Pacemaker et la télécardiologie

Service de Cardiologie de la Clinique de la Dhuys | 1 rue Pierre et Marie Curie 93170 Bagnolet | France |
Tel: 00 33 1 48 97 50 04

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Telecardiology

Telecardiology has entailed a fundamental revolution in cardiology. The flow of patients in our rhythmology consultations has become hard to manage. Whether in the public or the private sector, the problem is getting increasingly critical. In our center, 80% of the follow up could be “spared”. Our efforts could then be focused on other treatments.

Rhythmology seems to correspond to such an approach to medical care since clinical examination is not a crucial act in the treatment of patients. The expertise of the rhythmologist is needed only to check the settings and to interpret the electrocardiographic recordings.

What is “telecardiology”? Telecardiology facilitates the remote follow up of patients who carry a defibrillator or pacemaker. The device sends a flow of information to an internet server through the GSM network. This information relates to both the good functioning of the device and the state of the patient’s heart. Those parameters are analyzed. If some of the parameters do not correspond to the norms set up by the surveillance center, a warning is sent to the implantation center via email, text message or fax.

The practitioner in charge can then log on to the website and assess the seriousness of the malfunction. If need be, he can meet up with the patient. For the moment, we cannot consider remote reprogramming. However, it should be known that only 15 % of the prostheses have necessitated a modification of the parameters for the moment.

In technological terms, the organization of such a surveillance system is easily manageable nowadays. The amazing development of the internet enables practitioners to have easy access to information just about everywhere. What is left to define is who will run the telecardiology unit on a daily basis. It is theoretically the business of practitioners who are specialized in rhythmology. But it is conceivable to train some of the nursing staff under the condition of strict supervision by a doctor in charge.

To finish, when any new medical technology is engineered, a legal framework has to be set in place so as to protect the patient’s rights as well as those of the medical staff. Indeed, since telecardiology constitutes a new service which does not yet enter the usual definitions of legal,

statutory and ethical obligations, it must be legally framed in a very systematic way when the remote surveillance system is implemented. The cardiologist must explain the remote surveillance system in “clear, fair and relevant terms” - to quote the terms of the Code de Déontologie (article 35): “[de façon] claire loyale et appropriée”-.that is to say he must specify what he will but also what he won’t do. However, this system is neither a warning nor an emergency system. It does not enable the practitioner to act at once or to remotely manipulate the device either. In case of doubt or emergency, it does not exempt the patient from calling emergency services. In other words, when the patient gives his informed consent for the treatment, it is clearly brought to his attention that “the practitioner can get access to the received report, evaluate the data and contact the patient only during his work hours. He is therefore not obliged to insure permanent shifts and he can freely leave his work place on any personal or professional ground without being replaced or without warning all his patients of his work days and work hours.”

Last but not least, the cost and the reimbursement of such acts remain to be settled.

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