3 ms·

The technology exists -- see http://www.physio-control.com/ProductDetails.aspx?id=2147484983 http://www.physio-control.com/ProductDetails.aspx?id=2147484... and

by tgokh 11y ago

The technology exists -- see http://www.physio-control.com/ProductDetails.aspx?id=2147484983 http://www.physio-control.com/ProductDetails.aspx?id=2147484... and http://www.zoll.com/medical-products/data-management/rescuenet-12-lead/ http://www.zoll.com/medical-products/data-management/rescuen... from PhysioControl and Zoll, two of the biggest EMS EKG monitor manufacturers, but its certainly not easy to use. In my system, we used to have to upload the EKG to the computer and then "e-fax" it from he computer to the Emergency Department -- practically, this took 3-4 minutes to do, and when you're in an urban area and nearly always < 10 minutes from the hospital, its not the most productive use of time. Most of the time, if was easier to do the EKG, and in case of a STEMI, call the "code STEMI" via radio, print the EKG and spend the rest of the time doing important patient care (IV access, aspirin, etc) That said, we were in a Paramedic system with a relatively short to-hospital drive time, and going to an academic medical center that had 24/7 in-house interventional cardiologists. If you're in a aystem with only EMT-Basics (who are trained to perform the EKG but cannot interpret the printout), or going to a hospital where the interventional cardiologists need to come in from home, or if your primary hospital doesn't even have a cath lab and will need to divert you to another bigger hospital, it makes a lot of sense to be able to send the EKG from the field and get the ball rolling early.

maxerickson 11y ago
Are there procedural hurdles for the reasonably local hospitals to automatically get copies of any emergency EKG being done in the region? There would clearly be some concerns with making sure that the right data was matched up with the right patient, I'm just wondering about how the technology could work, and what the more subtle issues might be.
- stephengillie 11y ago
  I'm not sure how to approach the topic, but there is competition between hospitals. They are ultimately forced to be businesses and have bottom lines.
- JshWright 11y ago
  Why would you want to send it anywhere other than the hospital you're heading to?
  - maxerickson 11y ago
    It isn't clear to me that the destination is always strictly determined; in the article, the ER doctor or consulting cardiologist would sometimes divert the ambulance. So the simplest implementation has the copy being easily available at the 'reasonably local' hospitals, rather than having someone push a button to send it to the diversion destination. edit: I see in your other comment that you are talking about scrolling to the correct hospital. It seems less good for the immediately involved technician to spend time on this than for whoever it is at the hospital to do it (I did already mention the caveat about record matching).
    - JshWright 11y ago
      It adds, _maybe_ three seconds to the process of transmitting an EKG. The interface is pretty well designed. It makes more sense for me to be the person making that decision as I am the person with the most complete clinical picture at the time that decision is made. If I'm sending an EKG, I'm also going to be picking up the phone shortly to talk things over with the doc at that ER. There would never be a situation where I don't already know where I'm going before transmitting an EKG.
      - maxerickson 11y ago
        My question could be rephrased as: Why is it a decision?. When you pick up the phone and are talking to someone, the system could be showing them the EKG you did, with no intervention on either end. I realize there is much opportunity there for bad implementation, I'm more interested in understanding the characteristics of a great implementation. Maybe there are reasons to leave it to the discretion of the EMT, but it being easy for the EMT to handle isn't one that I find very satisfying (I find it arbitrary to the implementation).
        11y ago
stephengillie 11y ago
> In my system, we used to have to upload the EKG to the computer and then "e-fax" it from he computer to the Emergency Department -- practically, this took 3-4 minutes to do, and when you're in an urban area and nearly always < 10 minutes from the hospital, its not the most productive use of time. Those steps could be automated. And since this would usually be life-threatened situations, they should be automated. I wonder how much HIPAA rules complicate the technology; they certainly don't make the space attractive or fun to work in. This sounds like a great disruption for a startup to make, if they can deal with HIPAA effectively. I interviewed for Physio, but turned down their offer due to mandatory drug testing. They seemed to be really, really locked down due to regulations, and I suppose I do want the regulations on defibrillators to be fairly strict.
- JshWright 11y ago
  Physio absolutely has an automated version of that, it just requires integration on the part of the hospital (and an upgrade to the LifePak to add a cell modem). The entire process: - Hit the send button - Click the wheel to pick the destination - Spin the wheel to highlight the destination hospital - Click the wheel to select - Spin the wheel to 'Transmit' - Click the wheel to send it Done...
- GoodOldNe 11y ago
  Those steps could be automated. And since this would usually be life-threatened situations, they should be automated. I wonder how much HIPPA rules complicate the technology; they certainly don't make the space attractive or fun to work in. This sounds like a great disruption for a startup to make, if they can deal with HIPPA effectively. There are several companies (including a couple YC alums like Aptible) working in the helping-developers-deal-with-HIPPA space already. Creating a compliant application for transmitting ECGs wouldn't really be a new thing-- when attending an emergency medicine conference two years ago I met a physician/programmer who had done just this for both stroke and heart attack, designed and marketed as a wraparound subscription-based solution. The trick is doing it well, and if you could integrate the information with the receiving hospital's workflows (e.g. EPIC integration or something) you could sell it easier. Pictures of ECGs are also a fairly inelegant solution compared to sending it to the ECG printers that a receiving hospital has, or sending the actual waveform data, but for rural/underfunded EMS agencies it would be nice. (FWIW, I work in a Bay Area emergency department that is a STEMI receiving center but does not receive field-transmitted ECGs prior to arrival. There's room to work on this stuff. If anyone wants to do research relating to it or build a system and then let me do research with it, get in touch.)
JshWright 11y ago
Our integration is much better. We have cell modems on our LP15s, so it's just a matter of hitting the 'send' button, using the scroll wheel to pick the hospital, and click to send...

by tgokh 11y ago

maxerickson 11y ago

Are there procedural hurdles for the reasonably local hospitals to automatically get copies of any emergency EKG being done in the region? There would clearly be some concerns with making sure that the right data was matched up with the right patient, I'm just wondering about how the technology could work, and what the more subtle issues might be.

stephengillie 11y ago
I'm not sure how to approach the topic, but there is competition between hospitals. They are ultimately forced to be businesses and have bottom lines.
JshWright 11y ago
Why would you want to send it anywhere other than the hospital you're heading to?
- maxerickson 11y ago
  It isn't clear to me that the destination is always strictly determined; in the article, the ER doctor or consulting cardiologist would sometimes divert the ambulance. So the simplest implementation has the copy being easily available at the 'reasonably local' hospitals, rather than having someone push a button to send it to the diversion destination. edit: I see in your other comment that you are talking about scrolling to the correct hospital. It seems less good for the immediately involved technician to spend time on this than for whoever it is at the hospital to do it (I did already mention the caveat about record matching).
  - JshWright 11y ago
    It adds, _maybe_ three seconds to the process of transmitting an EKG. The interface is pretty well designed. It makes more sense for me to be the person making that decision as I am the person with the most complete clinical picture at the time that decision is made. If I'm sending an EKG, I'm also going to be picking up the phone shortly to talk things over with the doc at that ER. There would never be a situation where I don't already know where I'm going before transmitting an EKG.
    - maxerickson 11y ago
      My question could be rephrased as: Why is it a decision?. When you pick up the phone and are talking to someone, the system could be showing them the EKG you did, with no intervention on either end. I realize there is much opportunity there for bad implementation, I'm more interested in understanding the characteristics of a great implementation. Maybe there are reasons to leave it to the discretion of the EMT, but it being easy for the EMT to handle isn't one that I find very satisfying (I find it arbitrary to the implementation).
      - 11y ago

stephengillie 11y ago

> In my system, we used to have to upload the EKG to the computer and then "e-fax" it from he computer to the Emergency Department -- practically, this took 3-4 minutes to do, and when you're in an urban area and nearly always < 10 minutes from the hospital, its not the most productive use of time. Those steps could be automated. And since this would usually be life-threatened situations, they should be automated. I wonder how much HIPAA rules complicate the technology; they certainly don't make the space attractive or fun to work in. This sounds like a great disruption for a startup to make, if they can deal with HIPAA effectively. I interviewed for Physio, but turned down their offer due to mandatory drug testing. They seemed to be really, really locked down due to regulations, and I suppose I do want the regulations on defibrillators to be fairly strict.

JshWright 11y ago
Physio absolutely has an automated version of that, it just requires integration on the part of the hospital (and an upgrade to the LifePak to add a cell modem). The entire process: - Hit the send button - Click the wheel to pick the destination - Spin the wheel to highlight the destination hospital - Click the wheel to select - Spin the wheel to 'Transmit' - Click the wheel to send it Done...
GoodOldNe 11y ago
Those steps could be automated. And since this would usually be life-threatened situations, they should be automated. I wonder how much HIPPA rules complicate the technology; they certainly don't make the space attractive or fun to work in. This sounds like a great disruption for a startup to make, if they can deal with HIPPA effectively. There are several companies (including a couple YC alums like Aptible) working in the helping-developers-deal-with-HIPPA space already. Creating a compliant application for transmitting ECGs wouldn't really be a new thing-- when attending an emergency medicine conference two years ago I met a physician/programmer who had done just this for both stroke and heart attack, designed and marketed as a wraparound subscription-based solution. The trick is doing it well, and if you could integrate the information with the receiving hospital's workflows (e.g. EPIC integration or something) you could sell it easier. Pictures of ECGs are also a fairly inelegant solution compared to sending it to the ECG printers that a receiving hospital has, or sending the actual waveform data, but for rural/underfunded EMS agencies it would be nice. (FWIW, I work in a Bay Area emergency department that is a STEMI receiving center but does not receive field-transmitted ECGs prior to arrival. There's room to work on this stuff. If anyone wants to do research relating to it or build a system and then let me do research with it, get in touch.)

JshWright 11y ago

Our integration is much better. We have cell modems on our LP15s, so it's just a matter of hitting the 'send' button, using the scroll wheel to pick the hospital, and click to send...