In this interview, EP Lab Digest speaks with Dr. Joseph Winget, Director of the Cardiac Device Clinic, and Kelly Hanley, RN, Nurse Supervisor for Cardiology/Cardiac Rehabilitation and Prevention, at the University of Vermont Health Network (UVM) in South Burlington, Vermont. The RemoteMD service is a new resource that helps practices to effectively transition into cardiac implantable electronic device (CIED) monitoring, eliminate CIED backlogs, provide real-time reporting on the CIED population, and train staff. RemoteMD, established by PrepMD in 2015, is currently monitoring patients across 4 states within both academic and private practices, and is inclusive of pacemakers, ICDs, and ILRs.
How did your cardiology practice manage remote monitoring of device patients prior to using RemoteMD?
Winget: We serve a large patient population — probably close to 1500 patients — and being in a geographically challenged area (we’re located in northern Vermont and northern New York state, abutting the Canadian border), many of our patients live up to 3 hours away from us. Early on, we realized that we needed to have a care model where we went to patients in some way, rather than doing device follow-up from a centralized location. About 25 years ago, our nurses and typically one of our electrophysiologists would staff outreach clinics, either monthly or semi-monthly, and see patients closer to their homes. As remote monitoring came online, we had the opportunity to do less in-person device follow-up and more remote checking. Up until 9 months ago, we had 2 very experienced nurses that had been with us for well over 20 years. These nurses staffed and ran remote monitoring, in-facility checks, and remote clinics. They also helped with administrative functions to ensure that patients weren’t falling through the cracks. Our challenge came when one of these nurses decided to make a lateral move within our organization. We had difficulty recruiting for another nurse to work in the CIED clinic. Despite aggressive recruitment, both locally and regionally, we were not successful in identifying a qualified candidate. Staffing a busy academic CIED clinic requires a highly technical skillset that is not easily found. Later, the other nurse, who was our senior nurse and our lead person, decided to retire. Therefore, we went from having a collective 40 years of experience running a CIED clinic to having nobody in short order. That led us to evaluate other options to manage this large and mostly rural patient population located in northern New England and upstate New York. We reached out to RemoteMD to address our needs for managing our remote CIED patient population. We sought PrepMD’s assistance to help us manage our acute staffing dilemma through their contract staffing service, PrepMD Professionals.
How did you find out about RemoteMD?
Winget: I’ve known Matt O’Neal at PrepMD for a long time. I’ve been an implanting electrophysiologist for 25 years, and I met Matt when he was with his previous employer.
When did you begin using RemoteMD at the University of Vermont?
Hanley: We started using this in October 2016.
What was the on-site training like? Tell us more about what the transition period was like in general.
Winget: We contracted with PrepMD Professionals to provide the University of Vermont with 2 trained individuals, so we didn’t need to be concerned about technical training — we just needed to train them on the intricacies of the University of Vermont Health Network. Just like any other new employee, they had to go through a series of competencies, mandatory learning modules, and internal clinical operations so that they could understand our environment at UVM Health Network.
In what ways did your practice customize RemoteMD for your needs?
Winget: Over the last many years in the cardiac rhythm management (CRM) space, devices have become substantially more complicated. If you are going to leverage the amount of information that is coming from these devices, you need to have highly specialized and trained individuals that understand not only the technical details of the CRM devices themselves, but the interface of that information with the patient’s clinical status. The CIED clinic plays a crucial role at UVM Health Network in managing this complicated patient population. In the past, it was simply a matter of “checking” a pacemaker or defibrillator, but now you have all these advanced parameters regarding device optimization, heart failure, and the presence of atrial fibrillation or other arrhythmias, that have to be evaluated and acted on. PrepMD has positioned themselves to assist facilities in this process.
What types of monitoring do you use RemoteMD for? For example, for scheduled transmissions only?
Winget: We are using it right now for our remote monitoring, so there is a huge amount of remote monitoring information that is generated automatically. That information is going to RemoteMD, where their trained staff look at all of it and send it to UVM. The device checks are done onsite or at our satellite clinics.
Hanley: We use multiple systems here, so we have our EMR system for patient notes, and we have a system that we solely use to schedule. Scheduling is something that we retained within our clinic because of linked appointments. However, RemoteMD was a big help to us when we experienced a gap in billing after our nurse retired. They pursued the backlog of remotes, created clean reports for us, brought us back up to speed, and have kept us current.
How has your workflow changed since utilization of RemoteMD?
Hanley: Implementing RemoteMD has afforded our tech and nurse to focus more on patient care, and not have to monitor first thing in the morning — Aimee Bollentin, NP, the RemoteMD Clinical Manager, and her lead cardiac monitoring associate (CMA), Michael Girard, look at that and alert us to anything needing more immediate attention. Despite all the nuances that vendors have in their reports, she does a great job of taking that information from the vendors that we work with and creating one clean and efficient report that is customized for us.
Has RemoteMD also helped optimize billing?
Hanley: Yes! Billing had become challenging when just our previous nurse was here, because it was being done only once a week, and she wasn’t really able to pursue all of the transmissions that were billable in the short term. By having our tech and nurse focus only on device interrogation, and having RemoteMD analyze these reports and rhythms to see what is billable, we’re able to pursue a higher volume of what is actually billable. I think in the past, we weren’t capturing that at all.
Is there anything else you’d like to add?
Winget: RemoteMD has been very helpful and flexible, so it’s been a nice collaboration. They were a big help when we experienced this shortfall!
Hanley: I would echo that!
Disclosures: The authors have no conflicts of interest to report regarding the content herein.