St. Jude Medical, a global medical device company, recently announced an upgrade to its Merlin.net Patient Care Network. Merlin.net is a remote monitoring system for patients with implanted cardiac devices that gathers and stores data from the implant procedure, in clinic follow-up visits as well as from both patient-initiated and automatic remote follow-up and monitoring transmissions from the patient’s home.
The newest version, 5.0, features updates and enhancements to this cloud-based system – among them, Mobile DirectAlerts, which can send an alert via SMS to a physician’s smartphone when an event, like an AICD firing, occurs. This feature, along with the other upgrades included are exciting advances and offer an interesting blueprint for other emerging remote management platforms, particularly those that use implanted devices.
St. Jude, Medtronic, and Boston Scientific are the dominant device companies, at least in the cardiology world. And as any cardiologist can tell you, they excel at centrally tracking patients and devices – if a patient walks in your door with a 10-yr old implanted cardiac device, you can know everything about the device (and therefore a lot about the patient) with a few short calls to these companies. With that centralized infrastructure in place, remote management systems were a relatively shorter jump. A little over a year ago, we talked about a similar system from Medtronic called CareLink, where we discussed the potential applications of this system including alerts to a physician’s smartphone when an event, like a device firing, occurs.
This upgrade to Merlin.net includes precisely that functionality. However, we should note that it appears that the alert only occurs when the patient is within range of their home monitor, which wirelessly downloads information from the device for transmission (Ed. Note: This is also true for other remote cardiac monitoring systems like Medtronic’s CareLink). So if a patient’s AICD fires or a pacemaker lead anomaly is detected, the patient first has to come home (or wherever their home monitor is) – the data downloaded can either be sent to the PCN via land-line or over a cellular network via a USB adapter. However, the potential benefits are still substantial.
Once a physician receives the alert, he or she can link directly to the patient’s alert transmission, creating faster and more convenient access to pertinent patient reports when physicians are out of the office. It is no longer necessary to login to a computer to find and access patient records following an alert, thus allowing for a quicker reaction time to potential clinical issues.”
St. Jude’s is currently pursuing a clinical trial, theREACT , study to determine whether in fact the alert system reduces time to clinical decision. Being run in the UK and Germany with an estimated completion in early 2012, this study will be an important step in determining whether these systems are as effective as we hope them to be. The ultimate test though will not be whether the effect on a physician action, but rather demonstrating some clear benefit to patients – reduced hospitalization, improved mortality, even improved satisfaction. If we can’t do that, then its important to understand why and change our approach accordingly.
There are many other interesting and exciting upgrades to the system. One Screen Follow-up capability is a tool that supports faster and more in-depth review of recent transmissions, with the goal of creating a more streamlined workflow.This upgrade, according to the article, also accelerates follow-ups by enabling physicians to review and print patient information, view follow-up reports and schedule appointments all from one page. Another cool feature is integration with EHR’s, described below.
“The new software update also adds the Auto EHRDirect Export feature, an automated connection from the Merlin@home transmitter directly to the clinic or hospital’s EHR system. The EHRDirect Export capability uses the IDCO profile (Implantable Device Cardiac Observation), an industry standard for the transfer of information from an interrogated implantable cardiac device to information management systems. Adhering to this standard allows St. Jude Medical to seamlessly integrate with several EHR providers. The Auto EHRDirect Export feature includes automated downloads, integrating data directly into the practice workflow and making the patient management process more efficient.”
Effective chronic disease management requires the kind of integration across disciplines, IT platforms, and environments that healthcare has been woefully inadequate at providing. Merlin.net, among other similar systems, demonstrates a move towards that kind of integration – merging data from different systems in a way that is conscientious of workflow, allowing us to follow patients at home instead of at clinic visits every few months, and so on. However, this is just the first step. As we shift to more holistic approaches to disease states, we can likely expect these systems to expand to integrate device monitoring, patient monitoring (i.e. vital signs, weight, etc), behavior modification interventions with involvement of multidisciplinary team linked by a seamless IT infrastructure.