March 12, 2012

Technology Manages Cardiac Devices Remotely
By Kim M. Norton
For The Record
Vol. 24 No. 5 P. 8

Electrophysiologist E. Martin Kloosterman, MD, director of the electrophysiology laboratory and chief of the cardiology department at Boca Raton Regional Hospital in Florida, has developed a new application, known as the Remote-K-Viewer, for the iPad that can remotely evaluate, monitor, and reprogram pacemakers and defibrillators while patients are in the hospital.

The current model for evaluating implantable cardiac devices (ICDs) is for a representative from the device company to assess the situation, which can be less than ideal, says Kloosterman. Typically, a representative will examine the device to determine if it’s functionally properly. The clinical data stored in the devices are relayed to the ordering physician, who may not be an expert in the field (ie, an emergency department (ED) doctor), who passes along the information to a specialist. In turn, the specialist may need additional data or for the device to be adjusted, necessitating a call back to the device company representative.

“The burden of service has been on the device company. There is no direct compensation to the representatives for their service in the field and is in fact very disruptive of their schedules,” he explains.

Kloosterman’s research indicates that the response time using the Remote-K-Viewer could be five minutes, whereas waiting for a device company representative could take anywhere from 10 minutes to two hours.

As technology grows by leaps and bounds, the possibility of transforming healthcare in the hectic environment EDs becomes more realistic. When it comes to monitoring ICDs, there’s plenty of room for improvement, says Kloosterman, who found patient care to be “inefficient, time-consuming, and with significant gaps.”

Capitalizing on Technology
To develop the Remote-K-Viewer, Kloosterman capitalized on a technology found in abundance in virtually every ED: computers. “[The Remote-K-Viewer] allows specially trained doctors or nurses to follow the remote physician’s screen, which is a mirror image of their computer, at the patient’s bedside in real time. The trained nurse or doctor follows the pointer on the laptop screen, which is being remotely controlled by the physician on the remote iPad,” he says.

Taking advantage of the iPad’s screen size and its ability to connect to the Internet virtually anywhere, Kloosterman put his application to an extreme test. While on a commercial flight at 30,000 feet, he used his iPad to connect to a Wi-Fi service and then to a hospital laptop via an encrypted line. (A 3G network can also be used.) Opening a chat line to enable constant communication with a hospital operator, Kloosterman gave instructions to the operator and accessed the computer screen pointer to interrogate and reprogram cardiac devices from three different companies: Boston Scientific, Medtronic, and St Jude Medical.

Kloosterman presented the results of his experiment at the Venice Arrhythmias 2011 international workshop and published an abstract in the Journal of Cardiovascular Electrophysiology in which he reported “that 28 consecutive patients were successfully evaluated … with the transmissions estimated to have a 3-5 second delay in communication and the transmission generally lasted 16 minutes.”

Back on the ground, the software system has proven just as worthy. “The model was tested in our hospital emergency and operating rooms and allows physicians to have direct access to the information on the patient’s device for adjustment and reprogramming in a moment’s notice, no matter where they are and at any given time,” says Kloosterman.

Real-Time Remote Access
In a fast-paced environment, the need for up-to-date health data increases. However, rapid information gathering is useless and potentially harmful if the data are inaccurate.

“An advantage of the Remote-K-Viewer is the real-time data acquisition by the cardiologist is firsthand rather than being described by the technician, which takes the opportunity for error out of the equation,” explains Evan D. Goldstein, MD, an ED physician and fellow investigator on the Remote-K-Viewer project.

Besides affecting care inside hospital walls, the technology shows promise for making expert care available to remote and rural locations where specialists are not typically found. “This is a cost-effective way to allow for a faster, higher level of care by an electrophysiologist to a wider array of patients,” Goldstein says.

Initial Reactions
Because it’s a nonobtrusive platform that works behind the scenes, so to speak, the Remote-K-Viewer doesn’t require a lot of effort to get it up and running.

“The only real investment in adding the Remote-K-Viewer to a hospital or urgent care setting is in staff training,” Goldstein says. “The computer is just another piece of equipment and acceptance by the staff has been good. Had this been introduced 15 to 20 years ago, acceptance would not have been as good.”

Remote patients of all ages have been impressed with the Remote-K-Viewer’s capabilities, Goldstein adds. “The older population, those not typically users of technology, are excited to take advantage of the technology that their grandchildren are using. They are seeing a very practical use of the technology and understand that while the specialist is not physically in the room, they are seeing the data firsthand,” he says.

Future Developments
Before settling on the iPad as a home for the application, Kloosterman tested it on the iPhone but found the screen was too small to get a practical view of cardiac activity. He did not test the application on the Android or BlackBerry because he was unsure if the devices would support the program, he explains.

“The Remote-K-Viewer concept is a new software/hardware communication system and the first step into an inevitable direction: real-time remote device management,” Kloosterman says. “We are excited [about] the possibilities that this application has to offer in regard to the development of a new generation of programs and service models in the near future.”

— Kim M. Norton is a New Jersey-based freelance writer specializing in healthcare-related topics for various trade and consumer publications.