Advances in ECG Management Systems

The movement from paper electrocardiogram (ECG) review to electronic ECG management systems in the past decade has helped improve efficiency and complete the patient electronic medical record (EMR). Current ECG management systems now offer improved workflow efficiencies, greater interoperability and integration into cardiovascular information systems (CVIS), vendor-agnostic integration of multiple vendor’s ECG system data, and mobile access to waveforms.

Third-party Integration of ECG Mangement Systems

With interoperability demands from healthcare reform, all vendors have made greater efforts to integrate with other vendors’ system. This includes eliminating proprietary coding and using open standards such as HL7 and DICOM.

Some ECG management system vendors have offered systems built on open standards to start with so they can easily integrate as a module into another vendor’s CVIS. Epiphany Healthcare is one vendor that has built its business as a third-party application provider offering integration with most ECG systems and CVIS. The vendor OEMs its Cardio Server software to several vendors, including Merge/IBM, Fujifilm Synapse and Siemens syngo Dynamics. Cardio Server also interfaces to other third-party CVIS systems via API. It also sells its software as a standalone system. 

“The biggest demand today in ECG management systems is the need for workflow efficiencies and the need for all interoperability between EMRs, CVIS and various vendors’ ECG systems,” said Joe Noto, Epiphany’s vice president of partnerships and alliances and marketing. Noto explained hospitals shopping for new systems should look at workflow to see how many clicks it takes to perform normal tasks. 

Hospitals should make sure the system will be able to accept input from all the ECG systems they use. At health systems that have gone through consolidation with several hospitals, this often means each facility may have several legacy ECG systems from various vendors that need to have their data integrated. 

GE Muse Finally Offers an Open Platform

The GE Muse ECG management system is one of the market leaders, however, it has often been criticized over the years by its users for not being able to integrate with ECG systems other than GE’s. However, GE said that changed as of the introduction of Muse Version 9, which was released at the American College of Cardiology (ACC) 2016 meeting. The new Muse platform allows clinicians better access to all ECG waveforms and related data from multiple vendors, devices and test types. 

The new Muse has opened its doors to multiple communication protocols using new HL7 or DICOM interfaces to access orders and send test results to the hospital EMRs and archival systems. The system uses a DICOM standard for ECG devices to allow bidirectional sharing of data with other vendors’ systems. Additionally, GE released a DICOM connection tool that allows GE ECG waveforms to be integrated bidirectionally into EMR. 

The new Muse includes monitoring of the Ziopatch and other types of wearable Holter monitors and implantable ECG monitors, like Medtronic’s Linq device. GE also said Muse now integrates with several vendors’ stress test systems. 

Other benefits of Muse V9 include a new A/D Connect (LDAP) capability and an enhanced audit and configuration change logging to simplify user management and improve security and privacy compliance.

GE began implementing integration technology for other vendors’ ECG systems’ data at ACC 2014, when it introduced an upgrade to Muse with the i2 ECG Connect technology. It allows bi-directional flow of data with non-GE ECG systems. That integration accepted data from ECG systems made by Philips, Mortara, Nihon Kohden, Edan and Schiller.

Mobile Access to ECG Waveforms

Several vendors have added smartphone interoperability to their systems so ECG waveforms can be sent for immediate review by a physician, regardless of where they are. This has had a particular impact on emergency patient evaluations, such as those presenting to the emergency department with chest pain or suspected ST-elevated myocardial infarction (STEMI). The rapid diagnosis on smartphones enables earlier activation in the catheterization lab, leading to better patient outcomes in STEMI cases. The technology is especially helpful to connect with cardiologists who are not near an ECG system workstation, or at home in off-hours. 

McKesson now allows dynamic ECG waveforms displayed on an iPad using McKesson’s mobile ECG viewer, which directly connects to the CVIS or ECG management system. 
ScImage offers the browser-based ECG delivery utility in its PicomWeb system to offer immediate access to raw ECG waveforms. 

The Lumedx HealthView Chest Pain Management system makes ECGs immediately available to cardiologists and allows them to compare with previous ECGs. It integrates current and historical clinical information from disparate systems into a single dashboard view available anywhere with an Internet connection.

Philips Healthcare offers mVisum Inc.’s STEMI Alert smartphone app to work in conjunction with Philips TraceMasterVue and IntelliSpace ECG management systems. mVisum’s STEMI Alert is a comprehensive tool designed to gather patient data surrounding an acute cardiac event and securely push it to physicians’ smartphones where is can be quickly viewed, assessed and responded to.

Some vendors have also partnered with Airstrip, which offers a third-party integration software to access dynamic ECG waveforms on remote smartphones or tablets. AirStrip recently received a U.S. patent for new functionality for its mobile Airstrip One ECG app, enabling visual calipers to allow measurements on digital waveforms, combine measurements, create waveform snippets and append documentation. The information collected using AirStrip One with visual calipers can then be constructed into a single document or booklet to document more complex events, which can be exported into the EMR. Structured data elements can also be sent into the EMR or a document management system.

Other Recent Advancements in ECG Management

Cerner Corp. has partnered with Mortara Instrument to create CareAware Waveform Management. The system displays waveforms and other physiological data from patient monitoring systems and integrates them into the EMR. Clinicians will be able to view physiologic waveforms, data and alarms on devices with access to the patient record. Caregivers will be able to monitor patient waveforms in the context of other relevant patient information. The solution will help streamline documentation by enabling clinicians to electronically view, measure, annotate and save waveform strips to the EMR, eliminating one of the final pieces of paper in the hospital setting.

At ACC 2016, Fujifilm Medical Systems released its latest version of Synapse Cardiovascular CVIS, which included enhancements to ECG management workflow.

Novarad introduced its NovaCardio ECG management system in late 2013, which integrates with its CVIS. It enables digital ECG reading, annotation, manipulation, storage and reporting. The software improves efficiencies with functionality including altering machine-generated diagnostic text as needed, automating movement to the next study, and automating sign, save and distribute functions. 

To improve reading, the software features multiple vertical and horizontal calipers and enables display by rhythm or single beat and comparison with prior studies. NovaCardio ECG also supports patient CD or hard copy paper printouts.

NovaCardio ECG supports all DICOM ECG outputs from 12- and 15-lead carts and bedside devices. For those not providing native DICOM, Novarad utilizes middleware to convert and import studies into NovaCardio.

ScImage introduced a cloud ECG management service as an extension of its PicomCloud cloud picture archiving and communication system (PACS). ECG management is commonly deployed as an independent app in a client/server environment or in a self-contained Web server. For many facilities and private practices, the cost of implementing an ECG management system is difficult to justify based on modest reimbursement levels. With PicomCloud, providers can have access to a full-featured ECG management system, including storage, ECG editing tools and Web access for primary care providers, using a low-cost fee per ECG.  

Read the related article “Trends and Advances in ECG Management Systems.” 
 

Comparison Chart of ECG Management Systems 

This story served as an introduction to a comparison chart of ECG management systems. The chart is available at www.dicardiology.com/content/ecg-management-systems. Access to the chart requires a login, but it is free and only takes a minute to complete registration. Participants on the 2017 chart included:

Carestream, www.carestream.com

Epiphany, www.Epiphanycardio.com

GE Healthcare, www.gehealthcare.com

Infinitt, www.infinitt.com

Lumedx, www.lumedx.com

McKesson, www.mckesson.com

Mortara, www.mortara.com

Novarad, www.novarad.com

ScImage, www.scimage.com

Link to GE Healthcare's Interactive, Digital Guide for Centricity Cardio Enterprise