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Amy Leiserowitz, RN, technical director of Arrhythmia Services at Iowa Heart Center, has documented clinical efficiencies through use of the Medtronic CareLink Network and other Medtronic information solutions.
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Headquartered in the figurative heart of Iowa - Des Moines
- the Iowa Heart Center branches out to several offices and
locations throughout the central, northern, and southern parts
of this primarily rural state. To manage the growing, multiple-site
practice and increase operational efficiencies, Iowa Heart Center
(IHC) relies on several Medtronic technologies that facilitate
information access, flow, and organization: the Medtronic
CareLink® Network, the Medtronic CareLink Programmer,
Paceart® System, and CardioSight® Service. With this suite
of information solutions, or "iSolutions," clinicians in all IHC
locations can access cardiac device information for any patient,
helping provide consistency of care across the organization.
"Each individual office at Iowa Heart Center works like a
small office, taking care of its patient population, but if a
patient shows up at another office, we're able to take care
of them," says Amy Leiserowitz, RN, technical director of
Arrhythmia Services.
David Gordon, MD, the first board-certified cardiologist in
central Iowa, founded Iowa Heart Center in 1970 with the
modest vision of building a cardiology practice of three
physicians. Today the center has grown to 60 cardiologists
and surgeons, including seven electrophysiologists, as well as
20 EP nurses. These clinicians serve thousands of patients in
Des Moines, West Des Moines, Ames, Carroll, Fort Dodge,
Council Bluffs, and surrounding communities.
The center's focus hasn't changed since Dr. Gordon opened
the first office: to provide quality, leading-edge, compassionate
care to patients and their families. Implantable cardiac devices
play an important role in the center's mission of providing
aggressive treatment that helps patients live longer, healthier
lives. The clinic also strives to provide primary prevention for
people at risk of sudden cardiac death, according to national
screening guidelines.
The center implanted 1,169 ICDs and more than 800 pacemakers
in 2005. "Iowa Heart Center has taken pride in providing the
newest and greatest devices available," Leiserowitz notes.
Better efficiency and care with the
The rapid growth in IHC's device patient population made
managing follow-up care a complex challenge. "With our
increase in volume of ICDs, we didn't have enough staff to check
all the patients like we did in the past, so we had to change the
process," Leiserowitz says.
She conducted a two-day observation in 2003 comparing
remote device checks via the Medtronic CareLink Network
with in-office evaluations. It took her and the staff nearly three
times as long to conduct in-office device checks (25 minutes on
average) compared with remote checks (8 minutes on average).1
Based on the study results, EP nurses calculated that remote
follow-up saved Iowa Heart Center the equivalent of seven
weeks of labor over the course of a year.
"We found that it took significantly less of the nurses' time
to get the same information, so it's more cost-effective,"
Leiserowitz notes. Today, three out of four annual device checks
are performed remotely through the Medtronic CareLink
Network for more than 1,400 enrolled patients. If patients
experience symptoms or hear an alarm tone between checks,
they transmit device data from home, and IHC staff review it on
the secure Medtronic CareLink Clinician Website.
Mary Jo Ytzen, RN, director of EP Services at Iowa Heart Center,
says that remote follow-up improves both patient care and
satisfaction; patients appreciate not having to take time off
work, drive to the clinic, or arrange transportation. "We also
have a much better opportunity to address therapy shocks," she
explains. "There have been times when patients have received
shocks for atrial fibrillation. That changes how we're going to
take care of the patient."
Another benefit, according to Leiserowitz, is the increased
flexibility for clinic schedules. "The greatest benefit to our
staff is that the Medtronic CareLink Network allows us to
triage situations and determine which patients need immediate
care," she says. "The Medtronic CareLink Network gives us the
flexibility to work nonsequentially, based on what needs to be
done most urgently."
Iowa Heart's EPs see great potential in Conexus™ Wireless
Telemetry used with both the Medtronic CareLink Network and
Programmer. Ben Johnson, MD, predicts that wireless-enabled
cardiac devices will become the norm, and sees their real value
in remote monitoring. According to Johnson, automatic, routine downloading of device data eliminates the need for "active
participation either by the follow-up center or the patient."
Ytzen says automatic monitoring will improve care. "Wireless
will provide patient confidence and minimize the number of
'no-shows.'"
Electrophysiologist Ben Johnson, MD, is excited about the potential for wireless-enabled cardiac devices to improve patient satisfaction, compliance, and outcomes.
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Says Johnson, "The whole goal of wireless is quicker integration
of the patient's data with what we can do initially with
medications and later with manipulation of programmable
device parameters to try to improve care. We have simply got
to create the means by which cardiac device information can
be translated to better patient outcomes and less expensive
solutions to their problems."
Harnessing the potential of
wireless communication:
Electrophysiologists at Iowa Heart Center use the Medtronic
CareLink (2090) Programmer to set device parameters and
therapies at implant and follow-up. IHC participated in clinical
studies of the Medtronic Concerto® CRT-D, one of the first
cardiac devices with Conexus Wireless Telemetry. Iowa Heart's
implanting teams appreciated the efficiencies they gained
through use of wireless communication.
"The wireless-enabled Medtronic Programmer is really nice at
the time of implant," notes Ytzen. "Programming can be done
without having to have the telemetry wand over the patient's
device. It can be done very quickly while the pocket is being
closed."
In the clinic, nurses can do evaluations of wireless-enabled
devices while talking to the patient or conducting a
physical exam.
Overall, the nurses find it convenient to use the Medtronic
CareLink Programmer with both wireless and non-wireless
devices. "I like the screen layout - it's very easy to read," says
RJ Kuskulis, RN. "It's simple to use the pen. I like the reports
that are produced. There's so much information. I give patients
a printout so they understand what their therapies are. I show
them how to read electrograms or marker channels."
An information hub:
From the Medtronic CareLink Programmer and the Medtronic
CareLink Network, data flow into the Paceart system, which
provides a central hub for organizing and archiving patients'
arrhythmia and device information. Iowa Heart Center clinicians
use Paceart to document and store all device evaluations and
follow-ups, including remote, in-office, and transtelephonic
monitoring follow-ups. Remote checks via the Medtronic
CareLink Network download automatically into Paceart
each night.
Leiserowitz notes that the automatic downloads help the clinic
staff manage workflow. "We schedule patients to send their
transmissions on a certain day, so we always know how many
transmissions we'll have to review the following day. We can plan
our time and prioritize."
Paceart manages information for all leading vendors' devices and
can serve as the gateway to electronic health record systems.
"All offices are up and running," says Leiserowitz. "Paceart
ties in nicely with what we're trying to accomplish - no paper
charts. Having everything in one place makes it easier to get the
information we need, which saves time."
CardioSight Service is another of Medtronic's information
solutions that Iowa Heart Center has leveraged for better
patient care. The service provides tailored heart failure
information to help cardiologists treating heart failure identify
problems such as fluid overload2 before patients report
symptoms. Although many of Iowa Heart's cardiologists work
in close proximity to the clinic's electrophysiologists, they
appreciate having a tool that provides quick, easy access to
a patient's device data, without having to rely on the EP for
a programmer device interrogation.
"Heart failure physicians don't want to know all the numbers
- they just need to see those parts of the data collection that
are relevant to heart failure. CardioSight Service gives them
that subset," says Ytzen. "From an efficiency standpoint in the
office, they get the information very quickly because the patient
doesn't have to be scheduled for a device check, and the device
nurses don't have to be involved in the data review."
According to Jolene Runkel, MSN, a nurse practitioner at Iowa
Heart Center's Heart Failure Clinic, CardioSight Service provides
more objective information for diagnosing intrathoracic fluid
buildup. "It makes my job easier because we're catching
problems earlier."
CardioSight Service provides either a Heart Failure Management
or Cardiac Compass® Trends Report, both of which are useful for
communicating with patients and with other providers involved
in a patient's care, says Runkel. "If I see that a patient has had an
irregular heartbeat, then I can go talk to the cardiologists or the
EP doctors," she says. "We have more evidence as to what's
going on."
With a wealth of patient cardiac device information flowing freely
throughout Iowa Heart Center, Ytzen sees many opportunities
for further development and a higher quality of patient care.
"We're on the foothill as far as what the possibilities are," she
says. "Anytime you can streamline your process, it allows you to
be more attentive to patient care issues, to deal directly with the
patient versus manipulating the data. Especially when you look
at the number of patients, we have a real opportunity to serve.
That's pretty exciting."
This case study recounts one clinic's experience using the Medtronic CareLink Network for remote device follow-up. Medtronic, Inc. cordially invited
doctors and clinic staff to share their story. Please bear in mind that this experience is specific to this clinic. Results may vary. Not every clinic will
have the same results.
References
1 Falk D, Straub K. Practice efficiency improvements resulting from the use of Medtronic CareLink Network Remote Monitoring Service. Fairfield, Iowa: Human Factors
International, July 2004.
2 For patients who have devices with OptiVol® Fluid Status Monitoring.
Brief Statement
ConcertoTM Model C154DWK
Indications: Concerto is indicated for ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life-threatening ventricular arrhythmias. The system is also
indicated for the reduction of the symptoms of moderate to severe heart failure (NYHA Functional Class III or IV) in those patients who remain symptomatic despite stable, optimal medical
therapy, and have a left ventricular ejection fraction < 35% and a prolonged QRS duration. Contraindications: Concerto is contraindicated in patients whose ventricular tachyarrhythmias
may have transient or reversible causes; patients with incessant VT or VF; and patients who have a unipolar pacemaker. Warnings and Precautions: Changes in a patient's disease and/or
medications may alter the efficacy of the device's programmed parameters. Patients should avoid sources of magnetic and electromagnetic radiation to avoid possible underdetection,
inappropriate sensing and/or therapy delivery, tissue damage, induction of an arrhythmia, device electrical reset, or device damage. Do not place transthoracic defibrillation paddles directly
over the device. Certain programming and device operations may not provide cardiac resynchronization. Potential Complications: Potential complications include, but are not limited to,
rejection phenomena, erosion through the skin, muscle or nerve stimulation, oversensing, failure to detect and/or terminate tachyarrhythmia episodes, acceleration of ventricular tachycardia,
and surgical complications such as hematoma, infection, inflammation, and thrombosis.
Model 2090 Medtronic CareLink® Programmer
The Medtronic CareLink Programmer is a portable, microprocessor-based instrument used to program Medtronic implantable devices.
Model 2490 Medtronic CareLink® Monitor
Intended Use: The Medtronic CareLink Monitor and the Medtronic CareLink Network are indicated for use in the transfer of patient data from some Medtronic implantable cardiac devices
based on physician instructions and as described in the product manual. These products are not a substitute for appropriate medical attention in the event of an emergency and should only
be used as directed by a physician. Warnings and Precautions: Do not use a cellular phone while the antenna is positioned over the implanted device.
Model 2020A CardioSight® Reader
Intended Use: The Model 2020A CardioSight Reader is intended for use in a clinical setting. The CardioSight Reader is indicated for use to interrogate compatible Medtronic implantable
devices to collect patient and device data and send the information to the clinician. The Model 2020A CardioSight Reader cannot be used to change therapy. Contraindications: There are no
contraindications for the Model 2020A CardioSight Reader. Warnings and Precautions: The CardioSight Reader must only be used for interrogating compatible Medtronic implantable devices.
Do not use a cellular phone while the antenna is positioned over the implanted device. The CardioSight Reader is designed for use in the continental United States, Alaska, and Hawaii.
Paceart®
For further information regarding Paceart, please call Medtronic at 1 (800) 722-3278 and/or consult Medtronic's website at www.Paceart.com.
See the device manual for detailed information regarding the instructions for use, indications, contraindications, warnings, precautions, and potential complications/adverse events. For further information, please call Medtronic at 1 (800) 328-2518 and/or consult Medtronic’s website at www.medtronic.com.
Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.
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