idco research study: direct patient messaging icd data · 2020. 7. 27. · idco research study:...
TRANSCRIPT
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IDCO Research Study: Direct Patient Messaging ICD Data
Implementation and Randomization
Michael J. Mirro, MD, FACC, FAHA, FACP
Chief Academic/Research OfficerParkview Health
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Funding• Feasibility IDCO Study (SJM-MIE) Office of the National Coordinator for Health Information Technology Challenge Grant awarded to Indiana Health Information Technology (IHIT).
• NoMoreClipboard and Parkview Research (grant sub-recipients)
• SJM-EPIC ICD messaging StudyIndustry Support ($150,000)
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Patients Speak Out About Access to Data
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Implantable Cardioverter-Defibrillators: High Value Data
Why implantable cardioverter-defibrillators (ICDs)?• Patients at risk for sudden cardiac death
Why remote monitoring?• ICD data (status, settings, episodes, events) available to clin
through patient home monitoring system• Reduces time between cardiac events and clinician review o
the data• Reduces the number of emergency room and office
visits
--> HIGH VALUE DATA FOR PATIENTS
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Current Practice Remote Monitoring
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• Current ICD patient notification standards• Patients receive letter through the mail• Simple statement that the device check is satisfactory• Little or no details about the actual transmission content• Many patients feel that they have a right to access and
view the data their ICD is transmitting
Current Standard of Care
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Current Information Shared -Patient Letter
RE: RECENT ICD/PACEMAKER CHECK
Dear Patient,
Your recent ICD check by phone shows essentially normal function. You did have 1rapid heart rate recorded briefly. NO therapy was needed from your device.
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Feasibility Study Remote Monitoring
NoMoreClipboard ePHR
WebChart EHR
Health Information Exchange(MedWeb)
Cloverleaf Secure Courier
IDCO Profile
Merlin.net
Discrete data elements
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Goal of Study
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Study Design
Sample: 21 St. Jude ICD patients undergoing remote monitoring (Merlin.net)Site: Parkview Physicians Group – Cardiology, Fort Wayne
Duration: 3 months
Intervention: electronic delivery of Patient Notification Summary using the Implantable Device Cardiac Observation Profile (standard)
Measures:-Baseline patient survey and three month survey to assess Patient
Activation (Patient Activation Measure, Insignia Health LLC)-Semi-structured interview at 3 months-Number of logins into NoMoreClipboard PHR-Provider survey at PPG-Cardiology
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IDCO Profile
Implantable Device Cardiac Observation (IDCO) Profile Standard message
Nomenclature - same language X systemsIEEE 11073-10103
Structure - where data landsHL7 v. 2 orders and observations
Specification of integration – rules for data transferIntegrating the Healthcare Enterprise (IHE)
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IDCO Profile
Pacemaker & ICD data interoperability
• Allows device data to be captured in EMR systems automatically which reduces workflow complexity
• EMR implementation costs are reduced for those systems that comply with IDCO profile
• Ensures quality of care by conforming data to standard data format and terminology
• Oversight from Heart Rhythm Society (HRS)
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IDCO Profile: IEEE data elements & display
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NoMoreClipboard – Patient Notification Summary
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Patient Notification Summary
1
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Member Summary Page
Patient Notification Summary
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WebChart EMR – Flowsheet of data elements
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Patients want to know what their device is doing, if there is “anything wrong”, and their battery status
Patient Notification Summary – lessons learned
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Study AIM - Demonstrate the value of electronically messaging data from remote monitoring of ICDs via an electronic personal health record (PHR) to improve patient engagement
RESEARCH STUDY: Patient Notification of Remote Implantable Cardioverter - Defibrillator
(ICD) Monitoring Data: Impact of Patient Engagement on Outcomes – Merlin.net™
System
AKA….SJM-IDCO STUDY
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To evaluate the impact of sharing remote monitoring ICD data with patients through their PHR on:
• patient engagement. • provider--patient communication.• healthcare utilization.
To determine patient satisfaction about access to remote monitoring ICD data
To explore providers’ attitudes and perceptions regarding the value of the ICD Patient Notification Summary, its impact on clinic workflow and its effect on patient-provider communication.
Primary Objectives of the Study
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• Survey PATIENTS at baseline, 3 months, and 6 months on:– level of engagement (PAM) / attitudes – expectations about remote monitoring / receiving ICD data
• Survey PROVIDERS on:– attitudes/perceptions of the ICD Patient Notification Summary
• ENROLLMENT IS ONGOING (191 patients to date)Inclusion Criteria• Implanted with a St. Jude Medical ICD • Undergoing remote monitoring by the Merlin.net™ system• Have access to computer and/or Internet (Group A and B only)• Patient has a scheduled ICD download within the study period
at the time of enrollment
SJM-IDCO Pilot Study
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Project Overview
• Patients divided into three groups
• Group A - Receive ELECTRONIC notification summary. The intervention group will activate a MyChart account and will receive training on how to use their PHR and how to view/read their ICD Patient Notification Summary online
• Group B - Receive PAPER notification summary. Subjects will activate a MyChart account and will receive training on how to use their PHR and how to view/read their ICD Patient Notification Summary on paper
• Group C – Standard of Care, only
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Number of patients Total (191) Group A (73) Group B (71 ) Group C (47)Gender
Female 62 (32%) 24 (33%) 19 (27%) 19 (40%)Male 129 (68%) 49 (67%) 52 (73%) 28 (60%)
Age18-29 4 (2%) 3 (4%) 1 (1%) 0 (0%)30-39 5 (3%) 3 (4%) 2 (3%) 0 (0%)40-49 9 (5%) 5 (7%) 4 (6%) 0 (0%)50-59 30 (16%) 15 (19%) 9 (19%) 7 (15%)60-69 56 (29%) 20 (27%) 25 (35%) 11 (23%)70-79 60 (31%) 21 (28%) 21 (30%) 18 (38%)80-89 26 (14%) 6 (8%) 9 (13%) 11 (23%)
SJM-IDCO STUDYEnrollment is ongoing 191 patients to date…
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MyChart
Information Flow Research Subjects
Epic
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Patient Notification Summary-Patient view in MyChart
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Patient Notification Summary-Patient view in MyChart
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MyChart Display Design
ACC/HRS Guidance
Provide Patients with High Value Data Minimum Data Set
• Battery Status• Lead and Shock Coil Status• Ventricular Therapies (ATP/Shocks)
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MyChart Display Design
Feedback (Patient Interviews-feasibility study)
• For example: Patients appreciated and desired having explanations, However hovering over was not intuitive.
• Lesson applied: current study EPIC DISPLAY includes the definitions on the display page
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Patient Notification Summary-Patient view in MyChart
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Device Information
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Easy to read definitions
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Overview of heart rate
and pacing
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Date and time of
episodes
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Weekly Conference Calls: Parkview Saint Jude Epic -input from
Cardiologist ACC/HRS
Rules -> Match Patient Name, DOB, MRN
(otherwise route to error queue)
ALL Saint Jude Merlin.net patients routed to Epic
Discrete DataProgramming “Rules”- Epic
1. To Receive Reports (IDCO Profile)
2. Order type needed to be created
Technical Details
Research Flags• Programming Capability -
Auto release to MyChart(after 4 bus days).
• Manual Release Used for this study. – defined reports sent were those “processed” by ADC clinic.
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• Will the patients understand?• Will the clinic be inundated with calls?• Who is responsible, and when?• What is normal and what is abnormal?• Should information be held or flow directly to the
patient portal?• What will patients do with this information
Lessons Learned
Some Concerns Expressed Prior to Implementation
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Lessons LearnedFEASIBILITY STUDY Provider Perspectives
• 31% believe the Patient Notification Summary could reduce work for the clinic
• 73% believe it will allow for better patient care
• 44% think it has a positive effect on patient-provider communication, and the remaining 66% were undecided. No participants reported a negative effect on communication.
Providers (including physicians, nurses, and ADC technologists, N=41) completed a survey to explore attitudes and perceptions about the Patient Notification Summary @ PPG-Cardiology
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FEASIBILITY STUDYPatient-Provider Communication
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Lessons Learned
• The right information – High Value Data
• The right Time – Information in a timely manner to bring relevance
• Customized and personal to patient needs from reassurance to high level details
Apply patient feedback to the development of tools that will better serve and engage patients in their healthcare
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Thank you!Questions:
Michael J. Mirro MD FACC
Lisa Heral RNBA [email protected] - 260-266-5615
Carly Daley BA [email protected] 260-266-5587
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Extra Slides
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Number of patients Total (191)
Group A (73) Group B (71 ) Group C (47)
First ICD Patient Notification Summary released
33 23 10 N/A
Second ICD Patient Notification Summary released
1 1 0 N/A
Number of patients who had transmissions (Merlin)
87 37 35 15
Total number of transmissions (Merlin)
129 58 52 19
TO DATE: TRANSMISSIONS SENT Merlin.net IDCO MyChart
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Lessons Learned
Semantics
iEEE Enumeration List
PATIENT: 2am device Check
MERLIN: Alert Initiated EPIC: Remote Scheduled