How Automated Texting Provides Crucial Support for Keeping Cardiac RPM Device Users Connected

Remote patient monitoring (RPM) devices, including Cardiac Implantable Electronic Devices (CIEDs), are becoming increasingly common for physicians and patients to stay aligned on clinical goals and share essential data for monitoring between appointments.  However, they are only beneficial so long as patients adhere to recommendations for using them to manage their cardiac conditions.
 
While the technology behind CIEDs is highly sophisticated and reliable, it isn’t flawless. Patients may become disconnected from their monitoring devices for various reasons, halting the data flow and rendering monitoring ineffective. Reconnecting is often straightforward. However, the initial step involves patients and their healthcare providers recognizing the existence of a problem needing resolution.
 
Improving uninterrupted connection time is a high priority for all members of the care community. Patients want peace of mind during their daily activities, while providers must stay alert to early signs of clinical problems. Meanwhile, medical device manufacturers want to reinforce the value of their products to payors and providers while offering the best possible services to their end-users. 
 
Together, key stakeholders can achieve this shared goal by exploring innovative methods of identifying issues with cardiac RPM devices sooner rather than later.  
 
A new study from Implicity, published in Cardiovascular Digital Health Journal, shows that automated text messaging to a user’s device is an effective, lightweight solution that gets patients back on track faster without overburdening providers.  By actively engaging patients in the process, device makers can shorten disconnection periods and ensure their products are used to their fullest potential.
 
The rising challenges of managing CIED patients at scale
 
Each year, up to 1.4 million patients worldwide receive a CIED to assist with monitoring heart rhythms. That number will likely keep rising as the population ages and devices become more accessible. Remote monitoring using a third-party resource is associated with a reduced mortality so it’s no wonder that it has quickly become the standard of care for applicable cardiac conditions and included in international guidelines
 
However, many physician offices need help to keep up with the back-end requirements of prescribing these devices. CIEDs give off a considerable amount of data, including clinical readouts and reports on how the devices function.  
 
Managing that influx of information for dozens or hundreds of patients in a specialty practice is often overwhelming for clinics that are already dealing with staffing shortages and limited resources, especially since an analysis conducted by Implicity shows that as many as 19% of patients with CIEDs are not transmitting at any given time.
 
As a result, providers may not be immediately aware when a patient’s device goes offline – and they might not be able to address the issue with a phone call quickly enough, either. Currently, every CIED device manufacturer uses its own interface to collect data and provide alerts when a device is disconnected, compounding the challenge of identifying issues and working with patients to get back online.  
 
Standardizing and simplifying the process can relieve burdens on providers, reconnect patients faster, and maximize the clinical utility of implantable tools.
 
Leveraging automated text messaging to shorten disconnected periods
 
The newly published research examined the impact of text messaging (SMS) to alert patients of device issues and jumpstart the reconnection process. 
 
Using a platform that collects remote monitoring device data from CIED manufacturers, the research team retrospectively examined the disconnection and reconnection events in 6085 patients from 20 medical centers. The centers either used SMS to reach out to patients (4117 patients) or relied on the standard of care: a phone call to device users (1968 patients). 
 
The study found that during a one-year period, 43% of patients had at least one disconnection event, and half of those people experienced multiple disconnections during that time.
 
It took a median of 11 days to reconnect a patient who received a phone call from their provider. In contrast, patients who received SMS messages were back online in a median of 6.3 days. Almost twice as many patients in the SMS group (30%) were reconnected within the first 48 hours of receiving the notification compared to the phone call cohort. In the standard-of-care phone call group, 11% of patients never reconnected their devices, compared to just 7% of patients who received SMS messages.
 
The research indicates that automated text messages, which require no additional effort from the provider group or device manufacturer, are more effective than phone calls at catalyzing patient action to reconnect to their medical devices.
 
Integrating automated SMS messages into education and engagement strategies 
 
Manufacturers often take on the role of providing education and engagement tools to both patients and the providers prescribing their devices. Patients, in particular, may need additional coaching around the potential negative impact of disconnection periods and clear instructions about what to do when their devices stop transmitting data for an extended period of time.
 
Device developers should consider working with providers, patient advocate groups, and technology companies to create educational materials about the crucial importance of getting back online so that users and their clinicians are motivated to take speedy action when a disconnection alert is delivered.
 
For example, if automated text messages are available through third-party platforms, device manufacturers and cardiac care providers should ensure their patients are fully aware of what these messages mean and how to contact the right person to address the issue.
 
By integrating SMS messaging into the device onboarding and utilization process, providers and device developers may be able to avoid time-consuming, manual reconnection efforts while ensuring that patients are getting the most out of these advanced, highly effective remote monitoring tools.

 
About Arnaud Rosier
Dr. Arnaud Rosier is a cardiac electrophysiologist with a PhD in symbolic artificial intelligence. Dr. Arnaud Rosier is the founder and CEO of IMPLICITY®, a clinical algorithm company in 2016 to help HCPs optimize remote cardiac monitoring and improve their patient outcomes. With 20 years of experience in cardiac electrophysiology and 15 years in artificial intelligence and knowledge engineering applied to health, Arnaud is the author of a dozen international publications in peer-reviewed journals, in the field of cardiology and AI. Arnaud is also an angel investor of digital health companies including Cardiologs, Lifen, Prove Labs, LifePlus, Pixacare, Qynapse and Biloba.