Benefits and considerations of digital case support in interventional cardiology
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Digital health technology has been part of the health care landscape for decades, but adoption has been slowed by a range of issues including network reliability, user friendliness, organizational support and workflow efficiencies.
However, the COVID-19 pandemic has dramatically accelerated digital transformation in health care, with digital health technology (DHT) playing a growing role in clinical workflows, data collection, patient care and more. Growth in telehealth patient visits has been the most publicly visible change, but this is just one application of DHT. Another technology that holds much promise is digital case support, which allows physicians to observe new procedures remotely and enhance their overall training experience.
Solving the challenge of procedure training and observation
COVID-19 placed new financial and operational pressures on the health care system. Elective procedures were postponed. Hospital utilization continues to rise dramatically during infection spikes from new variants. And access to facilities requires cumbersome infection-control procedures.
Despite these challenges, there are certain specialties, particularly interventional cardiology, that are well suited to the realities of constrained hospital resources and limited access. For example, transcatheter aortic valve replacement has been shown to reduce length of stay, in-hospital complications and cost compared with cardiac surgery and other invasive procedures in many patient populations. During times of high hospital utilization, reducing a patient’s length of stay can make these procedures — many of which are considered elective — more accessible to patients. When patients spend less time in the hospital in close contact with providers, the likelihood of COVID-19 spread in these environments is reduced.
However, cardiologists typically must observe a certain number of TAVR procedures before they can perform them. Traditionally, this meant visiting a hospital in-person, which can be expensive, time-consuming and burdensome to physicians, especially if travel is required. Today, restrictions on travel and hospital access have made in-person case observation more challenging and, in many cases, impossible.
Thankfully, with the help of digital case support platforms, surgeons can overcome these obstacles to easily and efficiently learn new techniques and technologies remotely. These platforms use real-time video collaboration to provide a front-row seat to any procedure, along with a guided workflow via a digital procedural playbook that helps care teams fully engage with what is happening in the operating room (OR). Two-way communication allows specialists to provide remote support to clinical teams, and observers to ask questions and interact with the proctor, helping them gain deeper insights as they follow along step-by-step through the digital playbook.
There are many other advantages to using digital case support as a training platform instead of in-person scenarios. On a practical level, it reduces the need for physicians to travel, reducing the cost and complexity of adopting new procedures. Physicians can be located anywhere in the world and be a part of a procedure in real time, as DHT democratizes access to expertise and best practices. It also helps with overcrowding in the OR. Reducing the number of nonessential personnel in the OR through remote collaboration not only leaves more room for the surgical team to safely operate, but it also gives the people who are observing the procedure a better vantage point, ultimately providing more people with enhanced access.
More broadly, by enabling more case observation and collaboration in less time, it has the potential to reduce variability in device utilization, surgical workflows and patient outcomes. Digital case support helps medical device companies standardize training, disseminate best practices, keep users current on the latest improvements in care and capture intraprocedural data in new ways. Additionally, exposing the learning curves of using a new product or technique can improve support for surgeon proficiency and clinical team satisfaction while reducing OR inefficiencies — all of which encourage medical device adoption.
The real-time access, reliable connectivity and low latency of a digital case support platform can significantly accelerate the adoption of new interventional cardiology procedures, as well as those in any other specialty that requires regular proctoring and observation. Physicians can learn new techniques remotely that improve patient care, medical device companies can get their innovations to patients faster and patients can gain access to lifesaving technologies in more places worldwide.
Digital case support in action: A case study
In July 2021, three physicians from Texarkana, Arkansas, were planning to travel to Harrisburg, Pennsylvania, to train on TAVR, so they could start a program at their hospital. Their flight options included at least one stop with an average travel time of 9 to 16 hours one way, or up to 32 hours of total travel time. The lowest cost round-trip fare available was $2,100. The impact of this travel included 3 full days away from the physicians’ practices, which would result in a significant loss in revenue and patients going untreated, as well as disruption to the providers’ personal lives (Table).
With the help of a digital case support platform (Explorer Surgical), these physicians and their medical device representative observed a full day of my procedures in Pennsylvania remotely from their hospital in Arkansas. They were able to see the procedure in greater detail — and greater comfort — than had they been watching it on a monitor in the OR. From the operator’s perspective, it is always preferable to have fewer people in the room. It reduces potential distractions, physical workflow disruptions and exposure to infection. We were able to interact with the observers through the platform with ease, enabling us to exchange questions and answers in real time.
As far as the physicians’ hospital in Arkansas was concerned, there was little to no impact on their information technology department and no physician downtime, whereas we had fewer people entering and exiting the facility in Pennsylvania. The benefits of implementing digital case support are likely to far outweigh the challenges, providing not only immediate operational and safety improvements but also helping hospitals promote their innovative programs to a wider audience. Video teleconferencing has the potential to reduce care viability, increase consistency, improve outcomes and patient satisfaction, which can drive down costs. A hospital-grade collaboration platform is also key, particularly ensuring its security and privacy are designed to meet the requirements of HIPAA and other data privacy laws.
Additional applications for digital case support
DHT in the form of digital case support platforms have been used in other cardiology and endovascular settings as well. For example:
- Livestreaming during an intracranial aneurysm procedure provides a high level of situational awareness and high image quality, which is vital in teleproctoring neuroendovascular cases. Although clinical studies are needed to examine the impact of digital case support platforms, video technology and digital procedural playbooks provide effective remote proctoring and technical complication management during complex aneurysm cases.
- In the catheterization laboratory, livestreaming enables physicians to easily get a second opinion and proctor cases remotely, providing support on procedural-based specialties to trainees.
Digital case support during interventional cardiology procedures provides limitless possibilities for training, education and expert support. These platforms eliminate the time and cost drawbacks of travel, loss of revenue and delays in patient care associated with travel. In addition, trainees can learn advanced procedural techniques more efficiently, and employees at medical device companies can observe more cases without having to travel. Remote case observations can also extend internationally, allowing physicians in emerging markets to learn a TAVR procedure. Expanding the use of DHT in this way holds much promise to reduce costs, increase efficiency and improve patient care.
References:
- 2021 Review of Physician and Advanced Practitioner Recruiting Incentives, 28th edition, Merritt Hawkins, 2021. Published 2021. Accessed Sept. 21, 2022.
- AMA. Telehealth Implementation Playbook. Published 2022. Accessed Sept. 21, 2022.
- Baron S, et al. Historical Perspective and Future Predictions. American College of Cardiology. www.acc.org/latest-in-cardiology/articles/2019/06/18/07/43/economic-considerations-for-tavr-vs-savr. Published June 18, 2019. Accessed Sept. 21, 2022.
- Baron SJ, et al. Circulation. 2018;doi:10.1161/CIRCULATIONAHA.118.035236.
- Bechstein M, et al. BMJ Case Rep. 2020;doi:10.1136/bcr-2020-016722.
- Chong JH, et al. Front Cardiovasc Med. 2021;doi:10.3389/fcvm.2021.666119.
- Dulai R, et al. Future Healthc J. 2020;doi:10.7861/fhj.2020-0051.
For more information:
Hemal Gada, MD, MBA, is president of the Heart and Vascular Institute and medical director of the Structural Heart Program at University of Pittsburgh Medical Center (UPMC) Pinnacle, in Harrisburg, Pennsylvania. He can be reached at gadah@upmc.edu.
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