Meaningful Mobility for Cardiology Care

A 12-lead ECG is a snapshot in time of 3 spatial views of the heart's electrical activity from 12 angles. It is generated by placing 10 electrodes on various parts of the body including the arms, legs, and chest. With a 12-lead, we are simply taking a multi-dimensional picture of heart conduction from right to left, top to bottom, and front to back.

Once the electrodes are placed, the ECG recorder is run. The recorder digitally captures the multi-dimensional picture. Although the machine will virtually record all 10 seconds of data per lead, all traditional ECG print outs and the current pdfs currently used in most mobility solutions only provide 3 seconds of data for each lead, and those three seconds are printed, static, flat, and non-interactive.

The output of an ECG recorder is a tracing on a graph. Time is represented on the x-axis, and voltage, or amplitude is represented on the y-axis. Look at the following picture describing the time and voltage for a traditional ECG tracing. Notice, for example, how one small 1 mm x 1 mm block represents 40 milliseconds in time and 0.1 millivolts in amplitude? (See Figure 1).

Now let’s look at how mobility providers can add serious value to the ECG equation. One way is to mobilize a pdf version of the ECG tracing. (See Figure 2). Helpful - but where is our data transformation in this equation? Consider it’s time to move to the next generation mobile solution. (Figure 3).

Figure 1

Figure 2

Figure 3

AirStrip Cardiology ™ provides the ability to scroll through a full 10-second ECG for all 12 leads and set any of the leads as the rhythm strip – clinicians choose the beats used for analysis. In addition, the dynamic ECG layout functionality grants full control over how leads are rendered, providing the option to see all 12 or 15 leads for the ECG or selectively, in various comparative layouts and zoom levels.

AirStrip Cardiology can help clinicians detect changes in mV signal as low as .05 mV (0.5 mm). That’s a twentyfold increase in amplitude detection over paper tracings. End users clearly see sub-millimeter variations, as well as being able to visually scan all 12- or 15-leads at once and see any relative deviations.

In terms of playback control, marking the grid with the measurements coming from GE Marquette® 12SL™algorithms, we also allow play modes for the 10 second digital segment to be full, 1/2, 1/4, or 1/8 speed, as desired. Added features such as user-driven lead selection, maintaining relevance across leads with synchronized pinch and zoom, make this exponentially more interactive. Now that’s meaningful mobility.

References:
[1] http://en.wikipedia.org/wiki/File:ECG_Paper_v2.svg
[2] http://en.wikipedia.org/wiki/File:12leadECG.jpg
[3] © 2010. AirStrip Technologies. All rights reserved

Improving Cardiology Diagnostics with Meaningful Mobility

Meaningful mobility transforms data into intelligence in a way that supports the improved performance of physician cognitive tasks such as diagnosis and triage. Consider the 12-lead ECG.

There are currently solutions on the market that allow the transmission of a .pdf of the EMS 12-lead ECG to emergency room physicians for AMI diagnosis and triage. [1] This has significantly shortened EMS-to-Balloon times. [2] There are also solutions that pull ECG data digitally and store the results centrally, for enhanced serial analysis. [3] But, where is our meaningful mobility data transformation in this equation?

Enter: AirStrip Cardiology. This product mobilizes the digital information obtained from 12 and 15 lead ECG so that providers can scroll through a full 10-second ECG for all 12 leads and set any of the leads as the rhythm strip – physicians choose the beats used for analysis.  It also grants the physician full control over how leads are rendered, providing the option to see all 12 or 15 leads for the ECG or in various comparative layouts and zoom levels.

Now, using a native AirStrip application on their mobile device physicians can:

• Receive 12- and 15-lead waveforms and vitals wirelessly from EMS transport, which the clinician can then access from anywhere and review on their mobile device via a native AirStrip application.
• Simultaneously scroll through a full 10 seconds for all leads while retaining the traditional 12-lead layout.
• See a full presentation of results GE Marquette® 12SL analysis algorithms for 12 leads for EMS and inpatients.
• Review and compare past ECGs, and do detailed serial comparisons of waveforms for their patients.
• See clear and accurate waveforms and detect differences of less than .05 millivolts (.5 millimeter).

No more faxes, emails or .pdfs. Just transformative data that powers enhanced visualization and improved decision support by busy, on-the-go clinicians. Care is expedited. Outcomes will improve.

15.5% of emergency department patients arrive via ambulance. That's 18 million people. The leading reasons given by patients aged 15–64 years for visiting the ED were chest pain and abdominal pain, and for older patients (aged 65 years or over) the reasons were chest pain, shortness of breath, and abdominal pain. For adults 65 years of age and over, chest pain and non-ischemic heart disease were leading primary diagnoses for both men and women. Of the 16.7 million patients admitted to the hospital or transferred to another facility, 30% were admitted to critical care, stepdown or telemetry units. [4] Of 6 million chest pain patients, 400,000 were diagnosed with STEMI. [5]

We know that coordination of care for these cardiology patients is crucial to our health care system and the technology to support improved diagnosis and triage are vital to our ability to serve this growing population effectively. We are learning that superior diagnostic support is another way for hospitals and providers to win at meaningful use: engaging emergency room physicians, cardiologists, interventionalists, surgeons, critical care physicians and a host of others in the more timely and effective care of cardiac patients – anytime, anywhere.

References

[1] Physio-Control Case Study: Prehospital 12-Lead ECGs Help to Reduce EMS-to-Balloon Times http://www.physio-control.com/uploadedFiles/learning/clinical-topics/3300653.A%20Prehospital%2012-Lead%20ECGs%20Help%20to%20Reduce%20EMS-to-Balloon%20Times.pdf

[2] Rokos, I and Bouthillet, T. The emergency medical systems-to-balloon (E2B) challenge: building on the foundations of the D2B alliance. STEMI Systems. 2007; Issue 2, May.

[3] The GE Muse System. http://www.gehealthcare.com/usen/cardiology/diagnostic_ecg/docs/ECGenius.pdf.

[4] Niska, R., Bhuiya, F., Xu, J. CDC Division of Health Care Statistics (2010). National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary. National Health Statistics Report. Volume 26. August 6, 2010. Accessed online at http://www.cdc.gov/nchs/data/nhsr/nhsr026.pdf

[5] McCaig, L, Burt, C. National Hospital Ambulatory Medical Care Survey: 2003 Emergency Department Summary. In: Advance Data from Vital and Health Statistics, Centers for disease control and prevention, Atlanta, GA 2005.