2024 HRS perspective on advancing workflows for CIED remote monitoring

Abstract

Cardiac implantable electronic devices (CIEDs) generate substantial data, often stored in image or PDF formats. Remote monitoring, now an integral component of patient care, places considerable administrative burdens on clinicians and staff, in large part due to the challenge of integrating these data seamlessly into electronic health records. Since 2006, the Heart Rhythm Society, in collaboration with the CIED industry, has led an initiative to establish a unified standard nomenclature. This effort has harmonized terminology, aligning diverse terms with single terms approved by the Institute of Electrical and Electronics Engineers. With this foundational work complete, attention now turns to developing technical standards for interoperability, which would enable the smooth communication of CIED data between information technology systems used in clinical practice. In this article, by leveraging Health Level 7 Fast Healthcare Interoperability Resources, we present a road map for the technical committee to guide this endeavor. We identify critical data exchange points between remote transceivers, electronic health records, and third-party platforms commonly used for CIED patient data management. Our objective is to establish bidirectional communication among these resources, ensuring the accuracy, timeliness, and accessibility of clinical data for clinicians. We also anticipate substantial benefits for both clinical research and administrative efficiency through the implementation of this interoperability framework.

Keywords: Cardiac implantable electronic device; Fast Healthcare Interoperability Resources; Health Level 7; Implantable cardioverter-defibrillator; Interoperability; Standards.

Figure 1

Cardiac implantable electronic device (CIED) manufacturers A, B, and C∗ each use their own unique nomenclature and data formats to describe and record CIED functions and parameters. The Institute of Electrical and Electronics Engineers (IEEE) 11073 nomenclature, developed by the Heart Rhythm Society in collaboration with CIED manufacturers, standardizes these proprietary formats into a universally compatible system, endorsed by the international standards organization IEEE. Additionally, FHIR (Fast Healthcare Interoperability Resources) is a standard created by the Health Level Seven International for electronic health care information exchange. It specifies how health care information can be shared across different computer systems, irrespective of the storage method, thereby facilitating secure and efficient data access and sharing among health care providers. EHR = electronic health record.

Figure 2

Life cycle of cardiac implantable electronic device (CIED) data use. The instances during a patient’s care when data related to the patient, the CIED, or both are typically generated and should be communicated to all information technology systems used for managing the care of the patient. MRI = magnetic resonance imaging.