RPM CIED – Letting Technology Make the System Better for Everyone

As CANet strives to improve the lives of Canadians living with arrhythmias, one of the issues that come to the fore is geography. How can we ensure people are getting the best care where they are when they need it?
Dr. Ratika Parkash is an electrophysiologist at Halifax’s QEII Health Sciences Centre, and a Professor at Dalhousie University. Her innovative CANet-funded program, Remote Patient Management for Cardiac Implantable Electronic Devices (RPM-CIED) is an excellent example of a program that looks at how to serve people living in remote areas of Canada.
There are currently approximately 120,000 Canadians living with either a pacemaker or an implantable defibrillator (ICD). Patients who have these devices are required to visit a cardiac device clinic at least once a year.
Dr. Paul MacDonald, a cardiologist at Cape Breton Regional Hospital, explains the challenges that some patients face:
“We are over 400 km away from the teaching centre where these are implanted and so while we have dozens of patients with these devices if they do need to be checked or monitored … it’s a really big deal. It’s a trip to Halifax, it’s a five-hour drive, it’s generally an overnight stay … often patients’ families have to go, or patients are admitted to hospital and require ambulance service to transport them back and forth. So this can be very expensive for the healthcare system, certainly expensive and challenging for families to manage, and it really is an area that may be well suited to allowing technology and better communications services to let us manage these patients locally.”
RPM-CIED is assessing barriers, evaluating, and implementing a patient-oriented CIED management model that will help provide timely, uniform and efficient care for CIED patients across Canada. How will that care be provided? Through technology that allows remote monitoring and programming of CIEDs.
Dr. Parkash describes the benefits of the program:
“Rather than patients having to travel from remote locations in Canada like the Northwest Territories where there are potentially no heart rhythm specialists, or northern Ontario, or even parts of Nova Scotia, patients can be managed remotely and be managed just as effectively as if they travelled to the centre where the device might have been implanted.”
The first project in the RPM-CIED program involved surveying CIED patients to learn how they feel about remote monitoring technology. Patient engagement is a hallmark of CANet’s research program, and this is a prime example of how integrating patients’ feedback can improve the quality of the final outcomes. As Dr. Parkash notes:
“One of the key aspects we have learned is that patients demand feedback when they have a remote monitoring session. So they’re happy to have a remote monitor at home, but the missing link is the ability for that remote monitor to tell them what the device is doing and how it’s behaving. Through CANet we are going to create a link for the patient to be able to access what that remote monitoring session revealed to their caring physician.”
While the cost-savings for patients are easy to see, remote patient monitoring will also result in health care costs savings – through the reduction of inpatient and outpatient clinical services, and the potential reduction in stroke and sudden death through early detection of atrial fibrillation and ventricular arrhythmias.”
As Dr. MacDonald points out:
“It’s being more efficient with our time and resources. Everybody’s busy, everybody’s time is important, so it really does let technology make the system better for everyone.”