There are currently approximately 3 million people worldwide with pacemakers, and each year more than 600,000 new pacemakers are implanted. These devices are instrumental in treating bradycardia (a condition where the heart beats slower than normal) and have helped patients lead longer, fuller lives. However, the data contained on these devices is also necessary for clinicians to accurately diagnose and treat patients with pacemakers who present in an ER. Unfortunately, this data can often be difficult to access.
The ER at UC San Diego (UCSD) Medical Center regularly experienced the workflow disruptions and delays that came along with trying to access and analyze pacemaker (and other cardiac device) data. In response, the provider recently implemented a suite of data management, analytics, and clinical decision support software and cardiac device reader hardware to streamline this process.
By leveraging medical device data management technology, UC San Diego Medical Center was able to accelerate diagnoses for its cardiac patients and reduce the overall length of stay in its ER by 92 minutes.
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There are currently approximately 3 million people worldwide with pacemakers, and each year more than 600,000 new pacemakers are implanted. These devices are instrumental in treating bradycardia (a condition where the heart beats slower than normal) and have helped patients lead longer, fuller lives. However, the data contained on these devices is also necessary for clinicians to accurately diagnose and treat patients with pacemakers who present in an ER. Unfortunately, this data can often be difficult to access.
The ER at UC San Diego (UCSD) Medical Center regularly experienced the workflow disruptions and delays that came along with trying to access and analyze pacemaker (and other cardiac device) data. In response, the provider recently implemented a suite of data management, analytics, and clinical decision support software and cardiac device reader hardware to streamline this process.
Traditional Device Interrogations Cause ER Bottlenecks, Delays
Historically, when a patient with a pacemaker or defibrillator presented in the UCSD ER with cardiac issues, clinicians had to initiate a series of events to access the important diagnostic data ![]()
stored on the device. The first step would be to determine the manufacturer of the pacemaker or defibrillator implanted in the patient. Clinicians would then need to call an 800-number and request to have a representative from that manufacturer come to UCSD to interrogate the device. An interrogation is a process that checks to make sure that the pacemaker or defibrillator is working properly. It also collects the diagnostic data stored on the device. During this process, the device manufacturer rep would wave a wireless wand connected to a computer over the patient’s chest. The device data would then be wirelessly transmitted to the rep’s computer, and they would print out a report for the ER clinicians and attending cardiologists to review to aid in diagnosis and treatment.
“This traditional approach of interrogating cardiac devices took anywhere from five to eight hours,” says Dr. Jim Killeen, the ER director of information technology at UCSD Medical Center. “Needless to say, this contributed to bottlenecks in our ER and prolonged patient admission or discharge.”
Health IT Collaborative Sparks Cardiac Improvement Initiative
One of UCSD’s goals is to continually improve cardiovascular care, and the provider was able to take a huge step in this direction when it became part of the San Diego Beacon project. In addition to serving as an HIE, the San Diego Beacon project’s mission is to improve the health of all constituents through advances in health IT. The project was funded by the ONC, and one of the early focuses of the program was to approve cardiac care in the field as well as in area hospitals and ERs.
Through the funding and support of the San Diego Beacon project, UCSD began working with Geneva Healthcare in 2012 to address its pacemaker interrogation issues. Geneva developed a cardiac device management software suite that collects and organizes implantable device data from the major cardiac rhythm management device manufacturers including Medtronic, Boston Scientific, Biotronik, and St. Jude Medical. UCSD also created mobile carts equipped with the wireless readers from all of these device manufacturers so that UCSD personnel can perform their own pacemaker interrogations in the ER.
Point-Of-Care Interrogations Produce Device Data In Minutes
Now, when a patient with an implanted pacemaker or defibrillator visits a UCSD ER, clinicians can immediately access historical diagnostic data from their device by logging into the Geneva Healthcare Suite. The solution provides a Web portal dashboard with a single view of all device data collected from all prior interrogations performed at other clinical settings or that patients perform themselves with takehome readers. Furthermore, a trained UCSD technician can perform real-time, point-of-care interrogations in the ER using the mobile carts. It is no longer necessary for clinicians to call a device manufacturer representative to perform an interrogation and produce a diagnostic report.
“The capability to perform on-site cardiac device interrogations now provides us with all the device data necessary for a proper clinical evaluation within the first three to five minutes of seeing a patient,” says Dr. Killeen. “This is a far cry better than the five to eight hours it used to take waiting for a manufacturer rep to produce the data. As a result, we’re making quicker decisions in the ER, which is better for our patients and our staff.”
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This time savings is not insignificant. In fact, UCSD has estimated that faster decision making and patient flow as a result of real-time cardiac device interrogations has helped the hospital reduce ER length of stay by 92 minutes overall. And the benefits don’t stop there. According to Dr. Killeen, on-site cardiac device interrogations have also alerted UCSD ER clinicians and attending cardiologists to dead device batteries, lead breaks, and other malfunctions. These faults can put a patient at risk. Early detection of failure points ensures quick device repair or replacement and keeps the device functioning properly.
Dr. Killeen also states that its new cardiac device management solution has also led to several clinical benefits. “Ever since we started leveraging the Geneva Healthcare Suite, our physicians have been catching more atrial fibrillations,” he says. “This abnormal heart rhythm can often lead to heart attack and stroke. However, through early detection, our physicians can perform a nonsurgical procedure called an ablation to correct the issue. Our ability to detect and correct more atrial fibrillations as a result of this technology is literally saving lives.”
UCSD has been pleased with the preliminary results of its cardiac device management solution, and it understands the importance of ultimately integrating this device data into the patient’s EHR. Currently, the provider is doing this manually (i.e., scanning the device report and uploading the image into the EHR). However, UCSD is evaluating the process to create a direct HL7 feed between the Geneva Software Suite and its Epic EHR so this data transfer occurs automatically and seamlessly.
There are currently approximately 3 million people worldwide with pacemakers, and each year more than 600,000 new pacemakers are implanted. These devices are instrumental in treating bradycardia (a condition where the heart beats slower than normal) and have helped patients lead longer, fuller lives. However, the data contained on these devices is also necessary for clinicians to accurately diagnose and treat patients with pacemakers who present in an ER. Unfortunately, this data can often be difficult to access.
stored on the device. The first step would be to determine the manufacturer of the pacemaker or defibrillator implanted in the patient. Clinicians would then need to call an 800-number and request to have a representative from that manufacturer come to UCSD to interrogate the device. An interrogation is a process that checks to make sure that the pacemaker or defibrillator is working properly. It also collects the diagnostic data stored on the device. During this process, the device manufacturer rep would wave a wireless wand connected to a computer over the patient’s chest. The device data would then be wirelessly transmitted to the rep’s computer, and they would print out a report for the ER clinicians and attending cardiologists to review to aid in diagnosis and treatment.
This time savings is not insignificant. In fact, UCSD has estimated that faster decision making and patient flow as a result of real-time cardiac device interrogations has helped the hospital reduce ER length of stay by 92 minutes overall. And the benefits don’t stop there. According to Dr. Killeen, on-site cardiac device interrogations have also alerted UCSD ER clinicians and attending cardiologists to dead device batteries, lead breaks, and other malfunctions. These faults can put a patient at risk. Early detection of failure points ensures quick device repair or replacement and keeps the device functioning properly.
