All right, well thank you all for your patience as we waited for a few more to join us. Welcome, and we're excited today to present to you Managing CIEV Heart Failure Diagnostics, Clinic Experience, Collaboration, and Lessons Learned, Implementing a Novel Dedicated Heart Failure Workflow Solution. I'm Max Van Arzela, I'm the Director of Industry Partnerships here at MedAxiom. And as I mentioned, we're excited to present this topic to you today. As we go to the next slide, want to just point out a couple of important features as you are watching the webinar today. And so, at the bottom of your screen, you're gonna see two really important functions. We have our chat function, which you're gonna be able to find a link of the PDF of these slides that we will share once we've gotten into the presentation today. So you'll be able to access those slides. And then, over on the other side, you will see a Q&A function, and this is where you're gonna be able to submit your questions. We do have the lines muted, and we're gonna do this through the Q&A function today. So we'll be monitoring those throughout the presentation, and we'll be sure to address as many of those questions as we can during the webinar at the end of it in the Q&A session. Any questions that we miss, we will certainly try to address and follow back up with you. And again, we are looking forward to presenting this material to you. And with that, I'm gonna hand it over to Andy Winburn of Merck. Hey, everyone. Thank you, MedAxian, for hosting this, and thank you all on the call for attending. I'd like to welcome you to the Managing CID Heart Failure Diagnostics webinar. I think we've got a really spirited discussion today with some great clinicians who are on the front lines every day managing their large device clinics and working constantly to improve the efficiencies and care for their CID population. My name is Andy Winburn, and I'm a product manager at Merck. Quick question before we get started. Have you ever considered there might be a different way to more effectively manage your heart failure diagnostics that are present in many of your patients' remote monitoring devices? Maybe something that's independent from the EP clinic. It's a dilemma that I know I've faced in the field, and it's also one of the key frontiers of workflow development here at Merck. And we try to approach it in a very data-centric way with the co-management built in to the workflow. I imagine there's a lot of you here on the call who view patients' heart failure diagnostics on a day-to-day basis in your clinical workflow, and maybe you aren't sure how to harness that data in a consistent way and meaningful way, much less bill for it. Maybe you're part of a clinic where your EP provider signs off on heart failure diagnostics just as a matter of course with the remote monitoring transmission that comes in. And if so, that's great. That's one of the approaches we see across the country. But maybe you're one of the heart failure clinicians who wants to separate that data, that just the heart failure data, and just manage that and leave the EP data to the EP professionals. And maybe vice versa, the EP just doesn't wanna manage the heart failure because they may not have the bandwidth to manage that in a consistent way. So the question may come up, how do we carve out the heart failure data from the EP data and get it to the right, into the right hands and into the right clinic? It's been a conundrum, and it's a challenge to disseminate this to the right clinicians in a meaningful way. Well, today we're gonna highlight two clinics who've taken on that challenge and done very well in their workflows. And I think you're gonna see that they have a very impactful workflow that they've developed over a number of years. In some cases and just starting out in others, but they're able to parse this out, parse this data out and get it into the right hands. And like I said, in a meaningful way, all the while providing the collaborative touch points that are needed for this type of device management because of the overlap. So as far as our agenda goes, that's what we're gonna be discussing today. We're gonna be spotlighting two large device clinics. We have Bon Secours Mercy Health out of Cincinnati and Allegheny Health Network out of Pittsburgh. And we're gonna examine the various methods these clinics have used in their journey to manage this complex population, their successes, their strategies and the ongoing evolution of their journey to maximize the efficiency of their clinic and the care of their patients most importantly. So with that, I'd like to introduce the panelists. First off from Bon Secours Mercy Health, we have Jackie Aerosmith and Kara Jackson. They are both cardiac device specialists in the clinic at Bon Secours Mercy Health. It's about a 6,000 patient clinic and incorporated into that, they have about 1200 patients that they are managing in a dedicated heart failure workflow. Jackie and Kara have been very instrumental in developing their clinic workflow over the past three years, dating back to I think around 2021. And I think they have a really impactful story to tell that you on the call will find very impactful and insightful. Also joining us from the Allegheny team, we have Michelle Callahan, who is the Institute Director for Cardiovascular Medicine and Clinical Director of Disease Management and Cardiac Rehab. We also have Tracy Ader, who is the Practice Manager for the Advanced Heart Failure Clinic and the Program Manager, Diane Smith, who is also part of the Advanced Heart Failure Clinic. And last but certainly not least, we have Stephanie Ledbetter, who is the Program Coordinator for the Heart Failure Devices and she is managing and doing a great job of managing the incoming transmissions from these patients who they're monitoring heart failure, getting them opted into the workflow and coordinating the care with the EP clinic. I'd like to thank all of y'all on the panel today for joining. I know it's a busy time in clinics as usual, and thank you so much for taking your time out to share your experience. So with that, I'm gonna start with Bon Secours, MercyHealth, Jackie and Kara, tell us a little bit about your clinic and kind of the journey that you've been on since about 2021 and how it's evolved over time. Thank you, Andy. Welcome everyone and thanks so much for joining today. As Andy said, we're really excited to share a summary of our heart failure journey over the last few years. This is a great summary slide, gives you an overview of how far we've come and we'll delve into more on the next slide. But the key points to take away from here is that we kind of started everything in August of 2021 utilizing PACE-ART. There was some integration involved, but we've expanded a lot on that, which has helped immensely. We've implemented our heart failure program across our four locations with 19 providers involved, 10 EPs and nine heart failure providers are signing off in merge. We do manage all of our transmissions, EP and heart failure with four remote techs, two solely dedicated EP techs, and then Jackie and myself are hybrid, managing both the EP and the heart failure transmissions. As Andy said, we have a little over 1200 patients enrolled in our heart failure clinic. And what that to us means is that they have a diagnosis of chronic systolic heart failure and their device is capable of providing some sort of element in regards to heart failure. We are highly Medtronic dominant as a clinic with 83% overall and 89% of our heart failure patients are Medtronic. And we are currently utilizing all modalities for remote in an office. Next slide, please. In order to appreciate the progress we've made over the years, we've categorized our heart failure journey into four main chapters. With a starting point being prior to when I came back to Mercy. So Epic and PaceArt were partially integrated. It was more or less just an export process from PaceArt into Epic. There were limited user licenses, so only the device techs had the access to PaceArt. It was very tedious, cumbersome manual workflow. The EPs were signing in Epic, we were doing the appointments in Epic, we were doing the billing in Epic, and it just continued on from there with all the clicks. There were only two remote techs at this point and the heart failure billing component was only incorporated into the quarterly EP reports that the EP provider signed off on. I came back in April of 2021 to Mercy and with the sole intention of really building the heart failure program, but also helping to alleviate the remote techs load as it was immense. We saw the PaceArt Epic integration simplified in regards to that, but we did learn that the Epic appointments were actually synced with CareLink. So being Medtronic dominated, that was a huge efficient load relief in regards to all of our appointments can be made in Epic and crossover into CareLink, so it saved one step. We were gradually enrolling the patients into the heart failure program across the two smaller locations and it's on a 35 day schedule. The reason for the 35 day was previously before I had come back that it was controlled in regards for Monday through Friday. The patients weren't getting confused because all of the appointments were still in Epic and it just kind of made things a little more streamlined in regards to making the recurring appointments. So again, at this point, we had three remote techs and we were increasing the heart failure billing cadence to more frequently. So we were essentially doing three reports a quarter. So two heart failure reports were going to just the heart failure providers with the billing provided as well. And the, sorry, the heart failure billing. The chat popped up, I'm sorry, I got distracted. But anyway, the heart failure billing cadence. So the two reports were going to the heart failure and then the whole report, the quarterly, essentially 91 days, but for us it was 105 days to the EP and they were still getting that charge. So after proven success, we were approved an additional remote tech and Jackie came on board. So March of 2022, Jackie came on board and we continued the gradual enrollment with the addition of the primary and largest location. So Jackie was managing that and we were gradually enrolling patients not to overload us on the 35 day schedule. In this instance, we also had the, we were able to meet with IT to modify the export capabilities. So our Epic appointments were synced. So that was really nice. But in this instance, we could also export the same report to both providers. So the two heart failure reports were going, 35 and the 70 day reports. Whereas the final, the quarterly, the 91 and the 105 day, in this instance, instead of the EP getting all the credit and reviewing everything, we were able to export the exact same report to both the EP provider and the heart failure provider with correlating credit going to the same. In early 2023, we finally, Bonds of Core Mercy Health was trying to implement a universal software across the ministry, more for cost efficiency, continuity of care, and they decided on Merge. So at Go Live for Merge, we were about 90% enrolled for all of our heart failure patients across the three locations, the two smallest and the largest. With the final location, so the second largest clinic, that enrollment was still in progress at Go Live. Next slide, please. Yeah, before we go to the next slide, Carol, are y'all using co-management at that point, like the co-management websites from Medtronic, or have we? No, for all of the portals, we just set the schedules on the 35 day cadence. So in currently, instead of like the monthly, it was on a 35 day schedule, but we did it via Epic for most of them. Okay. Okay, that's what I thought, because I know co-management has become a big part of the clinics here. Thank you. All right. This is a great summary of our previous workflow. While inefficient, we tried to make it the most efficient that we possibly could with the allotted resources. Now, granted, it's showing you the thousands of clicks that we made every day, transitioning from the websites to PaceArt, back to Epic, copy and pasting, all of the clicks. And while I felt like that cat in the top right corner on a regular basis, I think we successfully, with the progression that we made and the timeframe and all the resources, we did the best that we could with what we had. Yeah, it's definitely impressive. Next slide, please. Okay, so enter merge. This is mid 2023, and this is our next chapter that we were kind of going into. Ministry-wide, we had decided on merge software. So they flew into town, helped us with the whole launch and going live, and we were finally able to achieve full EMR integration. Let me tell you how life-changing this was. Although we were used to a manual process, and it worked because every clinic's different, staffing's different, resources are different, we made it work and just changed what we could. Still, having the automaticity is life-changing. It really allows more time for you to look at everything clinically and act upon that and just do everything a lot more efficiently. So it definitely was life-changing. It was also a perfect time for merge, as well as us, to share a common goal. Cara and I continued to talk about, what did we want to do to continue growing the heart failure program and what would be next? Because to this point, it had been automated, or I mean, I'm sorry, it had been manual, and it also had been very tedious. And so we were kind of like, what do we want to do with these changes? And alike, merge was also wanting some feedback on their new dedicated heart failure platform. And so it was just a perfect collaborative relationship, and we were asked to help pilot with that new pilot program. And I think it was very helpful for both parties involved. So Cara had kind of talked about the hybrid workflow. Every clinic, again, is different, and it just depends on what works for you. For us, we had always kind of followed that for many reasons. And so at this point, we had decided to keep it. And when I say that, what it ultimately means is, we don't have a visual at this moment, but within the merge platform, you have your office track, you have your heart failure track, and you have your EP track. And so those are different billing tracks and cadences where it keeps everything kind of separate, although you can click into it and view different things. And that's perfect for the clinic that has different staff working those different roles. But for us, we decided to continue with the hybrid workflow, which essentially means that we were triaging the incoming EP reports and alerts, as well as we were also doing that with the heart failure data. And we decided to use that as our advantage, because if you think about it, we all know how EP and heart failure specialties are. Sometimes they don't always talk with each other, but through this hybrid workflow, we were able to really look at the clinical data coming in and use that as a way to bridge that communication between the modalities and the specialties. So for instance, I'm just kind of giving a quick example, but let's say that I have a patient that I saw an increasing Optovol, looked like they were retaining fluids. But I also had access to the EP cadence and tracks, and I can pull that data and really see more of the arrhythmia data that had come through on that track. And I can triage it, process it, and communicate with both of those specialties. Hey, I think we're going into heart failure, and I think that this is why. The ather burden's increasing, rates are going up, yada, yada. And so ultimately it really has helped in our clinic with the communication and bridging all of that. And with that type of back and forth communication we've been doing, we also kind of helped pilot this new feature that they have called Merge Connect, which is essentially just like an instant messaging component within the platform. And so it's really easy. If I want to send a message to the heart failure and the EP provider, I can go ahead, link whatever docket I'm wanting to send and just have full communication through that easy instant messaging platform. And so that's been proven to also be very helpful. So for this time, we've decided to continue with that hybrid workflow. The biggest thing that I would say that we have really started to shift our view on is the automaticity. Again, we had it down how we were doing everything manual, but you have to remember there is a big chance for some margin of error because everything is so tedious. When you have that automaticity, everything is set behind the scenes. So you have a much larger decrease margin for error. It also obviously increases your efficiency with patient care in many ways. And ultimately we were seeing just really quickly rising in the optimization of not only patient care, but also revenue. I really wanted to put this last part in, the trials and tribulations. We only had about 15 minutes to give you a quick blurb on what we've done with this program, but let me tell you that it has been quite the journey. We gave you just quick bullet points, but I think the takeaway to really know is that there are learning curves. Really do your preparation. And that is what Karen and I decided to really get across in this. Realize it takes time, realize that it is achievable no matter how you do it, manual or automated, that it is a lot more efficient with automaticity, but there are learning curves. You have to put in the elbow grease. You have to set all these alerts behind the scenes. You have to set up co-managed websites. You have to work with compliance, IT, coders, billers, make sure everything is on point ready for when you actually start using a system like this. The other thing is once you do actually get all that set up, it really is set and forget, and it becomes very easy. And you move into more of this area of what am I actually triaging? And what does this mean? And how can we use this in the patient's plan of care and make their treatment better for them? The last thing that we kind of learned was, just coming from a background of support staff, I am a registered nurse working hospital and ambulatory. I'm used to always kind of getting everything set up as much as you can with a red bow and handing it to your provider for them to act on. Well, you know, our providers have loved everything thus far, but the feedback from them was, hey, you know, you kind of forgot about us a little bit. You know, where do we fit in this process and what kind of feedback can we give to get everything set up? So just utilize the providers, have a champion for the providers to make sure that the process you're choosing is also good for them and that they have time to be educated on the system and its uses as well, because you really want to stay focused. The whole team, you know, is it clinical? Is it billable? And that's that is what your focus remains on. Next slide, please. So Kara gave you the much more busier flowchart. Mine is more streamlined because I'm after merge and there's a lot less steps because all the dirty work is done behind the scenes already for me. And Kara and I laugh daily that we drank the Kool-Aid. Let me tell you. So there is our little mascot up in the corner, our little Kool-Aid man, and he's holding up the merge, you know, and he's he's proud of it. And that's how we feel, because it's just the amount of time that has been taken from us taking away the admin type of tasks has been life changing. And it's really helped the program be a lot more efficient. So I just wanted to get that across. There is an easier way. Next slide, please. Okay, so this is just for those of you that are visual, you can really see launch for us with merge was August of 2023. So it is very low, because at that point, we were just trying to get everything integrated, go live, get these patients into the system. We were also dismantling our old system, tearing apart those schedules. And there was a lot of work behind the scenes, although it's not reflective in that. And as you can see, with each month, it continues to rise. January is not truly reflective, because we took those numbers early enough to provide for this webinar, but I'm sure it would have been higher as well. So on average, we do just heart failure transmissions, about 867 on average per month. And again, is it clinical or is it billable? So specifically with this modality, we go ahead and actually send through about 739 heart failure report transmissions per month. And that's, I mean, we're continually enrolling, so it's going to be a lot more, but these are these are early numbers for you. Next slide, please. Jackie, just before I go to the next one, that is still you and Cara mainly covering that volume, along with your EP responsibility? Correct. That is the way that we do it. And eventually, as we get busier, we do have that flexibility. We're talking about maybe in the future, we could parcel it out more. But for now, yes, that's what we're managing. So another visual, just to kind of share where we've been, where we're at, where we're headed. Initially in the 2021, like we did the August through the December since we went live with Merge in August. But for the 2021 of August, you can see that we're starting to get there in the little grays like we've graduated a little bit. But with Jackie coming on in 2022, again, we had a pretty significant increase in August, was a little increase gradually throughout. But as Jackie explained several times, the automaticity of Merge and all the features within it have allowed so much more time and progress. And I mean, life changing is the only word that ever comes to mind for me in regards to this, because I did a lot of the manual scheduling previously. Just looking at November for Merge, it doubled what we did initially in the first year. So it was just more like another visual for you to see where we've been, where we're at, where we're headed. Because again, it's only increasing. And while you may or may not be able to get the opportunity to drink the Merge Kool-Aid like we did, it is possible to build a heart failure program manually, but you can see the progress that's available as well. And we hope that you guys have learned a lot from this in regards to that it is possible, you can do it. There are different aspects, but just to be open to flexibility and any changes, I feel like we're constantly changing ours. Like Jackie said, we might be changing it to divvy up the workload a little bit more for the EP if we can take on more heart failure, et cetera. So the flexibility of it all is just key to keep in mind as you're building this. And we wish you all the best in your endeavors. Awesome. Thanks, Jack and Kari. Kari, I'm sure we're going to come back with some more questions later, but it's such a really cool story to hear and improvement on patient care. I think kind of the sky's the limit with where you guys are going. Now let's go to transition over to the Allegheny Health Network, who I also feel like the sky is the limit. I, too, think they have a very interesting story and they're kind of at the beginning of their journey, but have already found some really nice success and are building a program very methodically. And I'm kind of stealing some of their thunder, so I'm going to let Diane and team discuss their journey, but I think you'll see the similarities and maybe some of the differences as well. Hi, I am Tracy Ader. I'm the practice manager here at Allegheny Health Network. We're with the Advanced Heart Failure Department. And as you can see, we're the babies. We literally just launched in November. Merge happened to be a system that was being used for our electrophysiology department. They had just used it. It was a system that was working for them and they thought, here's our opportunity to actually jump in and start doing the heart failure part of the devices, which to that point we really had not even tapped into. We are now doing the automated billing through Merge. We've got one site right now where we have two providers that are actually helping us to do our dockets and monitor those patients, but we do have seven doctors and six APPs that contribute to our patient volumes and our device volumes and everything. Future state, we've got about 60 general cardiology physicians at 15 sites that we will be going to tackle to advance our program. Right now we are separate and probably will maintain that is heart failure manages heart failure devices, EP manages the EP part of it. We want to keep it separated. It seems to be a clean break for us. They have their own team and then we have our team that we've just established. Right now of those 6,000 patients that the electrophysiology clinic has, we pulled patients that had certain devices that had the heart failure component in it that we could use. Right now we're up to 194. I know that seems like a small amount, but that's with us contacting them, talking to them about this. Patients that have already had the device implanted, this is an additional thing for them. We try to take the time to walk them through it, let them know what's going on and give them an opportunity to say yes or no because as you know with heart failure patients, there is a component to whether they can afford it and co-pays and everything. We do have it. We're continuing to grow it. Our new patients, that's what we figure is our best market and we'll be aiming towards that. In terms of what we can offer those patients, from a heart failure standpoint, we do the remote co-managed program and then electrophysiology handles both the remote devices for electrophysiology, but they also do in-office care. That is while we're separate programs, we're in the same department in the same area, so we can help co-manage those patients. Next slide, please. I'm going to talk a little bit to just even take one step further back from what Tracy managed. Hi, my name is Diane Smith and I'm a program manager for Allegheny Health Network. Where Tracy is down in the clinic and she's working with our device team and our advanced heart failure and our EP physicians, I'm part of helping to bring some of these new programs to life. When we started this journey, like Tracy said, from the heart failure side, we were already up and running with Merge in our EP device clinic and had been for about a year. When we initially started with Merge, we were nearing the end of our contract. We also had used PaceHeart before. Our EP physicians, they were really interested in evaluating other software systems. Part of that process, efficiency was front and center. That was one of the biggest factors that we really looked at. Kara and Jackie's slide was great, where they showed the inefficiency of their pre-Merge heart failure workflow. That was right where we found ourselves in our EP device clinic. But on top of that, we didn't have the bandwidth or the ability to really utilize the heart failure data that was already there in those transmissions. Like Tracy said, we have a separate EP and advanced heart failure clinics that work side by side, but what we were really doing was leaving all of that data on the table, even when we had gone live with Merge from the EP standpoint. Both clinically, we were leaving that on the table, and then from a revenue perspective, we were leaving that on the table. Tracy will talk a little bit more about what our EP device clinic was doing. She'll talk a little bit more about what our pre-Merge workflow and some of those pain points looked like. But really, what ultimately led us from the path of our former software system to Merge was the ability to integrate heart failure, clinical management, and the revenue that that could also provide for our clinic. The icing on the cake of solving something that we knew was an issue with EP, but we were really able to expand our ability and improve the way that we could manage heart failure patients in our clinic. That co-management function within Merge, to have two separate tracks, like Kara and Jackie stated, they're the same folks who are doing the work for both sides. That wasn't really what was going to be the case for us as we built this from the ground up. We had a really well-oiled machine on the EP side, but what we needed to do was build this heart failure model from scratch, and Merge allowed us to do that and create two separate but parallel workflows where we could seamlessly connect and communicate when we needed to, but really allow us to start from the ground up on that heart failure side. Tracy, do you want to talk a little bit more about what that workflow looked like? You have been in the thick of that from day one, so you know it. Yes, it was quite painful. As Diane said, with the electrophysiology, they were doing everything. We hadn't tapped anything for the heart failure side, but our physicians still did want to see the reports and everything. Basically, every single day, electrophysiology, we'd give them a list and they'd print out all these reports, and then we'd match them up to each patient as they came in. Doc would ask any questions or make any decisions off of that, but it never went anywhere else. Talk about very inefficient. We're printing paper like I can't tell you. We had reams and reams of paper being printed every day. When we had this opportunity to integrate and do everything with MIRDS, it offered us a whole new world. I think for a lot of people, getting to, number one, clinically use this information, have it pulled separately from the electrophysiology. This is our physician going, this speaks to me. I don't have to go through 62 pages to find the one thing that I really want to look at. Not that they ignore the other, but they have things that they're more specific to as all physicians are, but it was an eye-opening experience for them. They were like, okay, we really want to do this with MIRDS. We want to make sure that we can capitalize on this in terms of clinic, but also from a monetary side. As you know, everything is about growing a clinic, finding different avenues for advancing your billing, and this was perfect. MIRDS came in, they helped us, showed us the way to do it. They were great with integrating with our IT team and with us, because as I said, we were brand new out the gate. It was a learning process, to say the very least. Our electrophysiology department, their manager and supervisor, she was fantastic and did help us with that a lot, but as heart failure and electrophysiology, they're like, that's yours, this is ours. So it was fantastic, because MIRDS actually helped us with that, too, in terms of figuring out what we needed from electrophysiology, figuring out what we needed from us in terms of what workflow we wanted to follow, how we wanted to communicate between departments. They were able to help us, again, with the MIRDS Connect, I believe Kara and Jackie mentioned that they helped implement that, and it's fantastic. Being able to communicate with each of us at heart failure, but also with electrophysiology. A lot of them work from home, while we're here in person, so that is a major factor in being able to get things done clinically for our patients without having to pick up the phone, call this one, call this one. You can just communicate. They have helped us, as you know, January just came in, and they were helping us update our billing codes and making sure that everything was processing correctly. And again, they also were able to provide us with the preliminary reports. A lot of times, especially now, since we're new and we're getting up to speed with everything, there can be a little bit of a lag time between our device reading being pulled and everything and then somebody getting it signed off on, but with these preliminary reports, we at least get the initial readings and see what's going on. So if there's something urgent going on that we're waiting for a physician to sign off on, we can go ahead and move forward with that. So I think in terms of how it's helped us, it's been fantastic, and it's opened up new opportunities for us, especially with the billing and with the clinical side of it. Our physicians are quite happy that this is something that we can do with the program. It enhances the treatments that we're able to provide the patients and also the speed with which we can provide that treatment to improve whatever's going on. And I know that was a lot. I get excited about it, but also a little bit nervous in front of everybody. But if Stephanie wanted to step up and kind of go over a little bit more of our clinical side of it. Sure. My name is Stephanie. I'm a registered nurse with Allegheny General Hospital, and I'm the program coordinator for our heart failure devices. So more clinical, less administrative. Merge compiles the data from several different sites for us and transmits that information quickly in an uncomplicated format that's easy to view and interact with. The automated billing process saves time so that we can focus on the patients who need care. This is going to enable us to achieve our goals as we branch out to monitor other clinics in our system. Yeah, that's that's that's really great stuff. And I just want to the preliminary report to I think is a is just something to kind of double back and kind of highlight on that. That is that's a big deal when we're fostering that collaborative care. So if we need that in this need that report in the system, it's going to be there, even though not everybody may have addressed it at that point. So just just want to touch on that, too. I think that's really important for for y'all's clinic, especially. We're going to next slide division. Oh, sorry. Go ahead. That's with our visions for growth. I believe I alluded to that earlier. We do have the opportunity to branch out into our general cardiology population. Once we've kind of narrowed down everything for us and got it working exactly how we want to, then we're going to branch out into those offices. We'll probably take it one side at a time just so that we can be very pinpoint specific with them, get everybody trained, how they need to be, what type of patients they should be sending to us. We'll help them that with that. Also, as we said, we do have access to the electrophysiology information so that we can pull that information from merge to know who we should be focusing in on. And I think that's something that merge is going to help us with our growth, because before it literally would have been manually going through each and every patient to figure out who would be part of that for us or an opportunity for us. And then we've also. Try to establish a standard of care that we want across the board for everybody, whether that's in the heart failure department, whether that's an electrophysiology or in general cardiology. Merge makes it very easy for us to offer this out to a very wide ranging group of people and different practices and everything that if we had had to do it manually, I cannot even envision what that would have been. So, in terms of growth, I think we have nowhere to go, but up and I'm kind of excited about it where we have one person right now one program coordinator that is handling our devices and we very much want to get somewhere near that 6000 population if at all possible and take advantage of everything that is out there for us to do that and I feel like. With margin that we've been able to really capitalize on it. Next slide that's awesome. So this diagram shows the simplified process for managing patients transmissions and merge patient will download information or transmit information to their manufacturing software. Merge then prepares a docket near instantaneously, and so I can review the information. If the patient is not showing any signs of heart failure at that time, I can place the docket in a compose or save space. If the information shows the patient is in heart failure and I need to act on that. I can contact the appropriate practitioner add comments under the impression. I can send the docket then to the MD for approval. Once the docket is approved, it is then visible in our EHR, which is epic for review. This is a very convenient document because then it is a multiple providers can then view that information for care for the patient. And with MergeConnect, I can communicate very easily with others. For instance, on our EP side, by clicking on the chat bubble right beside the patient's name. It's definitely made a difference in how our team communicates with each other. I mean, I know it seems very simple. Oh, it's just a chat, but literally you got a call, you got your multiple calls trying to get everything and I can't emphasize enough how much this has improved our care, but also our staff. And as it says, higher staff satisfaction. And that's within the departments that function around us too. They just want to not have that over. I know I'm mumbling here, but it's just a constant state of trying to connect with somebody. Pick up the phone, send an email. This simplifies it and we're good. Yeah, that's a great point, Tracy. And I think I just forwarded the slide too much. The communication here I think is good. And it shows kind of the difference in Karen and Jackie's workflow in that you all may need to communicate with the EP team and this kind of gives you that outlet to through MergeConnect. So it's more of that more independent workflow, but still with that collaboration touch point. Definitely. Next slide. Well, this slide here shows the growth that we've had so far. Like we mentioned, we're the babies in this when compared to Bon Secours, but we have seen growth month over month, which is what we would expect as we to continue to enroll our patients. One of the things that we have done a little bit differently than Bon Secours is as we started to build this, we've taken a blended approach. Some of our patients we are managing on a 31 day cadence and some of them were taking a 91 day approach. As Tracy, I think mentioned, we're an advanced heart failure clinic. We do have an LVAD and transplant program here at Allegheny General Hospital. And so we certainly have patients who have quite a high degree of acuity and all of those patients are being managed at that 31 day cadence. It's what is clinically appropriate for them. And it really matched the level of touch points that we were already having in their care, even before we had the ability of merge to help us with that efficiency and billing aspect. But we also do have some lower acuity heart failure patients. And as Tracy mentioned, we're an urban center. We do have patients where maybe their ability to manage co-pays from both the EP and the heart failure side would be a concern. And we certainly wanted to improve our ability to manage them clinically, but not to place undue burdens on those patients. So there is a subset that we are only billing for their care on a 91 day cadence, which is something that they were already pretty familiar with from the EP side. And so as we had these patients that had already been in our care for years, and now we're offering this new service, an additional co-pay, that really sort of helped us to grease the wheels as it were and bring them into the fold and our ability to engage them with this program. So if the patient is very high acuity, maybe they just had a heart failure hospitalization, we are managing them at the 31 day cadence, or like I said, an LVAD, a transplant patient, they are all being managed at that 31 day interval. But if we have a relatively stable patient and they've been stable for quite some time, we certainly are not trying to overburden them if they have a particular situation where we're trying to balance their financial needs with our ability to provide good, strong clinical care. So up until now, we have taken a little bit of a different approach. It's a little bit fluid. We're continuing to reevaluate our focus there. And as we bring new patients into our clinic, we are able to provide that 31 day management as our standard of care. And it's just what they come to expect. But this was really a slightly different approach that we took to try to offer this new service to patients who were already very used to our robust management, even without MERGE. So we expect to see continued growth month over month as we continue to enroll patients. And we are so close to that 200 mark. We're really excited about that. There's just something about that milestone of hitting another hundred worth of patients. And I think we'll have a little party whenever we hit that milestone. But that's something I just wanted to call out. It is a little bit different than the Bon Secours journey in that they already had this patient population of 1,200 folks who were already very used to being involved with that clinic and billing for the management of their heart failure. But our patients were used to the pick up the phone, call them, hey, what's your weight today? What's your swelling look like? And we certainly still do that. But we just took a little bit of a different soft approach to really get us up and running. And so far, I think it's worked really well. Our patients have been quite receptive to it. And we're excited about continuing to grow and move in that right direction. And we have a lot of providers who are very excited about the ability to bring this out to our general cardiology physicians as well, because a lot of heart failure is managed by general cardiologists and not necessarily an advanced heart failure team. So we wanna be able to have that patient population benefit from this service as well. Awesome, great points. Next slide, I think that was... Yeah, I think that is lessons learned in best practices. I think we've kind of been talking about that the whole time. I mean, it's kind of the running theme here. And I know we're getting close to time. So I wanna have at least some time to do Q&A. But this kind of sums up, I guess, just in one slide. Now, it goes much deeper, as I think y'all see. But be open to the evolution of the workflow. It's a partnership with a lot of different stakeholders. It's a collaboration, including the patient. I mean, as you see in Allegheny's case, especially that they're getting the buy-in from the patients and really being mindful of how that looks. And doing what we're doing today, seek out the support from others in the space, having webinars like this, having discussions. I think Allegheny and Cincinnati have been collaborating as much as possible on how to build these clinics out. So this slide kind of speaks to that. I hope it resonates with you in attendance today. If you want to know more about kind of next steps of what might be offered to you and where your clinic currently stands, there's a few avenues to take. If you're a Merge customer, you can always reach out to customer.careatmerge.com, or you can chime in on the chat bubble while you're logged in. The other avenue outside of collaborating with another clinic and kind of seeing how they do it is talk to your device representatives, your local device representatives. They're a wealth of knowledge about the secondary or co-management clinic offerings. And they're offering a lot of tools that are constantly evolving as well and getting their recommendations on how to set up that dedicated heart failure avenue through co-management. I know Medtronic, Boston, Merlin, they all have offerings that can speak to this co-management. And if you're interested in anything with the dedicated heart failure, you're not a Merge customer or any of the offerings that Merge has, you've always got www.merge.com. So with that, I'm gonna switch it over to Q&A, and hopefully we've got a little bit of time to touch on some points and maybe this springboards into another chat in another time. Yeah, absolutely. Thank you, Andy. Thank you, everyone who presented today. That was terrific. Really appreciate you taking us through your experience and sharing some of the benefits and efficiencies that you've been able to create through reworking your workflows here. We do have some questions from the audience. Andy, maybe I'll throw the question to you. And if you feel like there's a best person to direct that to, you can guide us in that way. But for the first question from an attendee, they were curious what kind of benefits patients of yours have seen from a dedicated heart failure workflow. And then if you maybe have a quick example, obviously without naming any names that you might be able to share. Yeah, I'm gonna pose that to the panelists, but from my point of view, I think I've seen just in working with these clinics is this the collaboration touch point. And I think that Allegheny speaks to that really well in terms of how they're engaging with their patients to opt them in. But anybody from the clinics wanna take a stab at that one? Yeah, that's a great question. And actually, Stephanie and I were just talking about this yesterday about a recent patient example that happened in our clinic where we were able to, I don't know if it was a save, if you will. So maybe Stephanie would like to share that example with the group. So we had a patient who had gone in for a procedure unrelated to heart failure or cardiac care. She wasn't feeling so great when she went home. I had an alert that came through the next day that showed that it looked like she was carrying some extra fluid. And so her nurse and I reached out to her to assess her and she had had extra fluid during that procedure. A lot of practitioners who don't have like a background in maybe heart failure wouldn't realize that that would be a problem for the patient. And so we were able to adjust her medications and she quickly came back to baseline. And we are thankful that we had that alert for the patient so that we could quickly treat her so it didn't escalate to anything worse. That's a great example. Anyone else? I think, you know, I can just kind of add that, I mean, we have a few stories, but in general, the response has been really positive, not only from the providers on both sides, meaning EP and heart failure, but as well as the patients. A lot of them actually find comfort in the fact that they're being monitored so closely because whenever we start to worry that it looks like they're showing signs of retaining fluid, we'll go ahead and start the communication, start a message. And then ultimately someone from the office reaches out to the patient and of course assesses symptoms, weight, that kind of thing. And so the patient really becomes involved and they know that we're really monitoring them extra in their mind. And a lot of them have expressed a lot of comfort with that. And if they're not, due to whatever reason it may be, financial or otherwise, it's very easy to opt them out of the program. It's their choice ultimately. Excellent. Perfect, yeah. Thank you very much for those answers. Another question we had from an individual in the audience, they currently have merged for their EP management, but not on the heart failure side. And they were curious if you had any insights or if you could share your experience with how did you get buy-in at the senior leadership level and in the organization to get it on the heart failure side as well? I can take that call, a question. So it was really something that we were excited about as we talked to merge as the software system that we wanted to use from the EP side, right? So it was simple enough to make a business case for what that would look like from the EP side. But as we said, we already had a fairly large heart failure clinic. And we knew how many patients were being managed in that heart failure clinic, as well as within our cardiology institute as a whole, that had a device that was capable of heart failure monitoring. So we were able to show that we had a device so we were able to show the number of potential additional patients that we could manage from a heart failure perspective. So certainly knew that we were unlikely to get 100% capture of all of those patients within this program. But we knew that we were gonna be starting within our advanced heart failure clinic. We were able to use our reporting functions within our health system, health record to pull a report of all of the patients who are currently being co-managed by both our electrophysiology team, as well as our advanced heart failure team that had a capable device. So we were able to lay out that business case pretty clearly of potential additional revenue, as well as look at how well we were doing managing those patients from a cost of safety perspective and note that there was room for improvement. So that was really a selling point for us in terms of working with senior leadership was that value add from both a clinical perspective as well as a revenue perspective. Thank you. And we had a few questions actually around CardioMEM and whether that's part of the workflow process for any of you and kind of how you've incorporated that, if it incorporates. And since we had a few was wondering if you might be able to just kind of generally speak to how that's incorporated in the workflow. I'm not sure if Allegheny would maybe be a better clinic to discuss with that. I know we have some CardioMEMs, but we're not a huge population of that. I think we have about maybe 15, 20 ish. So currently we are not tackling that, but once we have talked about adding that and eventually I think we will, it's just there's such a little population of them that it's not urgent. For us here at Allegheny, we have about 60 of the CardioMEMs. Now, when I say we have 60 patients that have CardioMEMs, that does not mean that they're all doing their device check as they should or anything, but that's how many we have in the system that we are following. We have not added that to MERGE yet. That is something that we want to do, but we wanna get a little bit more volume in order to really maximize what MERGE can do for us. We've always had the CardioMEMs where our nurses, specifically our heart failure nurses, were monitoring them from a day-to-day standpoint, but we were not doing any billing. About three years ago, we did kind of decide, okay, we'll try and step this up and figure out how to do the billing for it. But it was very separated where you had the clinical aspect going on over here and then we were separately billing over here based off of the readings that were being pulled. With MERGE, we're excited to have that opportunity when we do do that, that a lot of that will be more automated and it won't be as time-consuming as it is now. But we're excited about it. I think that's something that we actually really wanted to capture. But as we got into the ICDs and everything for heart failure and the devices, it was a quicker path to show growth. So we opted for that first. Yeah, that's a great point, Tracy. And it speaks to kind of the vision that you all have for your clinic. And CardioMEMs is certainly gonna be incorporated into that down the road and being able to use MERGE to do that. Thank you all. It'll be a one-stop shop. We're just not there yet. Terrific. Well, thank you to all of our panelists today. That was terrific. We really do appreciate you sharing your experiences and your insights around how you've been able to improve these workflows. And of course, a big thank you to MERGE for making it possible for us to present this material. And we're hoping that those in the audience were able to get some good insights out of this presentation. We did get a lot of really great questions. We are out of time and we're not gonna be able to get to those live, unfortunately. But if you asked a question that was not answered, we will absolutely address that and we'll be following up with you with an answer. So be on the lookout for that. We're certainly going to try to address that. And again, thanks to everyone who attended today. And thank you very much to our panelists who provided those insights and hope you all have a great rest of your afternoon. You as well. Thank you. Thank you. Thank you very much.

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heart failure workflow

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