Information Technology Aspects of Integrated Cardiac Rhythm Disease Management

Since several decades pacemakers and implantable cardioverter defibrillators (ICDs) are a common therapy for patients with cardiac rhythm abnormalities. More recently developed devices like implantable cardiac resynchronization therapy devices (CRTs) (Anand et al. 2009) or implantable loop recorders (ILRs) (Boersma et al. 2003) are implanted with increasing frequency and provide promising results. Selection and implantation of devices are only first steps in cardiac rhythm disease management. Continuous adaptation of device settings to patient’s needs, monitoring of device’s battery status, revision of devices and several other issues need to be considered. Additionally, the functionality of devices is closely related to other therapeutic aspects, such as medication or the patient’s health parameters – assessed either by general practitioners or by the patient him/ herself (e.g. blood pressure). In many cases a given patient needs more than one therapy: e.g. pacemaker therapy is closely related to medication monitoring; or an increasing number of remotely monitored congestive heart failure patients also have an implanted CRT device. Therefore, a system is needed which is able to handle data from various sources (from implanted devices, from patient’s home, from general practitioners, from hospitals, etc.) and provide the physician with all information necessary for an optimal therapy. While from the patient’s view it is primarily essential that all data from various sources are combined in one single system, from the physician’s view it is also important to have one single system for all the patients she/ he is responsible for. There are several manufacturers for each of the therapeutic tools used in cardiac rhythm disease management. Each of those provides the physician with its own proprietary data interface. And, of course, one physician’s patients are not all equipped with devices of one and the same manufacturer. Therefore, it is not only necessary to combine devices supporting different therapies (pacemakers, remote monitoring, etc.), but also to combine systems from different manufacturers within one single platform. Additionally, eHealth infrastructures with electronic health records are currently envisaged, conceived or already established in many environments (single healthcare institutions, health management organisations, whole healthcare systems, or even nation-wide) (Pfeiffer