Data Integration and Interoperability for Patient-Centered Remote Monitoring of Cardiovascular Implantable Electronic Devices

Daley, Carly; Toscos, Tammy; Mirro, Michael J.

doi:10.3390/bioengineering6010025

Cited by 12 publications

(6 citation statements)

References 18 publications

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“…Currently, patients do not receive information directly from their remote monitored device, which patients in this study pointed out as a downside. However, findings from a feasibility [ 42 ] and evaluation [ 20 ] study in the United States suggest that it is not only feasible to deliver data from remote monitoring directly to patients, but also that this data sharing does not adversely impact clinic workflow and that patients perceive a benefit from having access to their remote monitoring data. The same result was found by Mirro et al when evaluating the impact of sharing ICD data summaries through a patient portal.…”

Section: Discussionmentioning

confidence: 99%

“…For example, some patients (5%-22%) do not feel comfortable with RPM and report a strong preference for regular office-based visits to feel secure [ 15 , 16 ]. Furthermore, RPM has been described as system centered, providing patients with little or no data from their device [ 20 ]. Patients missed receiving feedback via their monitor, 84% wished for a more detailed response, and 21% wished for faster feedback after scheduled transmissions [ 16 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…Patients missed receiving feedback via their monitor, 84% wished for a more detailed response, and 21% wished for faster feedback after scheduled transmissions [ 16 , 21 ]. Yet another disadvantage is the lack of data integration with electronic medical record platforms and other systems in the current RPM systems, leading to the device diagnostics being underutilized by the health care personnel [ 20 ]. Despite a reduction of office-based follow-ups, RPM is perceived as increasing workload for the staff involved [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Patients' and Nurses’ Experiences and Perceptions of Remote Monitoring of Implantable Cardiac Defibrillators in Heart Failure: Cross-Sectional, Descriptive, Mixed Methods Study

Liljeroos¹,

Thylén²,

Strömberg³

2020

J Med Internet Res

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Background The new generation of implantable cardioverter-defibrillators (ICDs) supports wireless technology, which enables remote patient monitoring (RPM) of the device. In Sweden, it is mainly registered nurses with advanced education and training in ICD devices who handle the arrhythmias and technical issues of the remote transmissions. Previous studies have largely focused on the perceptions of physicians, and it has not been explored how the patients’ and nurses’ experiences of RPM correspond to each other. Objective Our objective is to describe, explore, and compare the experiences and perceptions, concerning RPM of ICD, of patients with heart failure (HF) and nurses performing ICD follow-up. Methods This study has a cross-sectional, descriptive, mixed methods design. All patients with HF and an ICD with RPM from one region in Sweden, who had transitioned from office-based visits to implementing RPM, and ICD nurses from all ICD clinics in Sweden were invited to complete a purpose-designed, 8-item questionnaire to assess experiences of RPM. The questionnaire started with a neutral question: “What are your experiences of RPM in general?” This was followed by one positive subscale with three questions (score range 3-12), with higher scores reflecting more positive experiences, and one negative subscale with three questions (score range 3-12), with lower scores reflecting more negative experiences. One open-ended question was analyzed with qualitative content analysis. Results The sample consisted of 175 patients (response rate 98.9%) and 30 ICD nurses (response rate 60%). The majority of patients (154/175, 88.0%) and nurses (23/30, 77%) experienced RPM as very good; however, the nurses noted more downsides than did the patients. The mean scores of the negative experiences subscale were 11.5 (SD 1.1) for the patients and 10.7 (SD 0.9) for the nurses (P=.08). The mean scores of the positive experiences subscale were 11.1 (SD 1.6) for the patients and 8.5 (SD 1.9) for the nurses (P=.04). A total of 11 out of 175 patients (6.3%) were worried or anxious about what the RPM entailed, while 15 out of 30 nurses (50%) felt distressed by the responsibility that accompanied their work with RPM (P=.04). Patients found that RPM increased their own (173/175, 98.9%) and their relatives’ (169/175, 96.6%) security, and all nurses (30/30, 100%) answered that they found RPM to be necessary from a safety perspective. Most patients found it to be an advantage with fewer office-based visits. Nurses found it difficult to handle different systems with different platforms, especially for smaller clinics with few patients. Another difficulty was to set the correct number of alarms for the individual patient. This caused a high number of transmissions and a risk to miss important information. Conclusions Both patients and nurses found that RPM increased assurance, reliance, and safety. Few patients were anxious about what the RPM entailed, while about half of the nurses felt distressed by the responsibility that accompanied their work with RPM. To increase nurses’ sense of security, it seems important to adjust organizational routines and reimbursement systems and to balance the workload.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patients' and Nurses’ Experiences and Perceptions of Remote Monitoring of Implantable Cardiac Defibrillators in Heart Failure: Cross-Sectional, Descriptive, Mixed Methods Study

Liljeroos¹,

Thylén²,

Strömberg³

2020

J Med Internet Res

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“…As discussed in the PGHD Accessibility section, depending on the health condition and the clinical purpose of RPM, PGHD presentation to patients in real time might be deliberately disabled by clinicians. However, studies have shown that accessing real-time data from the wearable increased patients' awareness of the wearable's function, further engaged them in self-care, and enhanced shared decision-making [92][93][94].…”

Section: Recommendation 17: Pghd From Wearables Should Be Available T...mentioning

confidence: 99%

Recommendations for the Quality Management of Patient-Generated Health Data in Remote Patient Monitoring: Mixed Methods Study

Abdolkhani¹,

Gray²,

Borda³

et al. 2023

JMIR Mhealth Uhealth

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Background Patient-generated health data (PGHD) collected from innovative wearables are enabling health care to shift to outside clinical settings through remote patient monitoring (RPM) initiatives. However, PGHD are collected continuously under the patient’s responsibility in rapidly changing circumstances during the patient’s daily life. This poses risks to the quality of PGHD and, in turn, reduces their trustworthiness and fitness for use in clinical practice. Objective Using a sociotechnical health informatics lens, we developed a data quality management (DQM) guideline for PGHD captured from wearable devices used in RPM with the objective of investigating how DQM principles can be applied to ensure that PGHD can reliably inform clinical decision-making in RPM. Methods First, clinicians, health information specialists, and MedTech industry representatives with experience in RPM were interviewed to identify DQM challenges. Second, these stakeholder groups were joined by patient representatives in a workshop to co-design potential solutions to meet the expectations of all the stakeholders. Third, the findings, along with the literature and policy review results, were interpreted to construct a guideline. Finally, we validated the guideline through a Delphi survey of international health informatics and health information management experts. Results The guideline constructed in this study comprised 19 recommendations across 7 aspects of DQM. It explicitly addressed the needs of patients and clinicians but implied that there must be collaboration among all stakeholders to meet these needs. Conclusions The increasing proliferation of PGHD from wearables in RPM requires a systematic approach to DQM so that these data can be reliably used in clinical care. The developed guideline is an important next step toward safe RPM.

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“…The primary goals of this pilot study were to gain insight into individual patients’ interpretations of device data and visualizations and their responses to RM data in daily life, and to contribute these insights to an emerging field of health data sharing that ultimately aims to design and implement technologies to further engage patients safely and effectively in self-management. 16 , 23 , 24 , 25 …”

Section: Introductionmentioning

confidence: 99%

Patient responses to daily cardiac resynchronization therapy device data: A pilot trial assessing a novel patient-centered digital dashboard in everyday life

Toscos

Daley

Wagner

et al. 2020

Cardiovascular Digital Health Journal

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BACKGROUND Heart failure (HF) is a growing public health problem in the United States. Implantable cardiac resynchronization therapy (CRT) devices reduce mortality and morbidity, and remote monitoring (RM) of these devices improves outcomes. However, patient RM adherence is low, due in part to lack of access to their RM data. Providing these data to patients may increase engagement, but they must be appropriately tailored to ensure understanding.OBJECTIVE The purpose of this study was to examine patients' experiences interacting with their RM data through a novel digital dashboard as part of daily life.METHODS In this mixed-methods pilot study, 10 patients with implantable CRT defibrillators were given access to a patientcentered RM data dashboard, updated daily for 6-12 months. Preand post-health literacy, engagement, electronic portal (MyChart, Epic Systems Corporation) logins, and RM adherence were measured; system usability scores were collected at exit; and dashboard views were tracked. Exit interviews were conducted to elucidate patients' experiences.RESULTS Participants (100% white; 60% male; age 34-80 years [mean 6 SD: 62.0 6 13.4]) had adequate health literacy, increased MyChart logins (P 5 .0463), and nonsignificant increase in RM adherence. Participants viewed their dashboards 0-42 times (mean 14.9 6 12.5). Interviews revealed participants generally appreciated access to their data, understood it, and responded to changes; however, questions and concerns remained regarding data interpretation and visualization.CONCLUSION Preliminary findings support potential future integration of a CRT RM data dashboard in the daily care of HF patients. With appropriate informational support and personalization, sharing RM data with patients in a tailored dashboard may improve health engagement.

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Data Integration and Interoperability for Patient-Centered Remote Monitoring of Cardiovascular Implantable Electronic Devices

Cited by 12 publications

References 18 publications

Patients' and Nurses’ Experiences and Perceptions of Remote Monitoring of Implantable Cardiac Defibrillators in Heart Failure: Cross-Sectional, Descriptive, Mixed Methods Study

Patients' and Nurses’ Experiences and Perceptions of Remote Monitoring of Implantable Cardiac Defibrillators in Heart Failure: Cross-Sectional, Descriptive, Mixed Methods Study

Recommendations for the Quality Management of Patient-Generated Health Data in Remote Patient Monitoring: Mixed Methods Study

Patient responses to daily cardiac resynchronization therapy device data: A pilot trial assessing a novel patient-centered digital dashboard in everyday life

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