title: Remote monitoring of patients with implanted devices: data exchange and integration.
abstract: BACKGROUND
  Remote follow-up of implanted implantable cardioverter defibrillators (ICDs) may offer a solution to the problem of overcrowded outpatient clinics, and may also be effective in detecting clinical events early. Data obtained from remote follow up systems, as developed by all major device companies, are stored in a central database system, operated and owned by the device company. A problem now arises that the patient's clinical information is partly stored in the local electronic health record (EHR) system in the hospital, and partly in the remote monitoring database, which may potentially result in patient safety issues.
  
  
  METHODS
  To address the requirement of integrating remote monitoring data in the local EHR, the Integrating the Healthcare Enterprise (IHE) Implantable Device Cardiac Observation (IDCO) profile has been developed. This IHE IDCO profile has been adapted by all major device companies.
  
  
  RESULTS
  In our hospital, we have implemented the IHE IDCO profile to import data from the remote databases from two device vendors into the departmental Cardiology Information System (EPD-Vision). Data is exchanged via a HL7/XML communication protocol, as defined in the IHE IDCO profile.
  
  
  CONCLUSIONS
  By implementing the IHE IDCO profile, we have been able to integrate the data from the remote monitoring databases in our local EHRs. It can be expected that remote monitoring systems will develop into dedicated monitoring and therapy platforms. Data retrieved from these systems should form an integral part of the electronic patient record as more and more out-patient clinic care will shift to personalized care provided at a distance, in other words at the patient's home.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. ETvanderVelde@lumc.nl
authors.forename: Enno T
authors.initials: ET
authors.lastname: Van der Velde
authors.forename: Douwe E
authors.initials: DE
authors.lastname: Atsma
authors.forename: Hylke
authors.initials: H
authors.lastname: Foeken
authors.forename: Tom A
authors.initials: TA
authors.lastname: Witteman
authors.forename: Wybo H G J
authors.initials: WH
authors.lastname: Hoekstra
mesh_terms: D000553:Ambulatory Care; D016507:Cardiology Service, Hospital; D017147:Defibrillators, Implantable; D019033:Delivery of Health Care, Integrated; D057286:Electronic Health Records; D004867:Equipment Design; D006751:Hospital Information Systems; D006801:Humans; D008498:Medical Record Linkage / Q000295:instrumentation*; D018670:Monitoring, Ambulatory / Q000295:instrumentation; D010138:Pacemaker, Artificial; D016730:Program Development; D019114:Remote Consultation / Q000295:instrumentation*; D012815:Signal Processing, Computer-Assisted; D018511:Systems Integration; D013686:Telemetry / Q000295:instrumentation*
keywords: ICD; IHE; Remote monitoring; data exchange; implantable devices; pacemaker; standardization