Optimizing Cardiac Device Management: Modern Care Pathways and Workflow Innovation at Sutter Health
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EP LAB DIGEST. 2025;25(4):27-28.
Junior W DelGiorno, IBHRE CCDS Testamur, Director of Electrophysiology
Sutter Health, Sacramento, California
Sutter, established in 1921 in Sacramento, California, has developed a broad network of cardiovascular services across Northern California. Early milestones included the first successful open-heart surgery and pediatric open-heart surgery in 1957, followed by the region’s first heart transplant in 1989. Over the ensuing decades, strategic mergers and acquisitions helped expand the system’s reach and strengthen its ability to offer advanced electrophysiology (EP) services, diagnostic procedures, and complex treatments for conditions such as heart failure (HF) and adult congenital heart disease (ACHD). Today, Sutter is supported by hundreds of clinicians, 24 acute care hospitals, ambulatory surgical centers, and multiple outpatient specialty clinics—underscoring its long-standing commitment to provide comprehensive cardiovascular care.
Over the past decade, Sutter’s Heart and Vascular Service Line has been committed to providing highly specialized, patient-centric care for individuals with cardiac implantable electronic devices (CIEDs). This commitment grew from the recruitment of industry-trained cardiac device specialists, early adoption of modern remote monitoring (RM) technologies, robust clinician support, and a system-wide initiative to standardize CIED management. As a result, Sutter has enhanced workflow efficiency and improved patient outcomes while reducing operational costs.
Although Sutter Health has established a century-long legacy of delivering innovative cardiovascular care, it continues to refine its services to better serve its patients and communities. This article explores Sutter’s approach to chronic care of its CIED patients.
Focus on Operational Efficiency While Delivering Best-in-Class Cardiac Device Care
The evolution of cardiac device management at Sutter has always been a top priority for our EPs and cardiologists, who remain steadfast in their commitment and adoption of constantly evolving technology. From the initial surgical implant to utilization of modern-day RM, Sutter remains focused on adapting the care curriculum to ensure patients are receiving the highest caliber of care. While the CIED hardware, implant techniques, and remote monitors change every few years, chronic care management of these patients remains constant and fluid. In the early years, transtelephonic monitoring (TTM) could be used for outpatient device surveillance, but the technology was limited, providing basic rhythm data collection and pacing function, and it required substantial staff time. However, the advent of advanced RM systems in 2001 revolutionized cardiac device management, providing clinicians with comprehensive and timely insights. From the beginning, Sutter embraced this modern-day technology, and in 2015, made significant investments in their approach to outpatient cardiac device management. Over the last 10 years, Sutter grew its CIED patient population, utilizing RM, to an estimated ±18,000 patients across its entire network.
Heart and Vascular Growth, Work Burden, Standardized Care, and In-House Device Specialist
Over the past decade, the heart and vascular service industry has experienced significant growth, driven by an aging population, increased access to advanced diagnostic tools, and ongoing innovations in interventional cardiology and EP with some areas, such as transcatheter therapies and device-based interventions, expanding rapidly. As a result, clinicians face heavier workloads and more complex patient care demands. High patient volumes, rapid technological advances, and increased administrative tasks have intensified clinician’s responsibilities, limiting their time. In response, Sutter has implemented telehealth, RM, and expanded care teams to manage patients more efficiently to support both clinicians and patients in this evolving cardiovascular landscape.
Within the scope of CIED management, Sutter recognized the need for specialized expertise to support EPs and cardiologists. As a result, a pivotal strategic decision was made in 2015 to recruit and hire industry-trained cardiac device specialists certified by the International Board of Heart Rhythm Examiners (IBHRE). Having these dedicated, onsite subject matter experts has ensured continuity of care, fostered stronger patient relationships, and provided robust clinician support. While some health care systems may depend heavily on industry representative support, Sutter’s approach has yielded consistent, high-level care for both patients and clinicians.
By 2017, most of Sutter’s CIED patients were using modern RM, with 2 sites employing cardiac device specialists working in collaboration with nurses, physician assistants, and nurse practitioners, all overseen by physicians. Within a few years, the benefits of a dedicated team for device management proved invaluable. Yet, when active sites were evaluated for replication, it became evident that some cardiac device clinics had slight variations in the workflow and processes. While these local approaches were effective, met compliance standards, and served patients well, the growing emphasis on standardization, improved documentation, and regulatory compliance prompted an internal search for a center of excellence. The Sutter Medical Foundation’s cardiac device clinic in Sacramento emerged as a leader—one of just 2 cardiac device clinics in the network to recruit industry-trained, IBHRE-certified cardiac device specialists. This cardiac device clinic’s successes were a direct result of regular collaboration and feedback from its patients, physicians, compliance, and revenue teams, ensuring alignment with regulatory standards, ethical considerations, and financial requirements.
Key Achievements
Since its expansion in early 2015, the Sutter Medical Foundation cardiac device clinic has achieved multiple milestones and recognition, solidifying its position as a model of best practice in cardiac device management. Through alliances with regional Sutter facilities and other specialty service lines, there are a few notable successes:
• In 2018–2019, the clinic was recognized by the Advisory Board’s National Cardiovascular Roundtable for its progressive and innovative approach to CIED management. This recognition highlighted the expansion of its RM services and the integration of cardiac device specialists to better support patients and clinicians. By focusing on continuity of care and strengthening alignment between the HF clinic, ACHD clinic, and Sutter Medical Center’s EP/cath labs, the clinic not only enhanced patient outcomes but improved patient satisfaction.
• A pivotal 2019 initiative between the Sutter Medical Foundation cardiac device clinic and regional radiology/direct imaging services improved access to advanced diagnostics and therapeutic procedures for cardiac device patients. By developing a process for magnetic resonance imaging (MRI) clearance, this collaboration significantly enhanced patient access and continuity of care, reducing delays and inefficiencies. Prior to implementing a new workflow, average turnaround time for MRI clearances ranged from 2 to 5 months, with around 10 MRI scans for CIED patients each year. As of January 2025, the average clearance time has dropped to roughly 2 days with close to 100 MRIs performed per month for CIED patients.
• In 2020, at the height of the COVID-19 pandemic, the Sutter Medical Foundation cardiac device clinic’s RM program ensured continuous cardiac device care, even as other health care services limited in-person visits. Thanks to standardized workflows and well-established processes, the device clinic was able to maintain productivity and patient care without interruption. Many patients who had been hesitant to use RM technology embraced it as an alternative to office visits, boosting the device clinic’s daily operations.
• In 2023, through the combined efforts of Sutter Medical Center Sacramento and the Sutter Medical Foundation cardiac device and HF clinics, Sutter earned The Joint Commission’s “Comprehensive Cardiac Center Certification.” This distinction underscores Sutter’s commitment to maintaining high standards in its cardiovascular services. Following review, The Joint Commission singled out the cardiac device clinic, highlighting workflow, data integration, and emphasis on continuity of care as “best practices in the nation.” Building on this achievement, Sutter Medical Center Sacramento and the Sutter Medical Foundation cardiac device and HF clinics are currently preparing for another Joint Commission survey to extend their certification for an additional 2 years—a testament to their ongoing dedication to advancing patient care.
Leveraging Electronic Health Records for Streamlined Device Management, the One-Sutter, One-Platform Philosophy
Sutter’s approach to cardiac device data management and patient care has been deliberate, focusing on maximizing a single platform—electronic health records (EHRs)—to streamline workflows, enhance clarity, and reduce operating costs. By integrating and documenting directly within EHRs, cardiac device data is housed in both familiar and centralized locations, providing clinicians with near real-time access to critical information. Implementing a standardized workflow has demonstrated end-to-end efficiency, giving Sutter greater control over data, ensuring regulatory compliance, and improving reimbursement timelines.
In contrast, other organizations may rely on or prefer third-party solutions to manage cardiac device data. Today, numerous companies offer robust cloud-based SaaS solutions or standalone applications that can integrate with EHR systems. Some solutions can even handle the technical component of data management, making them viable for sites with limited staffing. However, these options often come with subscription fees or require an upfront investment along with ongoing costs for warranties, upgrades, and maintenance. They may also increase the risk of system disruptions, create dependencies, and require additional staff training. Other challenges include integration hurdles, potential obsolescence, or corporate acquisitions that could disrupt patient care. While third-party systems may efficiently aggregate and consolidate CIED data, the information still requires careful review and validation for accuracy before final integration into EHRs.
By choosing to build in-house expertise and utilize Sutter’s own staff rather than depend on a third-party vendor, Sutter reinforces its commitment to seamless care, cost efficiency, and direct oversight of each patient’s cardiac device data. This strategic decision allows Sutter to maintain complete control over the workflow, fully leverage integrated capabilities of the EHR, and minimize both complexity and long-term expenditures—all while ensuring that patient safety and care quality remain paramount.
Enterprise Device Management and a Specialized Workforce
Sutter’s Heart and Vascular service line has consistently prioritized excellence in its delivery of care. By 2023, cardiac device management had grown across the network, becoming a critical component to the service line. Recognizing specialized care requires a specialized workforce, thus a new initiative was launched. The person instrumental in the growth and success of the Sutter Medical Foundation cardiac device clinic would be promoted to system director of EP and tasked with leading an “Enterprise Device Management” initiative to align care across the network. To support this effort, existing staff were realigned, and additional staff were hired, ultimately dedicating 32 full-time employees with a strategy to expand as needed.
A key factor in this initiative’s success has been the establishment of a multidisciplinary workforce, composed of advanced-level cardiac device specialists, intermediate-level cardiology device technicians, and ancillary support staff.
These teams collaborate closely with their peers and clinicians to ensure care is delivered safely and efficiently. Aligning device management into broader clinical teams has created opportunities to optimize patient care, reduce adverse events, and improve patient satisfaction. Using a unified EHR platform for cardiac device management provides clinicians with quicker access to data, reduces delays in care, and improves response times, all while fostering continuity of care.
Having a multifaceted workforce with varying degrees of knowledge and training in CIED requires a structured internal education program to promote alignment and keep pace with evolving technologies. In 2024, a training syllabus was developed and deployed to all cardiac device team members, regardless of experience. The program spans over a year, starting with basic cardiac rhythm training and progressively covering more advanced CIED technologies. This approach ensures all team members can function with a specific level of knowledge while offering opportunities for professional growth. Many of the intermediate-level cardiology device technicians are working toward earning allied health professional certifications offered by the IBHRE.
Challenges and Overcoming Barriers
Despite the program’s early successes, Sutter’s journey into this initiative has not been without challenges. The most significant hurdle is recruiting applicants with CIED experience. Becoming proficient in EP, particularly CIEDs, requires significant time and extensive training. Historically, it was rare for industry-trained cardiac device specialists to leave an industry position and join a health care system, but has become more prevalent over the last decade. To date, of the 32 cardiac device specialists at Sutter, 6 bring industry-level training and experience.
Providing a robust cardiac device RM program requires significant staffing ratios that can manage the daily work burden of remote monitoring transmissions, particularly alert transmissions, which can consume significant time.
Implementing a standardized workflow is critical during situations of staffing shortages. This allows for allocation of staff from device clinics with lower workloads to support higher volume or short-staffed device clinics as needed. Standardized work allows for cross-coverage to minimize interruption of patient care.
Other challenges may include the lack of adoption or standardization, system configurations, or inconsistencies in workflow.
Future Enhancements and Vision
Looking ahead, Sutter remains committed to operational excellence through the alignment of cardiac device management with its broader One Sutter–One Platform initiative. This strategic approach has streamlined operations, reduced costs, and improved coordinated care by leveraging the capabilities of EHR. Future enhancements will focus on driving further efficiencies, reducing workflow variability, and optimizing processes to ensure consistent, high-quality care.
Conclusion
Sutter’s transformative approach to cardiac device management has established a model of excellence, operational efficiency, and innovation. By utilizing advanced technologies, implementing a specialized workforce, and embracing continuous improvement, Sutter remains committed to delivering optimal cardiovascular care and improving patient outcomes.
Disclosure: The author has completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest, and reports no conflicts of interest regarding the content herein.
