Hi everybody, welcome to the webinar, we're certainly going to give folks more time to join so we will start in just a couple minutes. Hello, if you're just joining us, appreciate it. And we are going to start the webinar in about one minute we're going to give others a chance to join as well because we're so close to time. So please sit tight and we will begin shortly. Thank you so much. Okay, we will go ahead and begin today's webinar. I'm very excited for today's webinar. It is titled Tackling Operational Efficiencies in Cardiac Remote Monitoring, Looking at Strategies to Utilize Data for Long-Term Success. And today's webinar is really gonna focus on sustainable strategies to improve workflows and enhance efficiency, specifically inside of the device clinic. So we have with us today, Amy Coleman. She is a clinical manager at Centara Cardiology Specialist. And she oversees more than 50 other nurses across 10 different locations and is responsible for all the clinical process changes and implementation inside of Centara Cardiology Specialist. We also have with us today, Ashford Denman. And Ashford is a veteran of cardiovascular care and has over 20 years of experience running service lines inside of hospitals and has spent a large majority of that time specifically around cardiovascular. So we do have two folks who are very into cardiovascular services and have great experience specifically in the device clinic and with PaceMate. And so we thank PaceMate for helping to bring these two together so that we can provide this education to you today. So without further ado, I wanna introduce Amy and Ashford and I will have you both take it away in just a moment. Before I do, I wanna make sure that we understand how to navigate the system. And so at the bottom of your screen, you will see a Q&A button and a chat button. In the chat is where you will find the slides for today's presentation. We may put them in a few times throughout the webinar as well. And you can click on that link and download the slides for today. Additionally, we have the Q&A button and any questions that you would have for the presenters or if you're having any challenges with the audio or accessing the system or the slides, you're going to need to communicate with the presenters and the staff through the Q&A button at the bottom part of your screen. So those are the two places where you will not be able to chat with each other or type into the chat feature for today's webinar. You'll need to use the Q&A portion. So with that, I will turn it over to Amy and Ashford. Thank you for being here and take us away. Thanks, Joe. Thanks for having us. Let's go to the next slide. This is a three part. Oh, so first our disclosures you have here in front of you, we're both working with Pacemate. Go to the next slide. I wanna recap our conversation that we had at the Mad Axiom Conference. This is a three part series in which we are on the second part, but I wanna recap the first part for everybody. Just like a lot of service line executives out there, we had a journey to identify a new cardiac remote management system. And our problem was fourfold. Our legacy system was end of life. The server was on site. We had disparate instances throughout our organization. We had a credible lack of efficiency that was created by our legacy system, whereby users had to log in to multiple systems to be able to manage care and follow up on devices. This produced incomplete patient care. We saw gaps in care that were happening. There were missed checks and missed alerts. And actually from a primary care perspective, we lost some patients because we weren't able to follow those patients. All of this resulted in a huge opportunity for us around miss billing because of these manual processes. When we stepped forward to identify a solution, we brought together all of the stakeholders across our organization. And we actually unanimously identified PaceMate as our solution. It was an all-in-one cloud-based platform. A platform, as you recall from our presentation, was something that I was really looking for because it enabled us as an organization to interface with one vendor and then have those vendors interface with that one vendor. It enabled us to be a lot more efficient, a lot more versatile within our IT department. The other benefit that PaceMate gave us was it was cloud-based. We wanted to get rid of the old server on-premises limitation that we always had. This enabled our providers and our staff to log in anywhere from their homes, from their facilities. This also helped them eliminate a lot of administrative work that was out there. We were utilizing our staff as glorified billers. They were the ones that had to remember to manually check devices along the way. They had to log into disparate systems and make sure they were continuing to manage patient care. And so we were able to eliminate significant administrative burden from them. Also, there was a huge benefit to our real-time EMR integration that existed. This was something I knew was going to happen, but the bi-directional benefit, we really didn't see the benefits to that until later on in our implementation. And it really was something that moved this system from just a data warehouse that we had experienced with our legacy system to more of a actual interactive electronic medical record influencing and improving care. And then ultimately, everything comes down to a business case, and we did see a 20% increase in our net revenues associated with this new solution. And what I wanna do is jump from here into our next areas that Amy's gonna hit on, our strategies for utilizing that data for long-term success. Here on the next slide, Amy, take us through what we're gonna get into on this presentation. Yeah, so these are some of the things that we looked for, but also didn't realize we would get without the platform that we chose. EMR integration, like you said, Ashford, is huge. It's bi-directional, so there's less manual entering of any of the CPT codes or any of the data. The bi-directional has given us the benefit of pulling in things that we couldn't pull in before from the medical record to our legacy system. It has the ability to prioritize patient care within the platform. So we're able to really focus on the patients that need us first and most, and prioritize our workflows from there. We can also target care management. So if someone needs further follow-up or that something's missing, because we can run so many different reports and we can actually see things all in one place, we can really focus on the patients that maybe aren't sick or don't have an issue with their device, but maybe need a different plan of care that we can see from the information within Pacemate. One of the things I love as a device nurse and a clinician and as a leader is a frequent flyer option or component of Pacemate. So we can identify those patients that we get multiple reports in a week for that don't necessarily need a change in their care plan. They're on the right medications. We're not doing an ablation on them or it's medical management or something along those lines. We can eliminate those from the noise of the remotes and alerts that are coming through to our staff. And then another thing that I know, Ashford, you are a big proponent of this is the recall alerts. So in the past, the recalls weren't as easy to manage and now it's all in one place and we can manage those a lot better. It's not a manual process anymore. And then the reports that we have access to that we'll look into a little bit more into the presentation that really can show how we're productive and we're efficient and operationally we're just doing a better job providing care to our patients. Yeah, I'm really excited about the operational efficiency reports that we're gonna share here that really makes a lot of this real for the people out there. Absolutely. So Amy, tell us a little bit more about the benefit for your operational team on the next slide here regarding the EMR integration that existed. With the EMR integrations, it's real time. Everything is connected to our, we use Epic for our medical record. So every couple minutes PaceMate is connecting to Epic but it's also connecting to those vendor sites that we use. We're vendor agnostic when it comes to our implanted devices. So we have four vendors that we had to manage each site independently. So all of that is updated constantly. Somebody changes their medications on office visit that's updated in the platform as well. So we can really focus in one area. The physicians can look at the reports and know that, oh, this patient has some AFib but they're on an anticoagulant. Everything has reduced that manual entry because of the EMR integrations. You don't have to sit there and type in your note that they're on an anticoagulant or even if they were hospitalized. There's all these things that can functionality-wise that are right there at the tip of your fingers that are within the report. And also just automatically syncing that data without, like you said, having logins for so many different sites. The providers get frustrated with that. They have to log in to check EKGs. They have to log in for other non-invasive testing. So this kind of eliminated excess logins for them as well. And they could take it wherever they were. If they didn't wanna sign their reports at five o'clock in the afternoon and they wanted to do it at home, they had that access. And then also the real time and the critical alerts. We could prioritize those patients with the alert system that we'll go into a little bit further too. To focus on those patients that have the most need for their situation. Amy, I mentioned this before, this bi-directional feed. I knew it exists, but I didn't know that Pacemate would auto-populate so much of our data into their software. And what's really nice about that, our EMR is great. For the providers, there's a lot of noise in our EMR, lots of notes, and it's not always apparent what's happened to the patient in the past. And going through the system, the solution really provides one snapshot of everything that's relevant related to that device for that physician. And for me, that really turned this from just a data warehouse that we were kind of put, they were pushing data through to reduce the amount of vendors we were working with, to something that they're actively managing care. And not to mention the level of reporting that Pacemate had. Tell me a little bit about, on the next slide here about the reporting and the ability to do some patient prioritization and care management. So one of the great things about this is we wanna help the most severe patients first, right? We wanna help that person that maybe is dependent and they have a lead issue. We are able to do that with the flag system, but also it kind of filters out that noise that you don't need to focus on. The auto updates and the auto triage function within Pacemate, if the patient is on an anticoagulant, it's noted in there, it knows it, it triggers it so that if AFib comes in on that patient, it's gonna flag it as a green alert, not a yellow or a red alert because that patient isn't at risk for a stroke. So yes, their AFib might need to be assessed, but not as quickly as that dependent patient who has a lead issue. So with the flag system and with the updating of the medications and the anticoagulants and even the left atrial appendage devices can be included in that as well. It really allows you to focus on those patients that need it. Those AFib patients that aren't on an anticoagulant, they're gonna come in as a red alert and that's concerning because you don't want them to have a stroke. So you can focus on those patients first and really utilize your staff in the best way for the patient care. Yeah, I think this is amazing. So much noise that are thrown at your staff and our providers, being able to give them something that clinically they agree with, that prioritizes their patients and helps the staff to know who to reach out to, it reduces that noise. It's a huge problem in healthcare. If you look at the EMR, there's so much noise. What's relevant, this really does take it and allow for providers and staff to know who needs to be outreached to at what point in time. Well, and that noise, there's noise in a lot of things like you said. And one of the things that causes noise are the alerts and some of them just aren't necessary. So you have that frequent flyer option where you can eliminate some of that noise, but also you can further filter out alert criteria with Pacemate. So each of the vendor sites, you have the ability to set your alerts, but you can further customize them within Pacemate. You can customize them a little more individually, which I think is helpful. Not 10 physicians in a room are never gonna agree on the same thing. So they can also customize things for their patients as they come up and make those decisions based on how they wanna treat their patients and how their plan of care is kind of organized. And then obviously we will go more into the data and the analytics, I think further on in the presentation, but some of the alert trends we can look at. If things update, best practices update, that's automatic in here. We don't have to go, what was that thing again? We can set it so that it alerts if someone's V pacing all of a sudden greater than 20% instead of 40%, which was old data. You don't have that ability on those vendor sites to do that. So it's just given us the ability to be more proactive in patient care. And I think that's important. We should be changing always. We should always be keeping up with what's best for patients. Cardiology is growing so fast. It's one of the fastest specialties or subspecialties in the nation. And so this just allows us to be proactive and not reactive. And I think we talked about that in part one of our first session at the conference. Right. So it really does get rid of alert fatigue is what I heard. You have clinicians that are able to get rid of those cheat sheets that they're constantly scratching out the old criteria and putting in the new criteria with, and it puts it into a technology. And it also has some really cool features to get rid of the noise. Speaking of noise, you mentioned frequent flyer. On the next slide here, talk to me about the frequent flyer reports and how you utilize those and impact patient care. So frequent flyers, we used to have them, they'd show up on the different websites for the vendors and they're the little old lady maybe that presses her button every day because she doesn't understand the technology that it's automatic. Or maybe she feels a little flutter so she presses the button. And a lot of them are not clinically, you don't need to make a clinical decision on those patients. So you're able to filter those out and change the alerts for those specific patients to filter out more noise. And then if there is a patient that is chronically having an issue and maybe they've changed their medications, maybe they're set up to have a plan changed, but it's three months down the road because of access, you can focus on those patients and provide care. But it just pulls that excess, the people that are getting multiple reports from the same person out of the pool. And everybody gets that alert fatigue and this has eliminated a lot of that with our staff. So, I mean, we all want smart work, not hard work in our clinics and in our staff, we want them to stay longer. And I think anything that can reduce that administrative strain, so to speak, is important. And this is a key feature that we were able to utilize to be able to help do that. Yeah, and I think this is a powerful tool because back to the noise, one of the things that we hear from clinicians all the time and providers is the fact that there's so much data and so much information being thrown at them that they're having to parse through what's relevant and who really needs attention. And this really gets at who needs attention and it allows the provider to manage the entire care for the patient. A lot of times they don't even realize that the patient is a frequent flyer because it's buried in that medical record somewhere. And to go back through that and look at that, really nobody has time for that anymore. And so it puts that front of mind and I think it allows us to go after those patients that really need our care quickly and changes us from being reactive, patient presents on an exacerbation to proactive. We know that that can exacerbate, right? Yeah, and I think anybody that's had a history as far as a clinician, you get that alarm fatigue kind of terminology. You work on a tele floor in ICU and none of the beeps mean anything anymore because you hear them all the time. Kind of the same thing here, but this helps eliminate some of that. And it makes the staff happier when they can focus on what's real and what's needed and be productive. Right, right. And I talk a lot about from the administrator's perspective what I'm excited about. On the next slide here, I wanna talk about something that if you sit in my seat, you've been struggling with over the past few years. As everybody knows, CMS has really been leaning on provider organizations to make sure that there's a pass-through of vendor credits for device recalls or for early termination or depletion of devices whereby the provider is given a device for free because the manufacturer's device didn't last as long as it was supposed to and CMS is expecting that that that free device passes its way fairly to CMS and and that's been a very difficult thing for our compliance teams and our supply chain teams to really get their hands around and cardiovascular is a big area we put in a lot of devices we take out a lot of devices and when I found out that this this this solution had a device recall alert and and tracking mechanism and I got a chance to really share that with compliance and supply chain they were over the moon excited and really felt like we were probably ahead of the curve and and really from a compliance standpoint felt a lot better how you know that's that's from my look at an administrative standpoint tell me a little bit more about the device recall alerts and how do you use them operationally Amy well like you said you know you want to make sure that you address them quickly too and luckily we haven't had any in recent years that are that could be harmful to patients but how would you like to be the person that you know has a lead that's now recalled and you might not get shocked if you have a ventricular arrhythmia that could cause death so in the past we would get a notification and we get a list from the vendor but it would be based on implant so our doctors implant for a lot of private practice people that aren't part of our health system but we don't follow those devices after implant so we had to sort through all of that to make sure that we were really addressing and making programming changes or even generator changes or whatever you know our team of doctors decided was the best course of action we had to make sure we were you know targeting our patients and not other people's patients but at the same time communicating back to those vendors that hey you need to reach out to these practices too because they might not be aware that their patients are involved in this and then you know after we came up with a decision and all of our patients were remedied so to speak depending on what the the recall was and what our course of action was then you get an email from compliance a month or two later going hey did you know about this because they aren't kept in in the know but now everybody is there's one place this is updated constantly just like the emr the medication you know if a recall comes out and it's published today it's going to be in pacemate and we're going to be able to pull the report very quickly and these are only patients that we manage they're not patients that you know we can filter all that out we can even filter it down to the last time we had a report from the patient if we only want to look back two years so again focusing our manpower where it should be focused and that gives better patient care right because the patients aren't calling constantly going hey I got this letter from medtronic and it's saying that I have this issue with my device I don't know what it means and what do y'all think and you know we're still working through the process so we don't have to do that anymore happier patients again and I think ultimately no matter where you work in health care whether you're on a service line in the clinic or in the hospital we all want to give excellent safe patient care and you know happy patients happy staff kind of kind of thing but in the end we want them to be safe and being safe means managing these recalls quickly and efficiently and we're able to do that now whether it's early battery depletion or a lead issue or you know it can be a logistical nightmare and we don't have to deal with that anymore which is amazing yeah I mean you're just talking about moving from reactive to proactive care I can't help but think about like the patient that calls and is the one that's informing us of a device recall and how how awkward of a situation that is but how horrible for the patient to be in that situation where they we we don't we should be the ones contacting them we should be managing their care and and I really feel strongly that with these these tools we're able to do that much better than we've done before on the next slide we get into you do a great job in your team of filtering and managing this patient data through the through the reports that they have it's next level as far as what you can see and what you can do tell me a little bit about a little bit more about that so I think it's next level not only for the the staff but also the providers you know the providers wanted a one-stop shop now they can do that they can be in a report that they're evaluating and before they e-sign it they can look at the demographics of the patient what medications they're on have they had any recent hospitalizations what are their diagnoses that are maybe associated with cardiology and that's the thing too it pulls the things that are pertinent so that it can be focused on that report you know do they care if they take vitamin c maybe but it's still there they can still see that they're on that medication which they get the picture of the whole picture of the patient but they're able to deal with that one incident of that report I think going into the device alerts and the programming and all that having the flag criteria and you know we decide that we decide what we feel is an urgent alert now by we I mean our providers obviously they're the experts in their field but sometimes different people have different ideas of what's an urgent alert and we can downgrade those as time goes on you know things are constantly changing but the fact that the nurses can go in there and they can focus on those red alerts on one spot and not go to four different vendor sites and go oh this guy had a shock on this site oh there's a shock over here too oh this threshold's high who do I deal with first it's it's there it's you know you're not going back and forth between sites and then having to really determine which you do first it's it's it's just easy you know smart work and the staff like it there's less errors right so everything's there and one you're not pulling the wrong report you're not having to manually attach it it is right there but it also allows you to edit the report to add more information if a patient transmits multiple reports so to speak you know maybe they're still on manual transmissions and they send in three transmissions the same day they're not going to have any they might have different information on each report so you can add those and combine them and not send the doctor three reports to look at and sign and add more work burden to them excuse me sorry um and you know the providers also they want it to be not complex right they want to be able to go there see everything in one site sign the report and move on to the next patient or if there's something that they need to intervene on they want everything there so that they can make a decision without going into multiple areas and making those decisions um so i think overall the the patient care is just easier you know i think it's all there it's you're not toggling back and forth you're not having to figure out where to go to look at if they're on anticoagulant or if they've been in the hospital in the past month because of their heart failure because their optoval is really high um so it's i don't know it's a one-stop shop yeah and and i know from an operate from my perspective the administrative perspective operation we talked about this um the one neat thing about this solution is it builds in the cms criteria for how often the patient is supposed to be checked which was before a manual process and so it reassures our teams that that check is actually happening um and uh that leads through to better reimbursement better billing better rv use but what's really cool about the filtering aspect of things is i as administrator can drill down look at our cpt i can break it down by cpt by vendor i can do it by provider i can do claims i can look at what's billable and what's not billable work um and and obviously i can track reimbursement and this is actually really important in this area because for me it reminds me a lot of ekgs it it's a it's a low reimbursement service um that tends to get forgotten by or overlooked by a lot of people like rev cycle but it's a service that happens hundreds of thousands of times so it adds up very quickly and you know what i've seen in working with our rev cycle people is is we've given them back bandwidth to be able to concentrate on on higher value um opportunities and procedures and and they get the reports they need to make sure that we're doing what we need to do within this system to appropriately bill and you know and they know they feel comfortable because they know it's updated through cms and and complies with cms guidelines which is a huge thing a huge benefit for us absolutely well and you know in health care and anything there's so many working parts and you know when we were dealing with four vendor sites you didn't know who was pulling who had already pulled that report there was no way to tell if somebody was already working on something with the solution that we went that we chose you can't go into a report if someone else is in there so it also cuts down on there's nothing worse than you go to sign a report and it says somebody's already done it and you did all this work you typed up this note you know in our legacy system that's what would happen because you you didn't get locked out so to speak so it's less double work we're already doing less work less clicks and all that because it's a more efficient system but then you're also not working over top of people without knowing because we do have people spread out we have people working from home we have 10 offices that we have device nurses spread out and so you know you're not going to pick up the phone and go hey are you working on mr smith or can i grab it but this eliminates all that you can just click on a report and start working on it yeah targeted management and the ability to drill down and one of the things um amy that i'm pretty excited about um is on this next slide is showing some of the operational efficiency reports that we use um i you know this is just light years beyond what our legacy system could report or any of this um you know i start with the top left one here billable transmit transmissions i actually have the ability to drill into this and look at those non-billable um opportunities and and where do those exist because you know ultimately we want to we want to make sure that our providers are working at the top of their licensure and there's billable opportunities are the ones that we really maximize and there's non-billables are things that we create workflows to be able to work through and so we we drill down into the cpt by vendor by provider through that report talk to me about some of the operational um things operational dashboards you use here to the right of that so i love the the staff efficiency you know covid taught us one good thing probably lots of good things but one good thing as far as i'm concerned as a leader is people can work effectively from home they don't have to be on site to be able to work but in order to prove that to a large organization and to the people in the service line or the corporate kind of areas you have to show that there's they're being productive and this can be tracked through pacemate we know exactly how many reports each person does so not only can we hold people accountable but we can also shift workflows you know if someone's workflow all of a sudden exponentially increased because all of a sudden they're using you know our docs are starting to all trend towards a different vendor than what they used in the past because of a new technology then we can shift that workflow if they're working by vendor so that it's more equalized throughout the staff so i love that one um i also like the device usage like what devices are we putting in who's putting them in um you know in in just the region where i am i have seven hospitals so are we not putting them in one hospital are we having i mean this is also a service line thing are we transferring these patients from one hospital to another to put a pacemaker in when you know what's more efficient maybe we leave the patient there and bring the doctor to them so we can look at those kind of workflows through some of these reports as well and and maybe there's physicians that prefer or they're really good at those left bundle leads and you know we can track some of that through this too and and maybe those are the the providers that focus on that type of technology and the other providers maybe focus on the crt technology you can utilize it however you want um but it's all right there and it's easy to break down even further if you need to yeah summary or you can break it down you know how however you want yeah and amy you can drill into this report and see who um has the most alerts by by device and by vendor as well is that right yeah so so you know non-billable we like to say all those are alerts but a lot of that's noise so you know like you said drilling down into those non-billable ones can help us create better workflows you know change our alert criteria um yeah and you know i think too you can probably speak to it from a service line you can look at the different companies we're using through these dashboards and you can figure out what you want to do from a corporate standpoint oh yeah amy i mean so the the bottom left um grid here that says implantable devices by vendor i use this a lot because before i didn't ever have the ability to drill in to each vendor look at what devices we're using by provider and now i do and so it's really enhanced my conversation as an administrator when it comes time for a biannual crm renegotiation with our vendors it doesn't just enhance it it adds so much value to what we need to focus on and where our utilization is or where we need to shift utilization because we have better pricing that's one of my my favorite reports being able to see preferences and you could see it by facility as well because before you could just do it by cpt code right so you didn't necessarily without really digging into a patient chart to figure out who the vendor was so yeah and it really it required supply chain to work with finance and crossover and a lot of manual work and even sometimes the physician that it was assigned to wasn't right and then your data i love the cpt code report as well because it tells me what cpts are driving our our net revenue and i can see it year over year to make sure that we're improving and that we're growing and i can show this to the rest of corporate and it helps benefit the device clinic because we're bringing in more revenue and you're able to bring in more more staff as a result right absolutely we yeah since we've implemented this we've been able to bring in quite a few more staff which you know generates more clinic visits as well which generates more revenue i mean nobody wants to talk about health care as a business but it's a business we're here to provide health care but we also have to be able to keep the doors open so yeah right and and what about the billable um e-sign transmission graph so i think i think the docs really like this too and they have access to a lot of this um and you know what they don't have access to i can get for them but they can look at are these being billed you know they want to know that they're getting credit for their work obviously who doesn't right we all want to get credit for what we do but they can see where their trends go you know you know maybe my first year out of fellowship i only implanted you know 20 devices that year but here i am four years later and look at what i'm doing i'm more efficient and they can look at it that way too but they can also make sure that they're not missing any of their billable um opportunities yeah and for me these reports just are they're actionable they're actionable insights that we use on a day-to-day month-to-month basis that we just didn't have with our previous system and you know it's something we're not at all yeah um it's something we're pretty excited about we're still more that we want to sift through and and understand about the system there's still more we want to do um with our partnership and and we feel like we can we can do that because the partner is amenable to being able to help us um filter and and create new reports like this um but this is just a step through our journey like your favorite report yes like my favorite report yeah exactly the my gdmt report yes your gdmt report yeah that's that's one of my favorites um that i talked about at the uh the part one um that i was wowed about but you're right we we have a great partnership in that you know we come up with questions and they come up with the solution so that we have access to what we want but also it's cloud-based it's you know technology's always changing so as things come into play it can be included in the platform um which has been great yeah absolutely absolutely so as we shift from here the next slide um we'll open it up to q a hopefully we fostered a lot uh joe if you're still there um you know let us know um we appreciate the opportunity to be here absolutely sure i would uh appreciate that first of all thank you ashford and amy that was fantastic and just provided a wonderful overview you got into so many of those little operational tidbits and almost answered so many questions along the way that i'm sure people have but i'd like to redirect anybody that has questions to the q and a button at the bottom of the screen and that's where you can type some of your questions for ashford and amy and submit them there but i i'm going to start because i heard you say something ashford that was pretty important and you said i know i can go back and quote you on this it's a 20 percent increase to your net revenues was something that you said during this call and what i'm wondering is how how you got there is that you know more patience is that just more captured billing you know how do you impact such a massive change and then of course you know you've got software costs on top of that so what does that really look like um in terms of how you seize that opportunity where is it coming from yeah it's it's coming from so before we were relying upon our our staff to be billers you know they had to take care of patients and they had to remember what checks they could bill for and what checks they can't bill for and and you because they were jumping from multiple systems they were having to manage patients disparately and remind themselves you know is this a 60-day check is it a 90-day check am i supposed to check this device how often that's what i was talking about with that cheat sheet the new solution moved us to an automated algorithm. So the staff don't have to remind themselves. And a lot of those checks we weren't billing for, and those are billable checks. And that's what I meant about the EKG point. You do a lot of EKGs and you think it's a small amount, but it adds up over time. It's significant. I think it was upwards of a couple million dollars of opportunity that was left on the table there as a result. And this was work we were already doing. We just weren't collecting the bill. And that doesn't even include the RVUs benefit to our providers. And that increase in 20% too, just sorry, I'm going to tag on that, was not even the first year that we were using this solution. It was only like the first six or seven months that we were able to recoup that to show where we were really kind of missing the mark on some billing opportunities. Well, you showed a couple of slides ago and we don't need to go back to it, but you also showed Amy some differences there in terms of the staff and show us hypothetical data, but the staff and the number that they're doing per day and things of that nature. So what I'm curious to is how many devices, device nurses were able to monitor and create reports for prior to the solution versus after the solution or any other types of operational efficiencies or staff or patient satisfaction you want to mention. But I think for me, that's kind of drives at one of the main things we're looking at here. So they've probably reduced their workload by I would say 70%. So, I mean, they were doing, we actually went through and with our legacy system and did a couple of different scenarios where we were actually processing everything. And it was a tremendous difference in the clicks, in the typing, you know, we were doing three times the amount of work in some cases. So I think that they, I would say safely, as far as on the remote side of things, whether it's alerts or routine remotes, our device techs do our routine remotes, our RNs do the alerts. I'd say they've probably been able to increase the patients that they take care of by 50% easily. As far as in our clinic, we've been able to shorten our clinic appointment times and also add more appointments to the day. So we've been able to increase our access. And because we've been able to increase our revenue, because we're capturing more billing data, we've been able to add nurses, which also add more clinics, right? It's, you know, kind of a cycle, life cycle, so to speak. And we've also in the past, we might have only had three main offices that had clinics open where there's a clinic nurse and they're able to do device checks. Now, because we've been able to expand, we can have a device clinic in all of our offices. And most of them we can manage five days a week. So patients don't have to drive as far. They don't have to drive from one part of southeastern Virginia to another part just to get their device checked. They can go five minutes from their house in most cases and get their device checked, you know, closer to home. Yeah. So I've got, I want to say something else here. Q&A button, bottom of the screen, please submit any questions you have. I have one that has come in here and it's, it's asking whether or not you are just using the software solution provided by your partner, or if you're also using the clinical and communication services. And then I guess that was the question that was asked, but I would like to build on that just to say, you know, if you are using clinical communication services, what has that impact been to your program? So, you know, Ashford and I were both key stakeholders in this project from the beginning. And one of the things that we wanted in a platform was we wanted to be able to use it as a platform, but we also wanted to have the opportunity to have that service as a backup. You know, we already had an established staff. We have a pretty robust device clinic as it is. We've just been able to expand that. So we have the ability to turn that service on, which is huge for us. You know, if, if we decide to change paths or do something different and utilize that in the future, or maybe we have a bunch of people out sick and we just want to turn it on for a couple of weeks, we have that kind of cushion for us, which is great. What we didn't want was just the remote monitoring service. And you know, they were able to deliver both. We, we have great confidence that if we, you know, utilize that service, that we're going to get the same kind of excellent, excellent quality that we've gotten in the platform and the customer service that we've already had access to. I don't know if Ashford wants to add to that. Two birds with one stone. I mean, it provided a service that we, we knew we needed and every vendor has come, come forward to us offering but we haven't really ventured out. And we knew you've talked about ad nauseum, how, how long it takes to train these techs and nurses. I think you've said it's up to six months, maybe a year to get them even proficient. And, and, you know, they're constantly being recruited. And so we're constantly under the gun of, do we have staff? And, and we have now we have the service available to us. So it keeps all those clinics open, regardless of what our turnover or vacancy could look like. We haven't tapped into that service yet, but it's there. It gives us a boost of confidence to know that we can grow and we can meet our patients needs as we go beyond just the, the platforms abilities. Yeah. So again, I'll make a call for the Q and a box at the bottom of the screen, but you said something, Amy that I'll come back to. And it was that there was about a 70% kind of decrease in workload, right. And, or time to process or however we quantify that. That's a lot of change and change is hard and bringing in software scares people and it requires its own set of training. So I'm kind of curious with that, you know, all of a sudden new bandwidth while volumes are increasing getting people comfortable with this, like, what did it take from an operations and staffing perspective? They're actually becoming less burdened. It sounds like, but how did you manage that staff transition piece? So I talked about the product and the platform long before we went live. And I gave all the staff opportunities to work with the pacemate staff with some testing sites so that they kind of had a hands-on understanding of some of it and were able to ask questions. So they weren't like, you know, deer in the headlights on day one, but we set up a really robust training on the first two days before we went live. And we were able to train our device techs, our nurses and our physicians two days before we went live. And so it was pretty seamless. We had great support on site. So if there were questions, like you said, we have to change. We're in healthcare. If we're not changing, we're not providing the best care for people, but a lot of people don't like change. So there's resistance. Sometimes they think it's not going to be good. I think we would have lost a lot of staff had we not made this change. I think we would have been looking for a remote services company more so than a platform to support our patients on the remote side of things. So this has drastically changed how our staff kind of view their role. And I would say within two weeks, they were pretty comfortable with it. Within a month, they were proficient. So, and I got a lot of apologies because I think they were very, they didn't think it was going to be great, as great as I was promising them it was going to be. So they were like, you're right. This is great. You're right. So, you know, kind of gave me a little, it was, it made me happy. So. And Amy, what about the providers? What was there? So the providers, we, you know, we made sure that we brought them in on the beginning to get buy-in because ultimately they're the ones that are taking ownership of this, right? They're the ones that are having to be responsible for those patients and those reports. And so when we were doing our deep dives on some of these companies, we brought them in, we let them be involved and ask questions and also voice what their desire was as far as from their standpoint. And I think they've been very happy. I know that, you know, they've been involved. We did a case study, you know, not too long ago, and they were happy to be involved with that. But they're in basket. If you use Epic, you have all these baskets and one of theirs is a cosine folder. And with our legacy system, all the reports were going into that cosine folder with their true cosine notes that they needed to sign. So they couldn't filter any of that out and they didn't know what was more important than, you know, the next thing. So it really delayed patient care and it was very frustrating to them. So I think they're happier. You know, I don't hear the same complaints that I used to hear. So like, I'm tired of my cosine folder, having a thousand messages in it. Happy provider, happy life. That's right. I'm not sure that's how it goes, but that's definitely true. As we're, let's see, I've got another question. I had a question for you, Ashford, but I'm going to hold it for a minute. And this question comes in, how was your IT team's perspective on implementation versus your legacy system implementation? So in terms of implementation, the feedback you got from those responsible for the technical side of it, thumbs up, thumbs down. I think that's a way to summarize the question. Well, I'll just harp on our legacy system was server-based. So, you know, there was a physical server on site. It was very close, if not past end of life. It took several IT members to keep that thing going. We were, we had frequent down times. We were constantly, you know, it's not their fault, but we were constantly yelling at IT, can you get the server back up? Can you get the server back up? You know, and they were doing their best to keep it going with duct tape and band-aids and stuff. And, you know, now moving, and it was difficult for IT team because honestly, we as an organization moved cloud-based a while ago to a lot of our technology software. And so having sites like this, really, we weren't set up to manage those. And the ability to move to a cloud-based software was huge for IT. They really appreciated that. The other thing that I knew was happening to us is we were constantly having the headache at administrative, at a provider and a staff level of having to log into multiple systems. That was a huge dissatisfier across the board. And the solution by every vendor, a dozen or so, was to, hey, let us interface with your EMR. You will all interface and be bidirectional. And that completely was a no-go for our IT team because, you know, each one of those integrations, each integration for them takes nine months. And so the ability to integrate with one solution versus having to integrate with a dozen solutions, and we may not keep all dozen. We may shift vendors over time. And so, you know, that could be wasted work. That was a huge benefit from our IT team's perspective. Amy, you work with them operationally. Anything else you'd add? So I want to just also let people know that our legacy system, we had separate databases for different locations. So as a system, we weren't even on the same database. We couldn't share information. We couldn't, you know, take care of one another's patients. Now we're on one system. If, you know, the Western part of the state has a staffing issue, we can take over their remotes if we need to, or we can do whatever we can to help with patient care. So we're one health system. We should be on one, you know, device system essentially. So that was a huge bonus. But also, Pacemate is part of the app orchard for Epic. So you already know that it's going to integrate pretty seamlessly. And there was a workbook. You know, we had some hiccups. The IT team wanted to do this their way or in certain areas. But having a whole team on the project, operationally, clinically, IT, service line, everybody together to make sure that we weren't missing any of the marks. They wanted to still do manual billing. And we said, absolutely not. This is part of the benefit of this system. So y'all got to figure it out. And you got to figure out how you can integrate that part of it. And they were great. We have great IT people. It probably took a little bit longer than some of the projects just because we really did want to use the platform to the highest benefit. But that was not because of Pacemate. Our IT just wanted to make sure they were mapping it out and keeping patient information safe. And in the end, it was a great integration. That's really helpful. Again, I'll make a call for the Q&A box for additional questions. And while I'm waiting for that, I'm going to come back to something you said, Ashford, which was that you can use this data in terms of product utilization and vendor type by physician to help you with your negotiations. So that was your comment. My reflection on that is how about taking a look at other characteristics of particular devices, like the longevity of certain devices or batteries or brands, and how to use that kind of data that you get from the system other than just brand and market share of the brand inside your institution, but all of the other device characteristics. Are you using any of that to inform purchasing decisions or no? What does that look like? I would say we were definitely not using it before. We never even had a clue that that data really existed and we could compare like that. And it will add to our device negotiations. It will also add to our conversations with our physicians. Amy, do you want to talk about the report that I was like, I didn't know that existed the other day with the time for each vendor, the alert times for each vendor, and the reduction. And so one of the reports that Amy shared- I'm drawing a blank. Sorry. Sorry. One of the reports that Amy, you provided so many of them. One of the reports that Amy provided me the other day that I'm actually going to utilize in our next negotiations is a report that tells you by vendor what the alert notifications are and who gives more alerts, meaning who creates more work for our staff, what vendor creates more work for our staff. And through that, you can surmise that those that provide a lot of alerts, there's a higher rate of depletion of that battery life over time. And so that will be a part of our next negotiations. That's sort of the added value. The other added value point is a lot of the- and we had no way of being able to see this data and know whether or not we're using this data- is every vendor now has a extra bell and whistle attached to their pacemaker, their ICD. And they've got their basic and they've got their platinum. And the platinum usually has those bells and whistles. A lot of providers don't use those bells and whistles. But we're still putting them in. And Pacemate has the ability to authenticate or hold us accountable whether or not we're using those bells and whistles and go back to the providers and say, hey guys, do we really need to shift over here or should we be more of a 50-50 split? That is informing for me and working with our vendors on how to negotiation, what do we need to negotiate on? Is it a basic or a platinum type of device? Amy, what were you going to say? No, I agree. We have these Optivols and some of these heart failure trends that not all our doctors utilize, but they're putting those ICDs in that can read that. And if they're not utilizing it, they could just put in a basic ICD. And I think that helps. Or the off side of that is, why aren't they using it? Does our patient benefit from that technology? And if we're putting them in, how can we do better as a health system to manage that information that comes through? Who gets that data? Because the electrophysiologist doesn't want to manage the heart failure on a patient. So where in our health system can we find that partnership or that expert that can be the filter that that information goes through to make sure those patients are getting good care and also staying out of the hospital? Because that's a goal as a health system. It's not just to manage their device, but it's to make sure we keep them out of the hospital and as healthy as possible. Got it. So we have time for, I think, one more question, and then we'll bring this to a close. The question is, did you roll out the heart failure features like Optivol at the same time that you migrated to Pacemate or did you stagger this? So they kind of came with it and, you know, you can turn off those alerts or turn them on. We don't really have a good setup to manage that data. So right now we don't manage it unless it's on an inpatient visit, then we'll note it. Or if it comes through, it's always noted in the in the report, and the tech or the nurse will speak to it. But whether or not the doctor does anything with it, you know, a lot of times they're not managing the heart failure. So the ones that cause separate alerts, we don't have those turned on right now. So we are coming up with, you know, we're looking at do we want an APC and an RN to be like the focal point or the center point for those types of alerts, and then they can filter out whether the patient needs better medical management, they need increase on their diuretics, that kind of thing. So until we have a good setup there, it's not fair to the patients to, you know, willy-nilly treat their alerts when there's no one to really make a decision on it. Sure. Anything to add to that, Ashford? No, I would just say, I mean, I think before this wasn't even a point of conversation, we didn't have the data, we knew we didn't have the data. So creating an infrastructure to manage the data or figuring out what the workflow would look like to manage the data, it wasn't even crossing our minds. And now that we have the data and the data is actionable, we're like, all right, now how do we staff this? What would the workflow look like? It gives us so many more possibilities, which ultimately just benefits patient care and the care disease that we're taking care of. Absolutely. Did you have another comment, Amy? No, I said absolutely. Agree. A thousand percent. Well, we have a minute or less left. So I want to thank you, Amy and Ashford. Appreciate your sharing all of your experiences with us here today and making sure that our journeys are even less painful than yours was, which did not seem to be painful at all, to be fair, but it's nice to be able to learn from others. And I appreciate you sharing. I appreciate Pacemate for giving us the opportunity to bring this out to our membership. And if anybody has additional questions, I'm sure that we can connect you with Amy and Ashford so that we can make sure those are answered for you. And other than that, that will bring today's webinar to a close. So thanks everybody for attending and we will talk with you soon. Thanks for having us.

cardiac remote monitoring

operational efficiencies

device clinics

technology integration

PaceMate platform

EMR integration

alert management

recall management

staff productivity

financial outcomes