Telemedical ECGs

AbOUT ECG Tests

Electrocardiogram (ECG) tests record the electrical activity of the heart over time. Analysis of the ECG test -- usually represented as a wave or trace, yields important diagnostic information.

ECGs are the standard method for the diagnosis of cardiac arrhythmias, guiding therapy and risk stratification for patients with suspected acute myocardial infarction. They can also be used as a screening tool for ischemic heart disease during a cardiac stress test, and can help with non-cardiac diseases (e.g. pulmonary embolism or hypothermia).

At present most UK Primary Care centres use a conventional 12-lead ECG machine to:

• Assess patients who present with acute clinical symptoms

• Evaluate progress in the clinical condition of patients with long-term conditions such a hypertension or diabetes

• As a screening tool to provide clinical data prior to an outpatient referral. These machines take a recording and then produce a paper tracing for the clinician (usually doctor) or the machine’s inbuilt electronic reader to interpret.

Why Telemedical ECGs?

ECG tests are usually only available in hospitals, or in larger GP surgeries in the UK. This creates a problem of access to ECG tests, especially in remote communities.

Furthermore, there is often a time delay between the test being conducted and the results being available -- often as much as two weeks. This delay could be critical, or fatal, in the case of certain heart conditions.

There is also the issue of accurate interpretation of ECGs. Within primary care, ECGs are usually undertaken by nursing staff who often have limited training in interpretation of the results. GPs may also experience difficulty in reading ECGs, as many do not see ECGs sufficiently often to interpret complex readings or on occasion maintain their clinical competence in this area of practice. In addition, questions are raised with regard to the reliability of the ECG machine readers, which may not always give an accurate result.

With all these factors in mind, telemedical ECGs could help GPs and other practitioners to access a reliable and accurate way to support them to interpret ECGs and so assist them with clinical diagnosis and management of the patient’s health needs.

The technology could also provide additional benefits including operational simplicity, reductions in inappropriate hospital attendance and achieve financial savings that could be re-invested in patient care.

How does the Broomwell HealthWatch telemedical ECG technology work?

Broomwell Healthwatch gives GPs and other healthcare professionals access to immediate, expert interpretation of ECGs by experienced cardiology-trained clinicians. Broomwell’s hand-held 12-lead ECG machine is used by a nurse, clinician or paramedic in the same way as a conventional machine. When the ECG is complete, it is transmitted as a sound signal by landline telephone or by fax in just 45 seconds to Broomwell’s monitoring centre, where it is displayed on screen for interpretation by experienced clinicians.

Based on the high-quality ECG trace, Broomwell staff give an immediate verbal interpretation by phone so that action can be taken quickly, if needed. A full written ECG report is also sent to the GP surgery by email or fax for inclusion in the patient record. Because constant communication with the patient’s doctor, nurse or paramedic is maintained during the test, the quality of patient care is high.

Proof of the technology's success

In early 2007 a NHS North West six-month pilot of Broomwell’s telemedical monitoring services involving 15 GP practices and two NHS walk-in centres, took place in Cumbria and Lancashire.

The pilot demonstrated the potential to save 90,000 A&E visits, 45,000 hospital admissions and hundreds of lives each year in England. The pilot’s results also estimated the minimum savings to the NHS from use of telemedical ECG tests are £46M per year, simply by [...] unnecessary hospital admissions for symptoms of chest pain.

Broomwell believes far larger savings are easily achievable. The Lancashire and South Cumbria report focused on savings by avoiding referrals to A&E.

However, if one considers potential savings in avoiding referrals to outpatient clinics, as well as telemedical applications for monitoring cardiac patients at home, (for post operative or post MI patients or for ‘frequent visitors’), weight monitoring for CHF patients, Peak flow and SPo2 monitoring for a large number of patients, the potential savings run into hundreds of millions.

The full report from the NHS Lancashire and South Cumbria Cardiac Network is available here: 1

This pilot recently won the prestigious Health Service Journal award for "Improving Care with E-Technology": 2

Broomwell HealthWatch's technology has also been chosen by the new NHS National Technology Adoption Hub, as one of the first three advanced healthcare solutions to be promoted within the NHS across the UK.

Links for further reading

Report on the success of the NHS pilot of Broomwell's telemedical ECGs 3

The use of Broomwell HealthWatch's service in an English community hospital 4

Article by Broomwell Chairman Joshua Rowe from Health Service Journal online 5

Use of Broomwell HealthWatch's service in an English prison 6

Broomwell Healthwatch website 7