In this article, EP Lab Digest® speaks with Dr. E. Martin Kloosterman, Chief of Cardiology and Director of the Electrophysiology Laboratory at Boca Raton Regional Hospital, about the remote-K-viewer technology he developed that is in use at the hospital.
Tell us about your development of this remote-K-viewer technology. How did the idea come about?
“If we can control a robot in Mars, we can certainly control a pacemaker in Boca Raton”; that was the original premise for this project and how the idea came to mind. A series of recent technological developments and cultural changes in the workplace, with regards to computer use, make the remote-K-viewer not only possible, but accepted.
I’m specifically referring to the last two years’ deployment of computer and general use in the hospital, along with communication lines and Internet connections, the use of electronic medical records, and the availability of the iPad with unparalleled mobile connectivity.
Describe the remote-K-viewer and its components. How does it work?
The standard way of interrogating and reprogramming cardiac devices requires a dedicated company programmer that directly interacts with the patient at the bedside and, for the most part, is operated by a company representative, particularly in institutional settings such as the ER or OR.
The remote-K-viewer is a system that allows a direct visualization of the programmer screen on a connected parallel laptop. The laptop can then be accessed remotely and the programmer screen mirror image can be visualized on an iPad (including an iPhone or any other computer with Internet connection). The iPad via an encrypted service network can also control the pointer of the bedside laptop, guiding the bedside operator in the operation of the programmer in real time. Additionally, the remote operator could be in direct telephone communication with the bedside operator or via an onscreen chat line. Lastly, once the device check is performed, the remote operator can generate a report that can be printed locally (Figure 1).
How long has the technology been in use at Boca Raton Regional Hospital? What staff members use it?
The system was used mainly last year as part of a study protocol involving members of the emergency room and operating room areas. Nurses and some ER physicians were the bedside users, and I acted as the remote operator evaluating the device function and instructing in reprogramming changes as needed. This protocol was conceived with a redundancy concept for which the company representative eventually checked on all the device interactions.
What training was involved?
The bedside operators (nurses and ER physicians), without previous knowledge of specific programmer function, underwent 45 minutes in service, with some reinforcement sessions as needed.
What makes the technology unique? Also, are there plans to use the technology elsewhere in the hospital?
Real-time remote cardiac device management is a novelty and is considered unexplored territory regarding challenges in communication and interaction. There is no other system currently that allows real-time direct viewing of a cardiac device and facilitates remote management by medical personnel without requiring extensive training.
I have successfully completed preliminary testing in the hospital floors involving multiple company programmers, and have plans for launching an outpatient office protocol.
What are the current challenges in remote cardiac device testing? How does this technology address this?
The company representative needs to be called in to bring and operate the programmer, and the physicians involved in these initial calls then need to resource a specialist to deal with the information obtained, who in turn may require calling back the company representative for programming changes.
The remote-K-viewer allows for immediate access to real-time information by a specialized physician to readily deal with the situation at hand without delays. The bedside medical personnel requires a minimal in service to understand the concepts of device interrogation and remotely follow in real time on-screen guidelines of the remote operator to execute the programmer functions. This is in contrast to the specialized and extensive instructional courses required to be able to interact with the programmer by themselves.
What are your future plans for the technology?
A new generation of programmers with a new interface and connectivity is being developed by companies. In the meantime, I hope to continue to use this system to further understand and address the challenges of real-time information in order to contribute to the development of a new service model concept.
Why is real-time remote device management important?
Real-time remote device management allows for immediate attention to a patient’s needs and potential lifesaving device interventions. Additionally, it expedites patient flow, allowing for better care and reducing the need and cost of human resources allocated for these functions.
What has been the feedback to this technology thus far?
The feedback has been extremely positive on different levels. The nurses participating felt empowered in being able to actively participated in meaningful patient care, the ER physicians appreciated the expeditious and on-point service, the patients were impressed by having a specialist physician dealing with their care remotely, and lastly, the company reps see the value of being relieved of needing to be in too many places at one time.
Is there anything else you’d like to add?
The use of this technology has allowed me to take care of patients in the ER in a moment’s notice, even when I’m in a different city. I have also tested the remote-K-viewer’s function while on flight from San Francisco to Orlando.