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.

Meaningful Mobility

Meaningful mobility is a prerequisite to Stage I Meaningful Use (data access and data sharing), especially by physicians. The key to success is to actually work with clinician workflow, rather than asking them to change it.  Mobility is important because it supports the actual multitasking and "on-the-go" realities and requirements of physicians, nurses, and clinical managers. Beyond anytime and anywhere access, mobility solutions must transform data into visually compelling information that supports better clinical decision making. Further, the mobility solution must guide better choices by incorporating evidence-based medicine and knowledge-based prompting. The goal is to improve clinical decision making at the point of care through data transformation.

It's not enough to provide interpreted or emulated application access or a .pdf view of EHR data via a mobile device. That's tantamount to booking airline tickets on your smartphone using the internet browser. You can do it, but it doesn’t really work. It’s awkward and time-consuming and lacks the value-added native application-quality data transformation that is critical to improved clinical decision-making. So, the patient's serum potassium level is 3.0 milliequivalents per liter. What is the relevance of that value in the context of that patient? Was the drop sudden or gradual? Is the low value chronic? What has been the patient's range? How does that map to the normal range? Has the patient been on potassium replacement of any kind? It is possible to present that data in an informative and visually compelling manner that promotes better choices by practitioners.

In health care we see time and again that those who make data access and data processes difficult for clinicians suffer adoption resistance and usage doldrums. We have learned that delivering mobile intelligence about assigned patients in concert with the workflow of providers is technology that is enthusiastically received and rapidly adopted, and we see high usage levels sustained over many years.