Claudio Saccavini

Large Controlled Observational Study on Remote Monitoring of Pacemakers and Implantable Cardiac Defibrillators: A Clinical, Economic, and Organizational Evaluation

Background Patients with implantable devices such as pacemakers (PMs) and implantable cardiac defibrillators (ICDs) should be followed up every 3–12 months, which traditionally required in-clinic visits. Innovative devices allow data transmission and technical or medical alerts to be sent from the patients home to the physician (remote monitoring). A number of studies have shown its effectiveness in timely detection and management of both clinical and technical events, and endorsed its adoption. Unfortunately, in daily practice, remote monitoring has been implemented in uncoordinated and rather fragmented ways, calling for a more strategic approach. Objective The objective of the study was to analyze the impact of remote monitoring for PM and ICD in a “real world” context compared with in-clinic follow-up. The evaluation focuses on how this service is carried out by Local Health Authorities, the impact on the cardiology unit and the health system, and organizational features promoting or hindering its effectiveness and efficiency. Methods A multi-center, multi-vendor, controlled, observational, prospective study was conducted to analyze the impact of remote monitoring implementation. A total of 2101 patients were enrolled in the study: 1871 patients were followed through remote monitoring of PM/ICD (I-group) and 230 through in-clinic visits (U-group). The follow-up period was 12 months. Results In-clinic device follow-ups and cardiac visits were significantly lower in the I-group compared with the U-group, respectively: PM, I-group = 0.43, U-group = 1.07, P<.001; ICD, I-group = 0.98, U-group = 2.14, P<.001. PM, I-group = 0.37, U-group = 0.85, P<.001; ICD, I-group = 1.58, U-group = 1.69, P=.01. Hospitalizations for any cause were significantly lower in the I-group for PM patients only (I-group = 0.37, U-group = 0.50, P=.005). There were no significant differences regarding use of the emergency department for both PM and ICD patients. In the I-group, 0.30 (PM) and 0.37 (ICD) real clinical events per patient per year were detected within a mean (SD) time of 1.18 (2.08) days. Mean time spent by physicians to treat a patient was lower in the I-group compared to the U-group (-4.1 minutes PM; -13.7 minutes ICD). Organizational analysis showed that remote monitoring implementation was rather haphazard and fragmented. From a health care system perspective, the economic analysis showed statistically significant gains (P<.001) for the I-group using PM. Conclusions This study contributes to build solid evidence regarding the usefulness of RM in detecting and managing clinical and technical events with limited use of manpower and other health care resources. To fully gain the benefits of RM of PM/ICD, it is vital that organizational processes be streamlined and standardized within an overarching strategy.

Structured reporting using a shared indexed multilingual radiology lexicon

PurposeA system for creating structured reports (SRs) using a standardized radiology lexicon was developed and tested to facilitate automated translation of content and multidisciplinary international communications.MethodsA database of radiology terms, RadLex developed by the Radiological Society of North America, was used to create a shared indexed multilingual radiology lexicon. A diagnostic workstation for generating structured reports (OpenEye) was implemented with a “RadLex manager” function for adding new words to the lexicon in both English and Italian. Sample reports of examinations included in the Medical Imaging Resource Center (MIRC) radiology imaging database of clinical cases were prepared using this system. The system was evaluated for teaching purposes and scientific dissemination.ResultsThe OpenEye system was able to manage the glossary to create new SRs and manually translate existing reports containing freely worded descriptions. The OpenEye system provides instant translation from Italian into English and enables clinical cases to be published in the MIRC, while making them accessible for consultation on an international scale.ConclusionThe SR is advantageous compared with a freely worded report in terms of clarity and completeness of the content. Creating SRs for each clinical case enables rapid and focused analysis at multidisciplinary meetings. All our cases have been included in the MIRC database as part of a broader-based European Project for research on soft tissues sarcomas (CONTICANET).

Assessment of Patients’ Perception of Telemedicine Services Using the Service User Technology Acceptability Questionnaire

Introduction: The purpose of this paper is to assess if similar telemedicine services integrated in the management of different chronic diseases are acceptable and well perceived by patients or if there are any negative perceptions. Theory and methods: Participants suffering from different chronic diseases were enrolled in Veneto Region and gathered into clusters. Each cluster received a similar telemedicine service equipped with different disease-specific measuring devices. Participants were patients with diabetes (n = 163), chronic obstructive pulmonary disease (n = 180), congestive heart failure (n = 140) and Cardiac Implantable Electronic Devices (n = 1635). The Service User Technology Acceptability Questionnaire (SUTAQ) was initially translated, culturally adapted and pretested and subsequently used to assess patients’ perception of telemedicine. Data were collected after 3 months and after 12 months from the beginning of the intervention. Data for patients with implantable devices was collected only at 12 months. Results: Results at 12 months for all clusters are similar and assessed a positive perception of telemedicine. The SUTAQ results for clusters 2 (diabetes), 5 (COPD) and 7 (CHF) after 3 months of intervention were confirmed after 12 months. Conclusions: Telemedicine was perceived as a viable addition to usual care. A positive perception for telemedicine services isn’t a transitory effect, but extends over the course of time.

Projet telemed-escape : la gestion digitale de la documentation clinique

Objectifs TeleMed-ESCAPE est un projet developpe dans l’hopital de Treviso avec l’objectif de maintenir les documents en version digitale sans utiliser le papier, en les delivrant directement aux usagers : medecins, techniciens, personnel administratifs, generalistes, citoyens. Materiels et methodes La nouvelle, gestion des documents prevoit l’implementation d’un systeme d’authentification, signature digitale, transfert electronique, distribution, conservation des rapports medicaux. Le systeme RIS et PACS sont fondes sur IHE cadre technique (Scheduled Workflow, Patient Information Reconciliation, Portable Data Information). Les procedures gerees de facon digitale offrent des nouveaux services aux usagers, qui peuvent afficher les rapports sur leur propre ordinateur ou sur l’ordinateur du generaliste (pour faciliter l’integration dans le fichier medical), ou bien ils peuvent recevoir les documents chez eux par courrier. Resultats Le systeme a remplace les documents en papier par des procedures digitales qui ont la meme validite conformement aux standard italiens et internationaux. Cela permet d’emettre plus rapidement un diagnostic et de vite commencer une therapie ciblee. Les usagers peuvent recevoir leur rapports chez eux, en toute surete, evitant un acces aux structures hospitalieres. Conclusion La gestion digitale de la documentation radiologique offre des garanties garanties et des avantages majeures pour les usagers, surtout pour le patients.