interoperability Between Cardiac Monitoring and Information Technology

LIfeWatch Services, a leading U.S. provider of cardiac telemetry monitoring, and Perminova, a developer of web-based information systems for cardiology centers, created a strategic alliance with the goal of expanding interoperability between diagnostic monitoring devices and cardiac EP information technology. This collaboration successfully integrated LifeWatch’s monitoring results directly into Perminova’s cloud-based system. In this interview, we speak with Gregory K. Feld, MD, Director of the Cardiac Electrophysiology Program, and Stephanie Empizo, Cardiac Technician, about the ease and efficiency of ordering LifeWatch monitoring for their patients through the Perminova EMR at the UC San Diego Sulpizio Family Cardiovascular Center.. 

What is the size of your EP lab facility and number of staff members at UCSD? 

Feld: Since the last time our EP program was highlighted in EP Lab Digest^® a few years ago, we have now moved everything from the downtown Hillcrest Hospital to the new UC San Diego Sulpizio Family Cardiovascular Center and UCSD Thornton Hospital, where we have remodeled an old lab into a brand-new EP lab with all of the latest up-to-date equipment. Next to this is an older lab that we are still using, and we also have a brand-new hybrid operating room where we do more complex procedures such as surgical AF ablations and lead extractions. We occasionally use one of our four new cath labs for some of our pacemaker implants. I also recently added two new EP faculty members, so we now have a total of four at UCSD. We also have a cardiac surgeon, about a dozen nurses and technicians that work in the lab (some full time and some per diem), two nurse practitioners, two full-time secretaries, and a research coordinator. We are also going to be hiring a nurse practitioner to help us establish the full independent pacemaker clinic.

Empizo: There are two Heart Stations here — one in Hillcrest and one in La Jolla. We do echocardiograms, Holter monitoring, and event monitoring in the departments at both stations. 

Feld: We order and read significant numbers of outpatient cardiac telemetry and Holter results from these two locations.

How long has your EP program at UCSD been using Perminova and LifeWatch for integration of medical device monitoring and information technology?  

Feld: After founding Perminova about five years ago, it has gone from a research database to a full system, including scheduling and interprocedural documentation, all of the supply documentation and professional billing, to a final operating report from that system. About a year ago we started the interface with LifeWatch, so now we have a two-way feed with their ordering and reporting systems. The Perminova EMR sends LifeWatch all the elements that they need for every patient service that we order. We get a feed from the hospital of all the patient demographic and insurance information, and then using an order form in Perminova, the Heart Station staff can fill out their monitor requests, including durations, start dates, etc. Once they hit the “order” button, it sends the order directly to LifeWatch electronically. They send out the requested device, the patient wears the monitor, and all of the EKG strips get sent back to our EMR so we can look up the data. The goal was to have the capability to look at one main site and have all the patient’s data, from the patient’s diagnostic and ablation procedures to device implants to the total number of cardioversions, as well as needed treatments and long-term follow-up. The system could also be standalone if an existing hospital EMR wasn’t available. 

Where do you see EHR systems providing the greatest benefit to cardiac care?  

Feld: Nowadays the use of EMR becomes routine, and you don’t realize how rapidly you are making decisions on patients and their management with an EMR, which you could never do before. Therefore, I think that efficiency, which then translates to better care as well as cost effectiveness, is all impacted by that availability. EMR has clearly impacted patient healthcare. I was just thinking about it this morning in my office, which is remote from the hospital. I was working on a book chapter that I’m overdue on, and during this time I kept getting calls and questions from my nurse practitioners and other staff about various patients. I logged into the EMR and was able to pull up data on these patients including their last progress note, their last EP procedure, device implantation, etc., and I was thinking that in years past, I would have had to tell my staff that in order to review the chart, someone was going to first have to pull the medical records, get the charts sent over, and that could take several days. 

Tell us about how the data integration process works and how reports from LifeWatch’s cardiac telemetry handled through Perminova? 

Feld: Most of it is done automatically with an HL7 interface between Perminova and the LifeWatch Connect system. I can log on to Perminova, search for a patient, and under their name, I’ll see a listing for LifeWatch monitoring reports. When you click on that, it opens up all of the daily reports that have been received for that patient. At the present time they send PDFs each day, so you can either look at it that way or you can click on a button that allows you to view it all on a single report. They send this information directly to us on any patients for which we have ordered a monitor. 

Empizo: I just wanted to add that I’ve noticed a difference from when we submit an order through the LifeWatch website — it just seems to be a lot more time efficient for me. They have been really good about handling what we have requested and the changes that we have needed to minimize the turnaround time for getting the patients monitored. 

Feld: In addition, doing this online rather than filling out a paper form saves hours and potentially several days of getting things ordered.  

What advantages are there for EP programs to have interoperability between their IT systems and cardiac monitoring services?

Feld: I can give you very clear examples on that. Let me preface this by saying that having been in EP for 25 years now, it is frustrating that although we have such advanced technologies today, they’re all so isolated from one another. It is advantageous for EP programs to have this interoperability with various systems in order to start integrating this massive amount of data to manage patients. We can take PDFs and images, and generate a consolidated report for EP. 

With the integrated LifeWatch/Perminova system, when we sign the report electronically, it will automatically be sent to the referring physician’s name and fax number. Therefore, all the monitoring and follow-up are done, and it is in the system. The goal would be for us to integrate a variety of high-level technological information into a single site so that the advantage to programs around the country would be enhanced efficiency. 

I think that having EMRs and systems like ours allows programs to become much more efficient from the standpoint of revenue generation and billing. In addition, we’re able to track turnover times using a built-in system. So by improving throughput and efficiency at multiple levels with this type of a system, perhaps instead of doing two cases, you could do three.   

In what ways does interoperability help your staff to improve patient care?

Feld: Along those same lines, with all this up-to-date information available from various systems, whether it is recent device interrogations or LifeWatch data, staff can make much more appropriate and timely decisions, which will also help reduce costs associated with patient care. Having the ability to get information from different sources into one system is going to help physicians take care of these patients a lot more efficiently and effectively.  

Describe your experience in working with vendors and support teams to achieve your current solution.

Feld: We’ve worked with other vendors as well, and it varies. However, LifeWatch is extremely helpful and we’ve worked together really well to get their monitoring reports and ordering integrated with our system. 

How does a richer set of diagnostic results in your EHR help with patient care?

Feld: I received an email this morning from a cardiologist colleague who was interested in a specific monitoring report. The patient had had numerous episodes of bradycardia, which I noted in the report findings along with the minimum rate. However, the cardiologist wanted more information, such as if the episodes lasted all night or only happened during the daytime. I wrote back and said if they logged into the system we’re using, they could view the information directly. I said I could write a summary, but it was probably not advisable for me to make any interpretations about the significance of these episodes of bradycardia. The point is that I reviewed the setting, looked at the actual recordings, and made a decision about this particular patient. The cardiologist saw my summary, which is always available for these types of things from the hospital’s EHR, but unless you can actually look at the tracings, a physician may not be able to make a good medical decision. Furthermore, I often receive referrals, and there will be an interpretation from a Holter monitor. Usually I’ll need to see the tracings because I will want to know whether I can agree with the original interpretation. I think that by being able to access this richer set of information electronically, you’re going to be able to make more accurate and better decisions.  

What would you like to see in the future integration of diagnostics and electronic record keeping?

Feld: In the future I’d like to see us be able to get more information from these sources in one place, to save time and improve efficiency. My goal with this software system, at least with this specialty area, is to be able to automatically, rapidly and efficiently access information from the various electronic systems that we use. The more sophisticated and comprehensive that it gets, the better care we’ll be able to deliver to our patients.

Disclosures: Dr. Feld and Ms. Empizo have no conflicts of interest to report.