Pacemaker Clinic Moves Transtelephonic Monitoring Patients to the Medtronic® CareLink® Network: One Clinician's Experience

B.J. Runge, LPN, Platte Valley Medical Group, Kearney, Nebraska

B.J. Runge, LPN, Platte Valley Medical Group, Kearney, Nebraska

The Medtronic CareLink Network is an Internet-based remote monitoring service for Medtronic cardiac device patients. The service has been available for patients with ICDs and CRT-Ds for several years, and is now being offered for pacemaker patients. Currently, nearly 200 Platte Valley Medical Group pacemaker patients are enrolled in the CareLink Network. Easy for Patients to Use I feel and share the frustration of patients who struggle with transtelephonic monitoring (TTM). Some patients, especially those who are elderly, find it confusing or difficult to use. For example, one of our patients has severe crippling due to arthritis and had difficulty putting TTM wristbands on. Since her arms are so thin, she had to place the wristbands near her elbows. In addition, since her arthritis made her shaky, it was difficult for her to sit still for the 30 seconds needed to send data, so we could never get good reports for her. She had some assistance from a home healthcare service, but it seemed they never were able to visit when her TTM was scheduled. Ultimately, we were able to sign her up with the Medtronic CareLink Network, and now sending reports is so much easier for her. We collect good data with more information than we would have with TTM. The CareLink Network lets patients use a simple, one-button monitor to gather pacemaker data and send it by phone line to a secure server. Unlike transtelephonic monitoring, no wrist or magnet electrodes are used, and there is no need to place a phone receiver on a monitor cradle and risk poor data transmission. Reporting from Anywhere in the United States Some of our patients submit their reports to the CareLink Network from their offices or homes in outlying areas, saving themselves the time and potential inconvenience of coming to the clinic. There are also patients who send reports to the CareLink Network when they travel. In addition, we have many snowbirds who go to Texas, Arizona, and Florida for the winter, but this does not pose a problem, since they can send their reports from there. Maintaining a personal touch with patients is a priority. After the data provided by the CareLink Network is reviewed, I call each patient or their caregiver to give them the results. If I can't reach them by phone, I send a letter. However, very often the patients call me before I have a chance to call them. Convenient for Patients, Caregivers, Clinicians If patients use TTM, their remote reporting must be scheduled at a specific time, and a clinician must work with them by phone to gather their pacemaker data. In contrast, with the Medtronic CareLink Network, patients can submit reports anytime on a specified day, or during a designated range of time. This flexible scheduling that the CareLink Network offers is a great benefit for patients. I know that many of our patients need assistance from a son or daughter to transmit information. However, since CareLink data can be sent any time of the day, family members don't have to be available to help at a certain time, and I don't have to schedule my time to meet their time. In contrast, I try to fit in all my TTM reporting one morning a week, usually on Wednesdays, when there is less demand for me to assist doctors in the clinic. The CareLink Network stores patient data on a secure, password-protected server and enables clinicians to retrieve it from the CareLink Clinician Web site at their convenience. In addition, batch processing allows me to click on my reports and automatically print them. Using Additional Data to Manage Care Unlike TTM, which only detects and transmits a real-time electrocardiogram, the Medtronic CareLink Network provides comprehensive clinical data, comparable to that of an in-office follow-up, including programmed settings, battery life prediction, lead measurements, trended data, episodes, pacing counters, arrhythmia counters, and stored electrograms. In addition, it has the ability to detect clinical events such as atrial tachyarrhythmia and atrial fibrillation. We've certainly had cases in which additional information from the CareLink Network has let us identify problems and modify patient treatment data we would not have had from TTM. There have been patients who have had changes in their extent of atrial fibrillation. We've adjusted their medication, then requested an additional CareLink transmission from them. There was also a patient whose report showed a lead warning, so we had the patient go to an outreach location for follow up. In addition, another patient who lives far away would have needed family assistance had she used TTM. Instead, we've been using the CareLink Network to monitor her pacemaker as it reaches the end of its life. Her latest report showed it was time to change her pacemaker; CareLink reports will tell you when a device needs to be changed. Patients at Platte Valley Medical Group appreciate the additional information the Medtronic CareLink Network can provide. After I have seen patients in the clinic, they get used to having more information about their device. They love it when I can use a CareLink report to say more than, "Yes, your device is working."  I can tell them about any episodes they may have had or talk with them about their pacemaker's estimated life. I've had so many TTM patients say they were feeling badly on such and such a date and ask if anything had happened. I have to tell them a TTM report only lets us know what's happening right now. It doesn't tell us anything about the past. I've also had patients ask me which is better, transtelephonic monitoring or an office visit. In the past I've had to say to them, quite honestly, an office visit would tell me more. Now, however, I can honestly say that I get the same information from the CareLink Network that I would get during an office visit. In conclusion, the Medtronic CareLink Network is easy to use, convenient and helps us provide improved care for our patients. Editor's Note: This article was peer-reviewed by one or more members of EP Lab Digest's editorial board.