Surgical Defibrillator Implant with Remote Monitoring & Follow-up Care by Electrophysiologist

1. Care Theme: Transitions of Care Surgical Defibrillator Implant with Remote Monitoring & Follow-up Care by Electrophysiologist Interoperability Showcase In collaboration with IHE Use Case 9

2. Care Theme: Transitions of Care UC 9: Surgical Defibrillator Implant with Remote Monitoring and Follow-up Care by EP • Primary Goal: To demonstrate how the use of remote monitoring of home-based medical devices and alarm management following the surgical implantation of a defibrillator to a patient with chronic irregular heart rhythm. Improves the follow-up care for the patient by the EP and patient’s cardiologist. • Key Points: • The demonstration will use the IHE Cross-enterprise Document Sharing profile for exchange of medical summary information between electronic medical record (EMR) Systems and personal health records (PHRs). • Helps with the transition of the patient’s care plan from the hospital setting to the home setting. • Allows device data to be captured automatically in EMR systems which reduces workflow complexity. • Meaningful Use (MU) Relevance: • Improving Care Coordination – Exchanging key information among authorized care providers • Improving Quality, Safety, Efficiency, and Reducing Health Disparities • Clinical Workflow: • A patient with an LV dysfunction due to a prior myocardial infarct and an LV ejection fraction of 25 % undergoes a surgery for the implantation of a prophylactic implantable cardiac defibrillator (ICD) implantation. The surgery is a success and once stabilized the patient is discharged with a care regimen that includes the remote monitoring of critical physical conditions as well as a home-based device for the monitoring of the implanted defibrillator. The patient’s is provided with care instructions for updating his PHR. • At home, a home nurse service has assisted the pt with setting up the remote monitoring equipment. The physiological monitoring info is captured regularly and forwarded to the Remote Monitoring Mgmt Service (RMMS) engaged for the Pt. The RMMS creates and publishes a patient summary of the physiologic monitoring information to the community Health Information Exchange (HIE) making it available for access by the patient at home and the electrophysiologist’s (EP) office responsible for the Patient’s care. • Approximately 2 weeks after the surgery, an Atrial Fibrillation (AF) event triggers an alert which is sent via the device’s monitoring service established by its manufacturer to the EP’s office responsible for the Patient’s care. (sent via email notification) • Upon receiving the alert, the EP downloads the implanted ICD device’s report and the physiological monitoring information. The EP reviews the ICD device’s report and refers the patient directly to the EP Lab to be examined. • A report of the recent EP encounter and detailed summaries of the patient’s EP Lab and remote monitoring results are shared with the patient’s Cardiologist.

3. Care Theme: Transitions of Care UC 9: Surgical Defibrillator Implant with Remote Monitoring and Follow-up Care by EP 1. OR/EP Lab 3. Remote Monitoring Management System 2a. Monitoring Devices 2. Home Setting Clinical Workflow: 5. Cardiologist 4. EP Office 2b. Device Manuf. / Monitoring Service A patient undergoes a surgery for the implantation of an implantable cardiac defibrillator (ICD). Later, the patient is discharged with a care regimen that includes routine monitoring of critical physical conditions as well as a home-based device for the monitoring of the implanted defibrillator. The patient is also provided with care instructions for updating his PHR. At home, a home nurse service has assisted the patient with setting up the remote monitoring equipment. The physiological monitoring info is captured regularly and forwarded to the Remote Monitoring Mgmt Service (RMMS) engaged for the patient. The RMMS creates and publishes a patient summary of this information to the community Health Information Exchange (HIE) making it available for access by the patient at home and the EP’s office responsible for the patient’s care. The patient has an abnormal event (AF) which triggers an alert which is sent via the device’s monitoring service established by its manufacturer to the EP’s office responsible for the Patient’s care. (sent via email notification) Upon receiving the alert, the EP downloads the implanted ICD device’s report and the physiological monitoring information. The EP reviews the ICD device’s report and refers the patient directly to the EP Lab to be examined. A report of the recent EP encounter and detailed summaries of the patient’s EP Lab and remote monitoring results are shared with the patient’s Cardiologist.

4. Care Theme: Transitions of Care UC 9: Surgical Defibrillator Implant with Remote Monitoring and Follow-up Care by EP IHE Profiles & Domains: Visit the IHE Product Registry at: ihe.net/registry