Previously submitted to: JMIR Formative Research (no longer under consideration since May 10, 2019)
Date Submitted: Feb 25, 2019
Open Peer Review Period: Feb 25, 2019 - Mar 4, 2019
(closed for review but you can still tweet)
Automated Fast Healthcare Interoperability Resources-based 12-Lead Electrocardiogram Mobile Alert System for Myocardial Infarction in an Emergency Department: A Retrospective Study
ABSTRACT
Background:
Timely information transfer is more important in the emergency care setting because it is associated with clinical outcome. For patients with time-critical acute coronary syndrome, reporting of electrocardiogram (ECG) findings is the most important component of the treatment process.
Objective:
This study aimed to develop and validate an automated Fast Healthcare Interoperability Resources (FHIR)-based 12-lead ECG mobile alert system in an emergency department (ED). The primary outcome was successful transmission of 12-lead ECG information via the FHIR system within 5 minutes.
Methods:
An automated FHIR-based 12-lead ECG alert system was developed in the ED of an academic tertiary care hospital. The system was aimed at generating an alert for patients with potential ST-elevation myocardial infarction (STEMI) based on interpretation by the legacy device. The alert is transmitted to physicians both via a mobile application and the patient’s electronic medical record (EMR). Transmitted information include patient identification, age, sex, location, ECG readings, and a direct link to the ECG image. A retrospective analysis was performed in patients aged ≥18 years who were admitted to the ED between November 14 and December 7, 2018. The automated FHIR-based 12-lead ECG alert system processing interval was defined as the time from ED arrival and 12-lead ECG capture to the time when the FHIR-based notification was transmitted. The patients’ characteristics and processing interval were analyzed.
Results:
The automated FHIR-based 12-lead ECG alert transmission system was developed using the “Observation” FHIR. During the study period, 3,812 emergency visits and 1,581 12-lead ECGs were recorded. The FHIR system generated 116 alerts. The alerted patient were significantly older (mean [SD]: 68.1 [12.4] vs 59.6 [16.8] years, P < .001), and the percentage of male patients was higher (55.2% vs 51.7%, P =.53). Among the 116 alerts, 146 (94%) were transmitted successfully within 5 minutes. The median interval from 12-lead ECG capture to FHIR notification was 2.7 min (IQR 2.2–3.1 min) for the group with cardiac-related symptoms and 3.0 min (IQR 2.5–3.4 min) for the group with non-cardiac-related symptoms.
Conclusions:
We found that the automated FHIR-based 12-lead ECG mobile alert system can be applied in the ED.
Citation
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