The phrase "3 to 5 hours of daily transmission review" appears in conversations about ICM remote monitoring often enough that it has become abstracted into a benchmark figure. It is worth making that time concrete — not as an average across all ICM-managing practices, but as a breakdown of the specific activities that consume it, because the breakdown reveals where intervention is and is not possible.
Most device coordinators begin the day by logging into the manufacturer platform portals. For a clinic with mixed-manufacturer ICM patients, this means Merlin.net for Abbott Confirm Rx patients, CareLink for Medtronic LINQ II, and Biotronik's Home Monitoring Service portal for BioMonitor patients. Each platform has accumulated transmissions since the previous day's review. Scheduled transmissions — most ICMs are programmed to transmit automatically at regular intervals, typically daily or every other day — arrive in overnight batches. Patient-initiated transmissions, triggered when a patient experiences a symptom, can arrive at any hour.
The coordinator's first task is to determine how many transmissions arrived and whether any triggered high-priority alerts. There is no unified inbox; this requires checking three separate queues. In a clinic managing 350 active ICM patients across all three platforms, a typical morning queue might contain 40 to 80 transmissions depending on the day of the week, with Monday volumes elevated because devices that transmit weekly often do so on a set weekday.
Each transmission review involves several steps that add up quickly:
For a routine benign transmission, the total review time is 4 to 7 minutes. For a transmission with findings requiring EGM review, documentation, and no escalation, 8 to 12 minutes. For a transmission requiring physician communication and scheduling action, 15 to 25 minutes. With 60 transmissions in the morning queue, of which perhaps 12 require EGM review and 4 require escalation, the arithmetic produces a review time between 3 and 5 hours without any interruptions or overhead.
The 3-to-5-hour estimate typically applies to uninterrupted review, which is not the working condition of most device coordinators. The coordinator's role in most EP clinics includes front-desk patient communication, in-person device check support during clinic hours, answering physician and nurse questions, and handling urgent calls from patients with symptoms. Each interruption during transmission review requires re-establishing context: which patient was being reviewed, what findings had been identified, what action was pending. The effective time cost of a 5-minute phone interruption mid-review is often closer to 10 to 15 minutes including re-entry.
Clinics that protect morning review time by having other staff handle calls during a defined review window report faster queue clearance times. Those without that structure find that the daily transmission review carries into afternoon or never fully completes before new transmissions arrive.
The intuitive response to increasing ICM panel size is to add coordinator capacity. This works up to a point. Adding a second coordinator in a clinic with 200 ICM patients halves the per-person queue if the work is cleanly divisible. But coordinator roles are not purely transmission review. They include all the patient communication, scheduling, and documentation functions described above. A second coordinator hired primarily to reduce the transmission review burden will spend significant time on non-review functions, and the net gain in review capacity is less than a full-time equivalent of transmission processing time.
More importantly, the review quality problem does not scale with headcount. Two coordinators working through a 120-transmission queue under time pressure are exposed to the same cognitive fatigue effects as one coordinator working through a 60-transmission queue under the same pressure. The decision quality per transmission under high-volume sequential review does not improve by adding reviewers — it improves by reducing the number of transmissions that require the same level of attention.
The device coordinator's workload is not going to shrink as ICM panel sizes grow. What can change is the composition of that workload. The goal of Implansense's review summary layer is to move the coordinator's attention toward the 20% of transmissions that are clinically actionable and reduce the handling time for the 80% that are benign. In practice, this means pre-classifying routine benign transmissions with structured note templates ready for one-click documentation, and presenting the coordinator with a prioritized list that surfaces the high-yield items first rather than the most recent items first.
A coordinator who begins the day with a clear view of which four transmissions require escalation discussion, which eight require EGM review, and which fifty are routine-benign and pre-staged for documentation will process the same queue in materially less time than the coordinator who opens the full unranked queue and works through it sequentially. The 3-to-5-hour review window does not disappear, but its composition shifts toward clinical judgment rather than administrative processing.
