Background: The volume of remote monitoring (RM) data generates a significant workload and is generally dealt with by clinic staff during standard office hours, potentially delaying clinical action.
Objective: The purpose of this study was to determine the clinical efficiency and workflow of implementing intensive RM (IRM) in patients with cardiac implantable electronic device (CIED) when compared with standard RM (SRM).
Methods: From a cohort of >1500 remotely monitored devices, 70 patients were randomly selected to undergo IRM. For comparison, an equal number of matched patients were prospectively selected for SRM. Intensive follow-up occurred via automated vendor-neutral software with rapid alert processing by International Board of Heart Rhythm Examiners-certified device specialists. Standard follow-up was conducted by clinic staff during office hours via individual device vendor interfaces. Alerts were categorized on the basis of the level of acuity as actionable (red [high], yellow [moderate]), or green [not requiring action]).
Results: Over 9 months of follow-up, 922 remote transmissions were received; 339 (36.8%) were coded as actionable alerts (118 in IRM and 221 in SRM; < .001). The median time from initial transmission to review was 6 hours (interquartile range [IQR] 1.8-16.8 hours) in the IRM group compared with 10.5 hours (IQR 6.0-32.2 hours) in the SRM group ( < .001). The median time from transmission to review of actionable alerts in the IRM group was 5.1 hours (IQR 2.3-8.9 hours) compared with 9.1 hours (IQR 6.7-32.5 hours) in the SRM group ( < .001).
Conclusion: Intensive and managed RM results in a significant reduction in time to review alerts and number of actionable alerts. Monitoring with enhanced alert adjudication is needed to facilitate device clinic efficiency and optimize patient care.
Study Registration: ACTRN12621001275853.
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http://dx.doi.org/10.1016/j.hroo.2022.11.002 | DOI Listing |
J Imaging Inform Med
January 2025
University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, BSH 5056, Cleveland, OH, 44106, USA.
The objective of this study is to implement an actionable incidental findings (AIFs) communication workflow integrated into the electronic health record (EHR) using dictation macros to improve the quality of radiology reports and facilitate delivery of findings to clinicians. The workflow was implemented across an academic multi-hospital health system and used by over 100 radiologists from 12 divisions. Standardized macros were created for different organ systems including the thyroid, lungs, liver, pancreas, spleen, kidney, female reproductive, and others, designed based on the ACR Novel Quality Measure Set.
View Article and Find Full Text PDFFront Pharmacol
December 2024
Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, United States.
Introduction: The Precision Medicine Program (PMP) at the University of Florida (UF) focuses on advancing pharmacogenomics (PGx) to improve patient care.
Methods: The UF PMP, in collaboration with the UF Health Pathology Laboratory (UFHPL), utilized Health Level Seven (HL7) standards to integrate PGx data into Epic's Genomic Module to enhance the management and utilization of PGx data in clinical practice.
Results: A key feature of the Genomic Module is the introduction of genomic indicators-innovative tools that flag actionable genetic information directly within the electronic health record (EHR).
Appl Clin Inform
December 2024
Medicine, UCSF, San Francisco, United States.
Background: The proliferation of electronic health record (EHR) alerts has led to widespread alert fatigue and clinician burnout, undermining the effectiveness of clinical decision support and compromising patient safety.
Objective: We introduce a comprehensive style guide for designing interruptive alerts (IAs) in EHR systems to improve clinician engagement and reduce alert fatigue that has been approved by our institutional alert governance committees. This style guide addresses critical aspects of IAs, including format, typography, color-coding, title brevity, patient identification, and introductory text.
J Am Med Inform Assoc
December 2024
University of California, San Francisco, San Francisco, CA 94143, United States.
Objective: This article describes the implementation of preemptive clinical pharmacogenomics (PGx) testing linked to an automated clinical decision support (CDS) system delivering actionable PGx information to clinicians at the point of care at UCSF Health, a large Academic Medical Center.
Methods: A multidisciplinary team developed the strategic vision for the PGx program. Drug-gene interactions of interest were compiled, and actionable alleles identified.
J Allergy Clin Immunol Pract
December 2024
Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, Calif.
The term "allergy" is inaccurate for the vast majority of the contents in the current allergy fields of electronic health records (EHRs). While EHRs have transformed access to health information and streamlined the delivery of care, their ability to reliably indicate medications, vaccines, or foods that mandate avoidance versus preferences or mild intolerances, is suboptimal. The current systems are reactive instead of being proactive and frequently fail to communicate the appropriate course of action.
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