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  • br Remote monitoring advantages br What

    2019-05-20


    Remote monitoring advantages
    What is obtained by remote monitoring? How should we act?
    Important factors at the time of informed consent Patients benefit greatly from RM, and they feel secure and safe because they feel connected to the hospital at all times. However, patients may have excessive expectations for RM. It is impossible to respond to all alerts immediately for the following reasons. One reason is medical staff. For medical staff, the workload of office visits can be reduced, but other workloads are increased. It is unclear whether the total workload decreases by introducing RM. It is thus difficult to respond to all alerts. To respond immediately to all alerts, dedicated staff is necessary for 24h a day because alert e-mails are often received at night. We do not currently receive sufficient reimbursement for emergency events, and it hydroxypropyl beta cyclodextrin is difficult to employ dedicated staff for alert e-mails. However, patients may have the misunderstanding that medical staff can monitor their RM data 24h a day. Another reason is technological problems. Even if the hospital has dedicated medical staff for emergency events, some alerts are not sent immediately. A third reason is occasional connection failures between the CIED and the transmitter or between the transmitter and server. Thus, we have to inform patients that RM is not for emergency events and that they must visit the hospital if they have any symptoms.
    An RM management method example RM team members are assigned different tasks. Mainly, doctors obtain informed consent, nurses provide instructions on RM transmitter use, medical engineers enroll the patients on the website and perform the primary RM data analysis, and doctors perform the secondary analysis. We have made one report for one analysis. For patients in associated hospitals, we have mainly helped to analyze RM data. Analysis reports are sent by e-mail or fax to associated hospitals[71]. By December 2013, we had followed more than 1000 patients with approximately 70 associated hospitals and made more than 8000 RM reports. Only ~5% of the data required intervention by medical staff. Thus, if we focus on only ~5% of the events, we can dramatically reduce the workload associated with CIED follow-up for both patients and medical staff and may also reduce the cost for CIED follow-up.
    Reimbursement considerations RM benefits not only patients with CIEDs but also medical staff. However, reimbursement for RM is insufficient for the workload of the medical staff. We have been able to claim reimbursement for RM since 2010 in Japan. We can now claim 5500 yen/4 months for office visits and 3600 yen for emergency cases. However, the reimbursement has been limited to office visits. This seems to be one reason why RM has not expanded despite the great benefits for patients with CIEDs. Matsumoto reported that the reimbursement fee should be higher in consideration of the workload of the medical staff [72]. The problem may be resolved in the future. Insufficient reimbursement has also been reported in other countries [73]. One main reason is thought to be a relative paucity of research data associated with prognosis. Although various evidence of RM has been reported, integumentary system is unknown whether RM can improve prognoses in patients with CIEDs.
    Unresolved problems with remote monitoring
    Conflict of interest
    Introduction
    Methods and results Five studies denied the need for optimization. The nominal settings, including a fixed VV delay (LV>RV of 40ms or LV=RV), met the clinical purpose. They tended not to measure small details, perhaps since optimal settings change in different situations and small details are of little consequence. If the clinical output is unchanged, there is no need to optimize the VV delay. The ability to obtain a detailed understanding of cardiac function using Swan–Ganz catheterization, thoracic impedance, and other methods has been proven, but few studies have proven their superiority; rather, they stated that cardiac output was changed by VV delay but did not determine its influence on clinical output [65,68].