HRS Urges Members to Get Aboard the Digital Health Train

SAN FRANCISCO, CA—Healthcare professionals, particularly those in cardiac electrophysiology, not only need to accept the way medicine is changing with the increasing availability of data from both medical-grade and consumer devices, they also must lead in the transition.

That’s the message delivered here during the inaugural Digital Health Summit held as part of the Heart Rhythm Society (HRS) 2019 Scientific Sessions.

The summit, cosponsored by the European Heart Rhythm Association, was essentially an awareness campaign, according to Nassir Marrouche, MD (University of Utah, Salt Lake City), chair of the HRS digital health working group. The goal is to raise awareness of the massive amounts of data coming from various devices, patients’ expectations that they’ll be able to access much—if not all—of it, and the need to figure out a way to modify clinical practice to accommodate these changes.

“The patient is so empowered by these new technologies, and we as physicians, we don’t know what to do with it [or] where to start,” Marrouche told TCTMD. “And today was really [about] putting this all together.”

Across various sessions, the summit provided a forum for various stakeholders—from patient advocates to physicians and medical societies to industry representatives to regulators—to air their thoughts on issues around the role of digital health in monitoring, diagnosis, and disease management as well as the challenges of incorporating data from implantable and wearable devices into everyday workflows, reimbursement, regulation, and the role of artificial intelligence.

Much of the information coming out of these devices concerns heart rhythms, and, as Marrouche said, “that’s why HRS has to take the lead and push it forward.”

We need to as a society try to figure out the best way to help move this forward because it’s not going to slow down, nor should it in fact slow down. David Slotwiner

Khaldoun Tarakji, MD (Cleveland Clinic, OH), told TCTMD that electrophysiologists recognize both the opportunities and the challenges presented by digital health technologies.

“For us, the whole goal of having a dedicated digital health summit is to bring all the players together under one umbrella,” he said.

“We need to get together and work with each other, recognize the opportunities, which are plenty, but also work to solve a lot of challenges as well,” he said. “It’s one thing to have a device on the market . . . but to adopt it clinically and in a meaningful way, in a way that doesn’t increase physician burden, in a way that’s secure [and respects] privacy, with a platform for billing and storing, all these are important steps to reach the ultimate goal. There’s still a big gap between the technology and clinical practice, and we’re trying to bridge that gap.”

To coincide with the Digital Health Summit, HRS released two new documents to highlight some of these issues and present some solutions: one addresses the transparent sharing of digital health data from cardiovascular implantable electronic devices (CIEDs) and consumer devices and the other discusses the interoperability of data from CIEDs made by different manufacturers.

David Slotwiner, MD (NewYork-Presbyterian Queens and Weill Cornell Medical College, New York, NY), lead author of both papers, told TCTMD that when HRS first started discussing these issues he was surprised at how controversial they were.

“It became clear that some early adopters were very supportive of giving patients access to data without restrictions,” he explained. “Others had concerns about that. Some argue that patients are not asking for it, they won’t understand it, it may be confusing, [or that] other doctors who are not used to looking at the data may incorrectly make a diagnosis of atrial fibrillation.”

The overall question that had to be answered, Slotwiner said, was how to respond to the evolution in medicine that is seeing patients take a greater role in their own care. “We need to as a society try to figure out the best way to help move this forward because it’s not going to slow down, nor should it in fact slow down,” he said. “And so we want to help voice a direction and help be part of the process of moving it forward in the most constructive and most effective way.”

Digital technologies change the way patients and clinicians interact in a positive way, Slotwiner said.

“This allows physicians to interact with patients and adjust therapies or treatment strategies in almost real time. It improves efficiency. It makes the care much more personal. I think it really helps bring the patient and the physicians or therapeutic team much closer together,” he said. “It’s a great example of technology working to bring the key stakeholders together rather than, for example, electronic health records, where everybody complains because doctors sit in front of the electronic health record instead of talking to the patient.”

The Digital Health Summit was geared toward educating the electrophysiology community about the potential represented by these new technologies and also, Slotwiner said, to let industry know that HRS is standing by to help support the transition to greater patient access to data.

Although some clinicians have expressed concerns about what can happen when patients have access to this information, “these fears have not materialized,” Slotwiner said.

“It tends to improve patient satisfaction. It improves physician satisfaction. [Physicians] don’t get inundated with calls,” he explained. “And so it’s clear to us in the digital health working group that this is inevitable: that patients are going to have increasingly more access to data and [that] they probably will start having access in real time to a lot of their data and soon perhaps all. So not only is this not something we can slow down, but it’s going to keep moving forward and we think that’s a good thing.”