Feature | December 17, 2012| Dave Fornell

ECG Review on Smart Phones

Software enables cardiologists to review ECGs from anywhere at anytime

As mobile devices become more integrated into the healthcare workflow, immediate anywhere access to ECGs can help improve collaboration and speed door-to-balloon times.

Physician smart phone and tablet PC use has exploded over the last few years, allowing widespread, immediate access to patient electronic medical record (EMR) information. One trend in cardiology is the ability to use this technology to immediately view dynamic electrocardiogram (ECG) waveforms anywhere, untethering them from hospital workstations.

The technology offers cardiologists immediate access to ECGs at home, in the car, during lunch or on rounds so they can immediately evaluate chest pain patients for potential ST-elevation myocardial infarction (STEMI). This can help reduce door-to-balloon times by enabling earlier activation of the cath lab, especially during off-hours. Hospitals using this technology found it simplifies and speeds collaboration, allowing the emergency department (ED) or ICU staff to ask a cardiologist’s opinion on abnormal ECGs. Physicians have also found these systems allow them to review regular ECG exams in between procedures or when they have time, but are not in the office.  

Enabling Smart Phone Interoperability

New software enables data from ECG management systems to be compatible with smart phones. Some basic systems allow a JPG image to be sent as a picture message to a physician’s phone. Newer technology now allows for dynamic, moving waveforms to be transmitted and reviewed in the same format as seen live on an ECG machine.

AirStrip Technologies has taken the lead with this type of technology, providing real-time access to ECG waveforms as well as all other current and historical patient information from EMRs. The expanded platform includes vendor-independent, real-time access to patient information housed in multiple EMRs, including Cerner Millennium and the Veterans Administration CPRS/VistA. It offers real-time access to clinical information including allergies, medications, laboratory results, medical images, clinical documentation and vital signs. It also allows clinical context messaging, video and voice integration. 

“Our cardiologists were very excited to get this because many of our clinicians here already have smart phones,” said David Huneycutt Jr., M.D., FACC, interventional cardiologist, COO and administrator of TriStar Centennial Heart and Vascular Center in Nashville, Tenn., which uses the AirStrip system. “Time is muscle and we are a STEMI destination site. These guys take their phones everywhere with them, so they always have that tool close at hand. Also, throughout the day, if they have five minutes between cath cases, they can look at the average 12-lead cases.”

At first, the hospital integrated AirStrip on a limited scale only with pre-hospital ECG. There was concern that the different EMS agencies that serve the area would have interface issues transmitting the waveforms because of using different systems, primarily Zoll and Physio-Control defibrillator monitors. However, he said the system has interfaced between the different vendors’ systems beautifully.

“Previously, 12-lead ECGs were faxed from the field and the waveform image quality was not that good,” Huneycutt said. “And if the transmission was bad, you could not read the waveforms at all. So, we were activating our cath lab sometimes based on an ECG sight unseen. We now have fewer false cath lab activations.”

Today, the cath lab cardiologist can see an ECG on their smart phone before driving into the hospital. “When you get that call at 3 a.m., it instills more confidence seeing the ECG themselves,” he explained.

The fact that the waveforms present dynamically is also a major benefit of the AirStrip system, Huneycutt said, rather than looking at the average paper printout of waveforms. “It’s the difference between driving a Toyota or a Cadillac,” he explained. 

Business Advantages

“This technology is allowing us to partner with some outlying facilities to differentiate ourselves in the marketplace,” Huneycutt said.

He explained the AirStrip system allows the hospital to work more closely with referring hospitals, especially with STEMI cases, streamlining and speeding the communications. 

“We have the ability to lower healthcare costs, even here on a smaller scale, to determine if a patient needs to be transferred or not. They might be able to be treated medially in the outlying facilities rather than transferring the patient,” Huneycutt said. 

In addition, the technology has enabled better collaboration in the hospital, where hospitalists on the floor or ICU can get cardiologists to look at 12-lead cases if they have a question.

EMS Pre-Hospital ECG Transmission Networks

The primary providers of EMS defibrillator-monitors, Physio-Control, Zoll and Philips, all offer remote, wireless transmission of 12-lead ECGs from their devices to the hospital via cell phone technology. This enables a still image of the waveform to be sent to doctors’ smart phones for evaluation prior to a patient’s arrival to determine if the cath lab needs to be activated.

These systems are increasingly becoming vendor-neutral platforms, recognizing that most hospitals work with numerous EMS providers using different vendors’ defibrillator-monitors. Physio-Control altered its LifeNet remote access system so it now connects 12-lead devices from various manufacturers via the Lifenet Adapter. Physio-Control also partners with AirStrip to enable dynamic ECG waveforms to be accessed anywhere using an iPhone or iPad.

Zoll’s RescueNet Link allows ED staff to evaluate incoming patients’ ECGs via email, fax, computer, tablet or handheld smart phone simultaneously. Management of STEMI is accomplished with RescueNet 12-lead, a tool for managing 12-lead information from the field or from referring Zoll’s secure, cloud-based server. RescueNet 12-lead is provided at no cost to hospitals or EMS agencies as an extension of Zoll’s 12-lead transmission solutions. 

mVisum offers a STEMI Alert smart phone app that works in conjunction with Philips TraceMasterVue and IntelliSpace ECG management systems. It allows patient data surrounding an acute cardiac event to be securely pushed to physicians’ smart phones where it can be quickly assessed. 

ECGs acquired by the Philips PageWriter cardiograph and analyzed by the DXL ECG Algorithm can determine which ECGs need clinical attention. They are wirelessly transferred to the Philips TraceMasterVue or IntelliSpace ECG management system, which then pushes the ECG directly to the appropriate clinician’s smart phone, removing the need to travel to a review station.

The STEMI Alert app is supported by most major smart phone operating platforms, including iPhone, Android, Blackberry and Windows.  

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