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.

Engaging Physicians in Meaningful Use

Amid the hubbub about meaningful use, AirStrip has stayed true to helping hospitals and physicians achieve their greater goals of clinical decision support:

1. Data access and data sharing – meaningful mobility with data transformation is a prerequisite to Stage 1
2. Understanding clinical practice - making the data available in a meaningful way for users, especially physicians in Stages 1 and 2
3. Guiding choices - incorporating concepts of evidence-based medicine in the offering in Stages 2 and 3
4. Knowledge-based prompting - providing views of data and rules that promote proactive, rather than reactive interventions to accompany Stage 3.

For hospitals to win at meaningful use, physicians MUST be engaged users - “use” being the definitive term.

We know that every hospital and physician needs useful EHR technology which provides clinical decision support in fulfillment of safe, effective, and more profitable patient care.  They've been struggling with this for 15 years, with fewer than 10% having achieved any level of success. The biggest challenges are interoperability, physician adoption, and change management. Congress hopes to use meaningful use financial incentives and penalties [1] to force hospitals and physicians to accomplish over the next 5 years what they have not been able to achieve in the previous 15 years. [2]

If hospitals want physicians to use the EMR (and LIKE it), then give them mobile (not remote) access. With AirStrip OB, obstetricians are interacting with hospital information systems an average of nearly five hours per physician per month beyond the time they are spending on CPOE or entering progress notes via a workstation. If you have 30-35 obstetricians delivering patients at your hospital or health system, that’s like adding one laborist FTE – without the cost. We are learning that other specialists are engaging at even more staggering levels with our cardiology and patient monitoring products. We need only look to the role of the physician to understand why.

Physicians perform two kinds of tasks: cognitive and procedural. Cognitive tasks include things like “triaging admissions, deciding whether a white cell count of 24,000 × 109/L with a 38.4°C temperature warrants antibiotics, whether surgery is indicated, etc. Procedural tasks include things like performing surgery, intubating a patient, placing a central line, etc. A subset of procedural tasks is administrative (e.g. prescribing orders, documentation, scheduling imaging studies)”. [3] Mobility solutions can effectively support multiple physician job functions.

Meaningful mobility transforms data into knowledge and, in turn, delivers that intelligence in a way that supports the improved performance of the cognitive tasks by physicians (diagnosis, triage, and clinical management), while mitigating the time management challenges of procedural tasks (physical assessment, interventional treatments, and prescribing). Meaningful mobility is vital to physician engagement and alignment with HIT.

References
[1] Section 1848 (a)(7) of the HITECH Act provides that beginning in Calendar Year 2015, eligible professionals who do not demonstrate that they are meaningful users of certified EHR technology will receive an adjustment to their fee schedule for their professional services of 99 percent for 2015, 98 percent for 2016, and 97 percent for 2017 and subsequent years. 

[2] Sections 1848(a)(2)(A) and 1886 (n)(3)(A) of the HITECH Act includes Congress’ identification of the broad goal of expanding the use of EHRs through the term meaningful use.

[3] Fackler, J., Watts, C., Grome, A., Miller, T., Crandall, B., Pronovost, P. (2009). Critical care physician cognitive task analysis: an exploratory study. Critical Care. 2009; 13(2): R33.