Benefits of Remote Patient Monitoring: Clinician Perspectives

In this interview, EP Lab Digest speaks with Saumil R. Oza, MD, and Margaret G. Pate about their experience using PaceMate^™ for remote monitoring of cardiac implantable electronic devices (CIEDs). Dr. Oza is a cardiac electrophysiologist and the chief of cardiac electrophysiology at Ascension St. Vincent’s Riverside Hospital in Jacksonville, Florida. Margaret G. Pate is the clinical service line director of cardiovascular services at Ascension St. Vincent’s Riverside Hospital in Jacksonville, Florida.

Tell us about your practice—health system affiliation, location, size, number of electrophysiologists (EPs), advanced practice providers (APPs), dedicated device staff, satellites, device patient volume, and annual number of CIED remote monitoring transmissions.

Pate: We are part of Ascension Health, a Catholic nonprofit healthcare system. We have 3 locations in the Jacksonville area and are about to open a fourth hospital in July 2022. We currently have 32 cardiologists (37 by the end of this year) and 6 electrophysiologists, adding an additional EP in August. We have 3 APPs that are dedicated to EP.

We have pacemaker clinics at several of the locations, including a supervisor as well as 3 other dedicated device staff among all the locations. We have 7 primary locations for our cardiology clinic and multiple outreach locations as well. We manage an estimated 97,000 remote monitoring transmissions on an annual basis.

What was happening in your device clinic that prompted your decision to seek out a remote monitoring company?

Pate: In the past, everything was done on paper. We were unable to effectively monitor if patients were actually compliant with their transmissions. Therefore, we wanted to improve the quality of care within our practice. First and foremost, this is what drove us to partner with PaceMate^™. We also knew that not everything was being captured from a billing perspective, so we were not optimizing revenue.

Oza: Yes, paper is pretty antiquated now with the availability of the electronic health record (EHR). Previously, if we were offsite at a satellite location and someone put a device report on our desk, we sometimes would not receive it for a few days. Therefore, from a physician perspective, the impetus to go with cardiac rhythm management (CRM) software was very important. We looked at several options, and PaceMate^™ was definitely far and above the best solution for our practice.

Pate: What made PaceMate^™ stand out from the competition was that other vendors did not have the ability to interface with our EHR. That was the driving force to choose PaceMate^™, because once the physician reads the report, all they have to do is click “submit” and it crosses over into our EHR and bills out.

As part of a large health system, how were you able to secure corporate support for your partnership with PaceMate^™?

Pate: Many other sites were unaware of an alternative company that had an interface with Athena. Therefore, we worked with our national team to discuss what advantages PaceMate^™ held in the marketplace. Since we went live in June 2020, there has been more migration within the system over to PaceMate^™.

Oza: One of the things that we found when talking with other practices who use PaceMate^™ was that they are extremely versatile, meaning that if you have any recommendations or questions, PaceMate^™ is able to implement those changes very quickly in their software. Therefore, since we started using it, we have been able to make improvements based on physician feedback.

The other thing is that Ascension is looking to collectively leverage their data and individual patient experiences and use that information to answer questions on health equity and population studies to help with volume. PaceMate^™ allows us to coordinate all of our implantable and external monitoring data between sites and use that for data mining research.

How did PaceMate^™ help you to address your concerns?

Pate: PaceMate^™ has excellent customer service. They have been receptive and willing to work with our physicians to continually enhance their product and tweak it based on recommendations.

Oza: I echo everything Margaret said. I was pleased to find how much PaceMate^™ has been able to adapt. When we first started using PaceMate^™, we were able to incorporate implantable defibrillators, pacemakers, implantable loop recorders, and other implantable devices into their management software. We learned we will also now be able to incorporate external wearable devices such as patches and mobile cardiac telemetry monitors from all the different manufacturers into PaceMate^™.

We are able to gather granular data from those monitors and have meaningful prereads. This has limited the amount of overreading by physicians because we are able to customize each field specific to each physician. That is going to be a gamechanger for a lot of our physicians who manage an immense volume of data from Holter and event monitors. Our biggest challenge was always in keeping up with these data, and this software is really going to help us with that.

Can you describe your experience onboarding during the height of the COVID-19 pandemic?

Pate: PaceMate^™ was very accessible. They came on site to meet with our physicians and staff. We recently had a new acquisition that onboarded with PaceMate^™ in December 2021. From the time the Jacksonville offices onboarded in June 2020 to when the new office onboarded in December 2021, it was interesting to see the positive changes PaceMate^™ had implemented in their onboarding process—it is clear they are interested in continually improving their process based on feedback. If there is ever an issue that we would like to discuss in person, I know that I can call anyone at PaceMate^™ and they will come down that same week to any of our locations.

Oza: Yes, the process was seamless. Going from paper to electronic can sometimes be difficult for physicians, since we are used to signing off on paper. It is a different workflow. However, I think what really got everyone on board was learning about the amount of data that we may have been missing before with paper documents.

With their management software, PaceMate^™ is able to alert us to a lot of different issues that patients may be having. PaceMate^™ really helps us with how exactly we should be reading these devices and with what frequency because each physician manages a large volume of patients. They were also able to put us in touch with other physicians to help us quickly work through the learning curve.

Clinical expertise is important when selecting a cardiac monitoring partner. Can you share your experience with PaceMate^™ relative to quality and safety in remote monitoring?

Oza: In terms of safety, the great thing is that our patients are monitored all the time. We are able to have patient monitoring over the weekends and overnight, so if there are any emergencies, the on-call person is alerted. PaceMate^™ sends emails and alerts the office if it is during business hours. Therefore, our turnaround time on critical items has decreased dramatically due to PaceMate^™ because we are able to care for patients almost immediately. That certainly was not the case before, when there was a longer lag with patient alerts.

I believe the improved quality and safety of our remote monitoring using PaceMate^™ has been the biggest benefit. PaceMate^™’s flexibility in allowing us to individualize what each physician would like to be alerted for and how often has also been very helpful. Certain alerts happen regularly and can be turned off so the physician does not become inundated. Having too much data can be unwieldy, so it is important to find the right balance to manage all that data. PaceMate^™ has done a great job at continuously improving that balance.

Pate: We have had several success stories where we have averted a potential adverse event in a patient because we were notified so quickly by PaceMate^™. Previously, we might have had a very different outcome because we didn’t have this type of system in place.

How have your practice, providers, and clinical team benefited from your partnership with PaceMate^™?

Oza: From the physician standpoint, I believe our outlying clinics have probably benefited the most from our partnership with PaceMate^™. These clinics do not always have the expertise there that we have available at our main hospital clinic. The MAs are the ones putting the wand on the pacemaker and printing things out for us, so now they have a lot more help.

We are also able to have the patient transmit ahead of time so that it can be preread through PaceMate^™. We make sure the report has all the elements that we need. This has helped us reduce the time it takes for us to see a patient, because we do not have to request anything during clinic—everything is done beforehand. Our MAs in the outlying clinics also benefit from it because they get more help for the clinic as well as expertise on pacemaker interrogations.

Pate: PaceMate^™ has also helped us improve patient compliance and transmission on a regular basis. Previously, we did not have any insight as to which patients were transmitting since it was all done on paper. With PaceMate^™, we have been able to increase patient compliance, which has translated to better care.

How have your patients benefited from the change—shifting to remote monitoring with PaceMate^™?

Oza: Patients definitely benefit from a quicker turnaround time for any actionable events on their pacemaker interrogations. We have also been able to get more of our patients on remote monitoring. This has helped reduce the need for inpatient visits, especially during COVID-19, when it was critical for our elderly and more vulnerable populations not to come into a crowded clinic. Patients can get most of what they need over remote monitoring.

During the last few years, we have shifted a lot to telephone-based visits or videoconferencing. PaceMate^™ has been integral in this transition. A few days before the telemedicine visit, we are able to get a full interrogation report so that we have all the information we need for our pacemaker and device patients. That has been a huge benefit for our patients.

What are additional advantages you have realized through PaceMate^™?

Pate: From a billing perspective, PaceMate^™ provides an authorization and pre-approval workflow dashboard to support our authorization process for quarterly remote transmissions. That has been a huge benefit, because some of the insurance plans require an authorization every 90 days. Before, we did not have a clear overview of what we were getting paid on. With the authorization, we receive a guarantee of payment, so that has been very helpful. Two weeks ago, we also successfully completed a large migration of most of our Holter and event monitors, and PaceMate^™ was on site at each location during that time. It is very helpful for our practice to have everything on one software platform.

Oza: The integration of external monitors with our CRM patients into one software is going to be a game changer. In addition, PaceMate^™’s ability to give us extremely customizable preread reports is amazing—it is something that we’ve been doing with them for months, and I think it speaks to how agile and responsive they are. It is going to completely change the way external monitors are read.

The other benefit is to our patients—they are going to have a much quicker turnaround on their monitor readings, flagging changes in their disease state so they can be seen in clinic sooner. This is important because I find that patients will often not call us every time they feel bad. Sometimes when we see something on their Holter monitor and call them, they will say their legs had been swelling or that they had been a little short of breath, but they were waiting for their visit in 2 months to mention it. By that time, they would have been in the hospital! So, improving turnaround time on our monitors will be a huge benefit to patients. I’m really excited about that. The preread aspect of it is already integrated with our CRM data. Overall, this will benefit our practice, physicians, and patients. 

This article was published with support from PaceMate™.

Disclosures: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Ms Pate has no conflicts of interest to report regarding the content herein. Dr Oza reports receiving stock options for his role as an advisor to PaceMate^™.