Early Findings Following AirStrip Cardiology Deployment at Three Hospital Systems

We know that communication technologies that transmit ECGs directly to a smart phone or mobile device allow rapid viewing of ECGs by experts and can be used to overcome logistical and geographic barriers to care. This approach has been proven to reduce E2B times, reduce mortality, reduce morbidity, reduce cardiac damage following STEMI, and improve clinical outcomes. [1] [2]

We hypothesized that by improving logistics, visual clarity, touch screen manipulation, and more data for analysis, providers may be able to more quickly and accurately interpret ECG findings. We delivered this with AirStrip Cardiology™ and we added simultaneous and comparative access to historical ECGs from hospital ECG management systems and from EMS in the field. We demonstrated this technology in previous blog entries. [3]

Over the past several months, we have successfully deployed this technology at a number of hospitals. At least 50 clinicians, most of them cardiologists, are presently using AirStrip Cardiology in a dozen facilities at three major health systems across the country – and that number is expected to quadruple by mid-July 2011.

The preliminary results show a great deal of promise. Physicians currently using AirStrip Cardiology have already reported that the clear, concise resolution and touch-enabled analytics significantly improved their ability to diagnose specific conditions, fostered more timely decisions, supported more rapid intervention, and afforded them an experience of freedom and workflow efficiency. This feedback is consistent across all users. We will publish our physician surveys in whitepapers and highlight them in future blogs.

We are learning that great things can happen with mobile, digital, enhanced ECG. For example, AirStrip Cardiology hospital clients have reported improved STEMI patient care, including reduced time to intervention and reduced false activation of the cath lab. Preliminary findings by hospitals include:

• A median time of 9 minutes from ECG acquisition to view time by a cardiologist, with a resultant 7 - 15 minute reduction in time to intervention.
• A reduced length of stay of 0.85 days per STEMI case, attributed to earlier intervention. Each STEMI day saved is estimated at $2,500.
• A 4% -5% reduction in false activation of the cardiac cath lab. The savings per false activation prevented is estimated at $7,500.

How? Physicians and program directors are attributing these benefits to the following features:

• Immediate, anytime, anywhere access to ECGs, creating the “un-tethered” cardiologist
• Twentyfold improvement in visual display over paper tracings and pdfs;
• Automated interval & axis deviation measurement and more digital data; 
• Elongated strips, making pattern variability more apparent;
• Access to historical tracings, allowing serial presentation and comparison

We will continue to share lessons learned from the deployment of this mobility solution. We are offering a complimentary webinar series detailing customer results from the use of this technology. We’ll post a link to the registration page in our next blog.

References
[1]  Sanchez-Ross M, Oghlakian G, Maher J, Patel B, Mazza V, Hom D, Dhruva V, Langley D, Palmaro J, Ahmed S, Kaluski E, Klapholz M. The STAT-MI (ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction) trial improves outcomes. JACC Cardiovasc Interv. 2011 Feb;4(2):222-7. Patients had significantly shorter D2B times (63 minutes versus 119); lower peak troponin I (39.5 ng/ml vs. 87.6); creatine phosphokinase-MB (126.1  ng/ml vs. 290.3); higher left ventricular ejection fractions (50% vs. 35%); and shorter LOS (3  days vs. 5.5 days).

[2]  Khot UN, Johnson ML, Ramsey C, Khot MB, Todd R, Shaikh SR, Berg WJ. Emergency department physician activation of the catheterization laboratory and immediate transfer to an immediately available catheterization laboratory reduce door-to-balloon time in ST-elevation myocardial infarction. Circulation. 2007 Jul 3;116(1):67-76. Epub 2007 Jun 11.

[3]  http://airstriptech.blogspot.com/2011/04/youll-never-look-at-ecg-same-way-again.html

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