Digital health in electrophysiology and the COVID-19 global pandemic

Abstract

The tools of digital health are facilitating a much-needed paradigm shift to a more patient-centric health care delivery system, yet our health care infrastructure is firmly rooted in a 20th-century model that was not designed to receive medical data from outside the traditional medical environment. COVID-19 has accelerated this adoption and illustrated the challenges that lie ahead as we make this shift. The diverse ecosystem of digital health tools share 1 feature in common: they generate data that must be processed, triaged, acted upon, and incorporated into the longitudinal electronic health record. Critical abnormal findings must be identified and acted upon rapidly, while semi-urgent and noncritical data and trends may be reviewed within a less urgent timeline. Clinically irrelevant findings, which presently comprise a significant percentage of the alerts, ideally would be removed to optimize the high-cost, high-value resource (ie, the clinicians' attention and time). We need to transform our established health care infrastructure, technologies, and workflows to be able to safely, effectively, and efficiently manage the vast quantities of data that these tools will generate. This must include new technologies from industry as well as expert consensus documents from medical specialty societies, including the Heart Rhythm Society. Ultimately, research will be fundamental to inform effective development and implementation of these tools.

Keywords: COVID-19 pandemic; Cardiac monitor; Clinical pathway; Digital health; Implantable defibrillators; Pacemakers; Remote monitoring.

Figure 1

a: Present state: All data generated by digital health tool must be evaluated with equal urgency and attention from the physician (MD) or allied professional (AP). b: Future state: Data would be sorted by urgency utilizing artificial intelligence tools and clinical pathways to guide staff. Only urgent data would be forwarded to the MD/AP on call. Semi-urgent and elective data would be scheduled for review by MD/AP the next business day or the next scheduled encounter, respectively. Artifact, a significant data burden particularly from subcutaneous cardiac rhythm monitors, would be eliminated from the review process. (Width of arrows corresponds with typical volume of data.)