A Sea Change in Treating Heart Attacks
nytimes.com
A Sea Change in Treating Heart Attacks
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Re: A Sea Change in Treating Heart Attacks
#2A month ago, a friend who'd worked as a doctor in South Africa for decades was interning with me to learn about the procedures in our German ER. I remember the first time a patient with a heart attack came in while she was there, and the speed of the proceedings just blew. her. mind.
What happens, if things go well, is this:
The EMTs transmit a picture of the electrocardiogram to us[1]. We confirm that it's a STEMI (the kind of heart attack where speed matters the most, as opposed to an NSTEMI, which isn't quite as urgent), and alert the catheter lab and the attending cardiologist. Half the ER personnel drops everything else to prepare for the patient's arrival.
The patient arrives. We transfer them to our gurney. One nurse gets the patient's clothes off (with scissors if necessary) while another nurse attaches electrocardiogram electrodes and a third shaves the puncture site for the catheter.
The ER physician puts in an iv line and draws blood while informing the patient of the treatment plan. The cardiologist takes a very quick history of the patient and confirms the STEMI with the second electrocardiogramm. We wheel the patient up to the catheter lab and get started.
Altogether, if everything goes well, it's something like five to twelve minutes from the moment the patient comes through our doors to the moment we've got the patient on the operating table.
[1]By taking a picture of it on their phone and transmitting it via Whatsapp, which is just about the ugliest, hackiest and probably borderline-legal way of transmitting patient data imaginable, but it gets the job done.
Re: A Sea Change in Treating Heart Attacks
#3A month ago, a friend who'd worked as a doctor in South Africa for decades was interning with me to learn about the procedures in our German ER. I remember the first time a patient with a heart attack came in while she was there, and the speed of the proceedings just blew. her. mind. What happens, if things go well, is this: The EMTs transmit a picture of the electrocardiogram to us[1]. We confirm that it's a STEMI (…
For the curious, differences between {N}STEMI http://imgur.com/HbREzfo
Re: A Sea Change in Treating Heart Attacks
#4A month ago, a friend who'd worked as a doctor in South Africa for decades was interning with me to learn about the procedures in our German ER. I remember the first time a patient with a heart attack came in while she was there, and the speed of the proceedings just blew. her. mind. What happens, if things go well, is this: The EMTs transmit a picture of the electrocardiogram to us[1]. We confirm that it's a STEMI (…
It's kind of startling that what is essentially a straightforward process improvement can have such a large impact. It's fantastic that it is happening, but it raises the question of whether there are similar opportunities, or more forcefully, where the similar opportunities are lurking. I'm reminded of the famous stuff about checklists and infections.
Re: A Sea Change in Treating Heart Attacks
#5A month ago, a friend who'd worked as a doctor in South Africa for decades was interning with me to learn about the procedures in our German ER. I remember the first time a patient with a heart attack came in while she was there, and the speed of the proceedings just blew. her. mind. What happens, if things go well, is this: The EMTs transmit a picture of the electrocardiogram to us[1]. We confirm that it's a STEMI (…
> By taking a picture of it on their phone and transmitting it via Whatsapp, which is just about the ugliest, hackiest and probably borderline-legal way of transmitting patient data imaginable, but it gets the job done.
Congrats on the massive process improvement on using readily-available technology. I'm no lawyer but I'm pretty certain that this violates HIPAA, which means it's a new market just screaming for PII-managing image-transfer networks and startups.
Re: A Sea Change in Treating Heart Attacks
#6A month ago, a friend who'd worked as a doctor in South Africa for decades was interning with me to learn about the procedures in our German ER. I remember the first time a patient with a heart attack came in while she was there, and the speed of the proceedings just blew. her. mind. What happens, if things go well, is this: The EMTs transmit a picture of the electrocardiogram to us[1]. We confirm that it's a STEMI (…
> By taking a picture of it on their phone and transmitting it via Whatsapp, which is just about the ugliest, hackiest and probably borderline-legal way of transmitting patient data imaginable, but it gets the job done. Congrats on the massive process improvement on using readily-available technology. I'm no lawyer but I'm pretty certain that this violates HIPAA, which means it's a new market just screaming for PII-m…
HIPAA doesn't apply in Germany...
PS - its HIPAA not HIPPA.
Re: A Sea Change in Treating Heart Attacks
#7Earlier quoted context omitted.
> By taking a picture of it on their phone and transmitting it via Whatsapp, which is just about the ugliest, hackiest and probably borderline-legal way of transmitting patient data imaginable, but it gets the job done. Congrats on the massive process improvement on using readily-available technology. I'm no lawyer but I'm pretty certain that this violates HIPAA, which means it's a new market just screaming for PII-m…
HIPAA doesn't apply in Germany... PS - its HIPAA not HIPPA.
No redaction necessary!
Re: A Sea Change in Treating Heart Attacks
#8A month ago, a friend who'd worked as a doctor in South Africa for decades was interning with me to learn about the procedures in our German ER. I remember the first time a patient with a heart attack came in while she was there, and the speed of the proceedings just blew. her. mind. What happens, if things go well, is this: The EMTs transmit a picture of the electrocardiogram to us[1]. We confirm that it's a STEMI (…
> By taking a picture of it on their phone and transmitting it via Whatsapp, which is just about the ugliest, hackiest and probably borderline-legal way of transmitting patient data imaginable, but it gets the job done. Congrats on the massive process improvement on using readily-available technology. I'm no lawyer but I'm pretty certain that this violates HIPAA, which means it's a new market just screaming for PII-m…
The technology exists -- see http://www.physio-control.com/ProductDetails.aspx?id=2147484... and 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 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.
Re: A Sea Change in Treating Heart Attacks
#9Earlier quoted context omitted.
> By taking a picture of it on their phone and transmitting it via Whatsapp, which is just about the ugliest, hackiest and probably borderline-legal way of transmitting patient data imaginable, but it gets the job done. Congrats on the massive process improvement on using readily-available technology. I'm no lawyer but I'm pretty certain that this violates HIPAA, which means it's a new market just screaming for PII-m…
The technology exists -- see http://www.physio-control.com/ProductDetails.aspx?id=2147484... and 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,…
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.
Re: A Sea Change in Treating Heart Attacks
#10Earlier quoted context omitted.
> By taking a picture of it on their phone and transmitting it via Whatsapp, which is just about the ugliest, hackiest and probably borderline-legal way of transmitting patient data imaginable, but it gets the job done. Congrats on the massive process improvement on using readily-available technology. I'm no lawyer but I'm pretty certain that this violates HIPAA, which means it's a new market just screaming for PII-m…
The technology exists -- see http://www.physio-control.com/ProductDetails.aspx?id=2147484... and 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,…
> 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
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.