Reply to the Editor - Remote monitoring devices and the unseen challenges.

We thank Latif and Patil for their interest in our study, which describes the challenges in managing a remote monitoring device clinic using a mixed-method approach. We agree, there may be some potential bias in respondents’ open-ended answers, given the specific question phrases used for the closed-ended questions. However, the phrases used in the closed-ended questions, such as connectivity, technology, staffing, and education, have been well described in the related literature and were validated by content experts, as noted in the study.1, 2, 3, 4 The major themes for the open-ended questions related to the biggest challenge perceived in managing a remote monitoring were connectivity, transmissions, and staffing. When asked what was the greatest barrier to optimal staffing, staff training and administrative/financial issues were identified as major themes. Finally, when asked to describe a process their clinic had adopted that improved workflow and quality of patient care for patients being remotely monitored, the major themes identified were optimizing alert transmissions, increasing remote staffing, and utilizing third-party platforms. A mixed-method approach facilitates the collection and analysis of data from multiple sources in a single study and enables researchers to answer questions with adequate depth and breadth. One of the challenges is choosing an approach that avoids the instance of one method possibly influencing data interpretation from another method, as possibly seen in the sequential design of this study. We appreciate the authors’ recommendations to further identify other potential issues with remote monitoring by either using more closed-ended questions or using only open-ended questions to prevent bias.

We used the Heart Rhythm Society Allied Community of Practice discussion forum as a means of deploying the survey. Since membership is international, we included all respondents, but we agree it may have been more appropriate to focus on clinics in the United States vs internationally, as others may not have had similar issues with staffing and technological education. We would also recommend future research to include the names of the manufacturers of various remote monitoring technologies that could provide additional insight as to algorithms, alert types, and frequencies. We feel our research has highlighted some important challenges with burgeoning remote monitoring technologies and look forward to future research investigating some of the unseen challenges.