In recent years, advances in information technology have made it possible for patients with pacemakers or implanted cardioverter defibrillators (ICDs) to be monitored at home by the physicians responsible for their follow-up care. The patient in the clinical case presented here lives in a highly disconnected region, an archipelago comprised of various islands, where interisland travel is dependent on planes or boats.
The LATITUDETM Patient Management System has permitted a substantial reduction in the number of visits the patient has to make to have her defibrillator checked. Thus, in the case of any event (in this case, several episodes of VF that required a number of discharges), one can access the information to check the arrhythmias in question and make a decision (in this case, transfer of the patient and a change in treatment).
Cooperation on the part of the hospital’s IT staff, which must take on the technical aspects, is critical for successful integration. The cardiologist must select those fields that he wishes to incorporate into the hospital’s electronic clinical application. Subsequently, trials must be done to ensure that the entries in the hospital’s EMR application are really the ones that need to appear there (e.g., that the impedance value for the right ventricular electrode is correct). In our case, we conducted trials before moving on to full adoption.A patient’s electronic medical record (EMR) has become a key tool for working in a hospital environment, with the unquestionable advantage of improved management of clinical and administrative tasks. This is accompanied by no longer having to deal with the paperwork associated with visits. However, visits to check on pacemakers/ICDs generate a lot of information that cannot be stored in the hospital’s clinical history (recordings on paper or diskettes, reports, etc.). Likewise, the existence of many different brands of devices makes the working environment chaotic. The solution to this is LATITUDE Integration, which provides integration of the information stemming from the LATITUDE Patient Management System into the hospital’s EMR – In this case the Cardiostim system developed in-house by the Dr. Negrin hospital.
There are many advantages offered by integration of the information supplied by the LATITUDE Patient Management System into the hospital EMR, including aspects such as eliminating paper and diskettes from visits, or improving the work flow by allowing information to be shared within the hospital and reducing the time required for visits (by not having to manually enter data into the CardioEstim system application), and others that are shown in the figure. It is important to highlight that aspects such as security are improved, especially back-up of the data via a security copy made using the hospital’s EMR application on one hand, and by the LATITUDE Patient Management System on the other.
A 55-year old woman with a history of arterial hypertension, hypothyroidism, repeated unanalyzed episodes of fainting, and a niece who died suddenly at age 25. Admission to the hospital after fainting various times, with ECG findings of ventricular fibrillation, presenting
in the postcardiology ECG a pattern compatible with brugada Syndrome. Function VI was shown to be normal in the ECG, without significant valvular alterations. A coronography was performed that showed normal coronary arteries.
A TELIGENTM 100 F110 DR defibrillator using the LATITUDETM Patient Management System was implanted. The patient lives on the island of Lanzarote, a 45-minute flight from our hospital. Several weeks after being discharged, the patient was referred on an emergency basis due to repeated shocks by the defibrillator, which we could see on the EGM’s sent via LATITUDE. After admission, the patient began treatment with quinidine sulfate, subsequently showing no episodes of arrhythmia, as we were able to determine in the records sent by the remote monitoring system.
Given the patient’s clinical stability, follow-up reviews involving her physical presence can be scheduled in- frequently, with intervening non-presence reviews done via the LATITUDE system. The information will thus be recorded in her electronic clinical history at the hospital via LATITUDE Integration.
Scope of the project:
• A pioneer in the use of new technologies, the Dr. Negrín Hospital participated in the initial launch of the LATITUDE Patient Management System in Europe.
• After agreeing to take part as a pilot center, the Dr. Negrín Hospital is the 1st center in Spain to use the LATITUDE Integration system, and the 3rd of 5 centers outside the U.S.
• The high flexibility of the CardioEstim system, the electronic case history system developed in-house by the Dr. Negrín hospital, combined with commitment from Dr. Garcia Quintana and Francisco Sosa’s IT team, allowed implementation of LATITUDE Integration in less than 3 months.
- Cost-effectiveness of the integration of home monitoring data with the hospital medical record (ESC 2012, Munich).
“Dr. Negrín” Hospital of Gran Canaria:
• Prof. Alfonso Medina, MD, PhD, Chief of Cardiology
• Dr. A. García Quintana, MD, FESC, Cardiologist
• Francisco Sosa, Head of the IT Department
• Juan Sosa, Miguel Ángel Ortega and Víctor Manuel Feria, technical and computer support
Boston Scientific LatituDe Support personnel