Easy access, anywhere to the ECG management system is helpful in patient care. This is the GE Muse system accessed at the patient bedside.
The movement from paper electrocardiogram (ECG) review to electronic ECG management systems in the past decade has helped improve efficiency and complete the patient electronic medical record (EMR). Current ECG management systems now offer improved workflow efficiencies, greater interoperability and integration into cardiovascular information systems (CVIS), vendor-agnostic integration of multiple vendor’s ECG system data, and mobile access to waveforms.
Basic ECG Management Software Functionality
Digital ECG management solutions display waveforms and other physiological data from patient monitoring systems and integrates them into the EMR or CVIS so a separate workstation or login is not necessary. These systems should help streamline documentation by enabling clinicians to electronically view, measure, annotate and store reporting. Vendors offer various workflow improvements, including automated diagnostic text generating the report that can be altered in the final edit, automating movement to the next study, and automating sign, save and distribute functions. Other features include measuring calipers and the ablity to display by rhythm or single beat, and comparison with prior studies.
While standard 12-lead ECG is the bread and butter of ECG assements and the core of ECG management system reporting, hospitals that use 15-lead pediatric ECG should make sure the systems can accommodate its reporting. With the rapidly expanding use of single lead cardiac monitors and consumer-grade ECG devices and apps, reporting systems that can accommodate capture and reporting for these devices might be a consideration.
When comparing ECG management software, one of the key pieces of advice to measure overall workflow efficiency is to count the number of clicks it takes to perform normal tasks. Hospitals also should make sure the system will be able to accept input from all ECG systems in their inventory. At health systems that have gone through consolidation with several hospitals, this often means each facility may have several legacy ECG systems from various vendors that need to have their data integrated.
For office-based practices and smaller clinics that do not require a standalone ECG management system, some vendors offer cloud ECG management service as an extension of their CVIS or picture archiving and communication system (PACS). This can help reduce the costs of implementing an ECG management system. An example of this is the ScImage PicomCloud. Providers can have access to a full-featured ECG management system, including storage, ECG editing tools and web access for primary care providers, using a low-cost fee per ECG.
Third-party Integration of ECG Mangement Systems
With interoperability demands from healthcare reform, all vendors have made greater efforts to integrate with other vendors’ systems. This includes eliminating proprietary coding and using open standards such as HL7 and DICOM.
Some ECG management system vendors have offered systems built on open standards to start with so they can easily integrate as a module into another vendor’s CVIS. Epiphany Healthcare is one vendor that has built its business as a third-party application provider offering integration with most ECG systems and CVIS. The vendor OEMs its Cardio Server software to several vendors, including IBM Watson Health, Fujifilm Synapse and Siemens syngo Dynamics. Cardio Server also interfaces to other third-party CVIS systems via API. It also sells its software as a standalone system.
GE Muse Offers an Open Platform
The GE Muse ECG management system is one of the market leaders, however, in the past it was criticized by its users because it was not able to integrate with ECG systems other than GE’s. GE changed that in 2016 with the the introduction of Muse Version 9. The newer Muse platform allows clinicians better access to all ECG waveforms and related data from multiple vendors, devices and test types.
Muse allows multiple communication protocols using HL7 or DICOM interfaces to access orders and send test results to the hospital EMRs and archival systems. The system uses a DICOM standard for ECG devices to allow bidirectional sharing of data with other vendors’ systems. Additionally, GE offers a DICOM connection tool that allows GE ECG waveforms to be integrated bidirectionally into EMRs.
Muse now includes monitoring of the new types of wearable monitor and Holter technologies, including the Ziopatch and implantable ECG monitors like Medtronic’s Linq device. Muse also integrates with several vendors’ stress test systems.
Mobile Access to ECG Waveforms
Several vendors have added smartphone interoperability to their systems so ECG waveforms can be sent for immediate review by a physician, regardless of where they are. This has had a particular impact on emergency patient evaluations, such as those presenting to the emergency department with chest pain or suspected ST-elevated myocardial infarction (STEMI). The rapid diagnosis on smartphones enables earlier activation in the catheterization lab, leading to better patient outcomes in STEMI cases. The technology is especially helpful to connect with cardiologists who are not near an ECG system workstation, or at home in off-hours.
Several vendors now allow dynamic ECG waveforms to be displayed on an iPad for remote access to either read studies outside traditional workstations, or for faster access to confirm suspected STEMI cases.
Change Healthcare’s mobile ECG viewer directly connects to the CVIS or ECG management system to allow dynamic ECG waveforms on mobile devices.
ScImage offers the browser-based ECG delivery utility in its PicomWeb system to offer immediate access to raw ECG waveforms.
The Lumedx HealthView Chest Pain Management system makes ECGs immediately available to cardiologists and allows them to compare with previous ECGs. It integrates current and historical clinical information from disparate systems into a single dashboard view, available anywhere with an Internet connection.
Philips Healthcare offers mVisum Inc.’s STEMI Alert smartphone app to work in conjunction with Philips TraceMasterVue and IntelliSpace ECG management systems. mVisum’s STEMI Alert is a comprehensive tool designed to gather patient data surrounding an acute cardiac event and securely push it to physicians’ smartphones where is can be quickly viewed, assessed and responded to.
Some vendors have also partnered with Airstrip, which offers a third-party integration software to access dynamic ECG waveforms on remote smartphones or tablets. The AirStrip One ECG app enables visual calipers to allow measurements on digital waveforms, combine measurements, create waveform snippets and append documentation. The information collected using AirStrip One with visual calipers can then be constructed into a single document, and exported into the EMR. Structured data elements can also be sent into the EMR or a document management system.
Comparison Chart of ECG Management Systems
This story served as an introduction to a comparison chart of ECG management systems. The chart is available at www.dicardiology.com/content/ecg-management-systems. Access to the chart requires a login, but it is free and only takes a minute to complete registration. Participants on the 2020 chart included:
Cardiocomm Solutions Inc., www.cardiocommsolutions.com
GE Healthcare, www.gehealthcare.com
IBM Watson Health, www.ibm.com/us-en/marketplace/merge-cardio