Cardio management

Cardio management saves lives and boosts revenue

By Rosie Lombardi

ECGs are one of the most common diagnostic tests ordered, but most family doctors don’t have the equipment or comfort level to do the tests themselves. Patients are typically referred to cardiologists or diagnostic labs for a resting 12-lead ECG or arrhythmia or Holter monitoring, which takes time and travel. But Toronto-based Cardiocomm Solutions provides a virtual solution that allows doctors to conduct ECGs themselves, in their own offices – without investing in specific computer hardware, phone services or software – and allows them to bill OHIP for the eligible services.

“We believe these ECG tests should be done more often, and our C4 service offers a sustainable business model that benefits doctors and patients,” says Etienne Grima (pictured), CEO of Cardiocomm Solutions and COO of the Canadian Heart Research Centre. “Our service is targeted for general practitioners, not just cardiologists.”

Grima points out that arrhythmia screening specifically should be done more frequently on younger patients, and not just elderly ones at risk for stroke. “You often hear of young people dying of sudden cardiac arrest while playing sports. Some of these deaths could be prevented if more people were screened and treated for atrial fibrillation.”

Patients who say they feel their heart skipping or butterflies in their chest are typically asked to wear an event loop recorder (ELR) monitoring device for a period of time to detect cardiac anomalies, he says. The device automatically records and transmits a signal via celluar technology or over phone lines when it has detected an abnormal heartbeat, and patients can also activate it when they feel something strange happening.

With Cardiocomm’s C4 service, the ECG is transmitted to the company’s proprietary virtual call centre, which is staffed with technicians and cardiologists who interpret the ECG, says Grima.

“Instead of referring the patient and waiting in a queue, the initial diagnostic can be done right away in the doctor’s office. It only takes about 15 minutes to train a patient on how to wear and use an event loop recorder. We can do all the maintenance and interpretation of results on the doctor’s behalf, who gets the results and manages the patient’s condition.”

When patient ECG data is transmitted to the call centre, Cardiocomm’s software decodes the signal, generates the ECG in 30 seconds, and saves it as a data file on its servers. The doctor is notified via e-mail every time the patient transmits data.

“The e-mail contains a link that allows doctors to log in and review the ECG, or our technicians and cardiologists can interpret it on their behalf if they prefer. We provide a full reporting system that’s approved by the FDA and Health Canada and is completely HIPAA compliant.”

There’s a shorter cycle time in diagnosing the patient’s condition, and in Ontario, doctors get reimbursed via OHIP for conducting and reviewing ECG tests, says Grima.

“Many doctors don’t realize they can bill for this standard testing, which is about $200 per patient in total for various steps in the process. They don’t have to buy computers or software in our approach, so there are no barriers to entry. And they can review the ECG results at home or at the cottage anytime on laptops and smartphones with an Internet browser.”

Patients with arrhythmias may then have a subsequent Holter monitoring period to better qualify the extent of any other cardiac abnormalities that may be present.

However, doctors do need to invest in the purchase of the event loop and Holter recorders, as OHIP won’t reimburse doctors unless they own the monitoring equipment.

“These cost about $900 to $1200, but we can provide them at a lower cost when they sign up for our C4 service. We don’t make our money on hardware, so we can provide them at a better price. Doctors typically recover their initial investment in these devices with only a few patients. And our service is device-agnostic, so it can be used with most ELR recording devices if doctors prefer to buy them elsewhere or have inventory already.”

About 80 clinics in Ontario and across Canada have signed onto Cardiocomm’s C4 arrythmia service since it was launched in 2009, and Grima says American clinics are also now signing up to use the service for performing 12-lead ECGs. “It’s a shame we’re getting more interest from the US than Canada for the 12-lead ECG service.”

Ontario is the only province that really provides sufficient reimbursement for these ECG services, so there are little financial advantages to using them in other provinces, although there are real clinical advantages to be realized in rural areas where diagnostic services are harder to obtain.

“In Ontario, the only barrier to entry is the knowledge gap. Many doctors say they didn’t realize how straightforward our service is, or that they could get reimbursed. And many doctors prefer the holter test because they’re familiar with it, even though it’s not appropriate for arrhythmia detection.”

The holter is a monitoring device that’s been in use for many years and which is worn for only two to three days. Grima says anomalies may be missed with this technology. “Some cardiac episodes only happen once a week. Our software is designed to work with devices worn by patients for 10 to 30 days.”

In the future, Cardiocomm plans to introduce wireless monitoring in Ontario, he says. Canada is behind the curve, as the US and Europe use wireless technology to transmit signals, which is faster and more efficient than telephone lines, says Grima.

“In 2012, we want to bring wireless monitoring in a cost-efficient way that works within the current funding available. We’re also planning to launch software that’s compatible with Windows 7. And we’re starting to look at other biometric monitoring that can be done at home or after patients are discharged from hospital. We want to bring more of this technology to Canada.”

Posted July 21, 2011