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A Sea Change in Treating Heart Attacks

nytimes.com

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Re: A Sea Change in Treating Heart Attacks

#41

Post by JshWright »

maxerickson wrote: post #40
JshWright wrote: post #28

Earlier quoted context omitted.

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 w…

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 i…

It's a decision because different hospitals have different specialities. Trauma, stroke, cardiac, etc. The most appropriate facility is a combination of what the patient needs, what they want, and the logistics involved (travel time, relative busyness, etc).

I call the hospital because I want to make sure they got the transmission and are going to be ready for me when I get there. The transmission and the call are generally a couple minutes apart.

There are certainly _plenty_ of places where the workflow in the back of the rig could be improved, but this really isn't one of them.

Re: A Sea Change in Treating Heart Attacks

#42

Post by shirro »

Reading articles like this you suddenly realise that living in a sparsely populated rural area you sacrifice a hell of a lot in health care as as well as the more obvious career, education and entertainment benefits.

Having some risk factors like age and weight and living hundreds of km from a cardiologist is a bit of a worry. Are there cheap, effective ways of screening people with no history of heart problems so perhaps they could be more closely monitored or something?

Re: A Sea Change in Treating Heart Attacks

#43

Post by oh_sigh »

stephengillie wrote: post #5
Cass wrote: post #2

A 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 is a set of American laws, and this is in Germany.

Re: A Sea Change in Treating Heart Attacks

#44

Post by benburwell »

JshWright wrote: post #24

They included ambulance drivers’ transmitting electrocardiogram readings to emergency rooms, E.R. doctors’ deciding whether a person was likely having a heart attack, and hospital operators’ summoning treatment teams with a single call. These hospitals also continually measured performance. I know it's a really minor thing, but the term 'ambulance driver' is a little irksome... It's like calling a doctor a 'prescript…

As an EMT, I too found this rather disturbing. Throughout the article, prehospital interventions were repeatedly not acknowledged. From the reference to "ambulance drivers" that you mentioned to things as subtle as saying that the clock starts when the patient rolls into the ER rather than when the ambulance arrives on scene, the article completely misses (or does not fully acknowledge) a hugely important factor in improving outcomes for STEMI: the prehospital care involved.

Re: A Sea Change in Treating Heart Attacks

#45

Post by reneherse »

JshWright wrote: post #41
maxerickson wrote: post #40

Earlier quoted context omitted.

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 i…

It's a decision because different hospitals have different specialities. Trauma, stroke, cardiac, etc. The most appropriate facility is a combination of what the patient needs, what they want, and the logistics involved (travel time, relative busyness, etc). I call the hospital because I want to make sure they got the transmission and are going to be ready for me when I get there. The transmission and the call are ge…

Have to say, this seems like an area where I'd be very happy there's an experienced human weighing all the various factors and making the judgement call.

After reading the procedure you've described I feel very grateful for our highly developed acute care system, and the dedicated pros who make it all work.

Re: A Sea Change in Treating Heart Attacks

#46

Post by chasb »

stephengillie wrote: post #5
Cass wrote: post #2

A 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…

It depends on whether the message/pic is identifiable. If it's not -- just "HEY IS THIS BAD?!" -- then it probably would not constitute protected health information, for HIPAA purposes. (Presuming this is in the US.)

Re: A Sea Change in Treating Heart Attacks

#47

Post by maxerickson »

JshWright wrote: post #41
maxerickson wrote: post #40

Earlier quoted context omitted.

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 i…

It's a decision because different hospitals have different specialities. Trauma, stroke, cardiac, etc. The most appropriate facility is a combination of what the patient needs, what they want, and the logistics involved (travel time, relative busyness, etc). I call the hospital because I want to make sure they got the transmission and are going to be ready for me when I get there. The transmission and the call are ge…

I get that it isn't a big time taker, so this is just abstract commentary.

This is an obvious opportunity for improvement: I call the hospital because I want to make sure they got the transmission. The ideal case would be that you don't even have to think about whether they have the information or not, the system should handle that with very high reliability.

You've also taken "decision" differently than I meant it. I meant, why do you have to decide to transmit the EKG, not the decision about which hospital to go to. Repeating myself, it would seem to be an improvement if you didn't have to pay any attention to whether the appropriate hospital had access to any readings/recordings that you had (I would think it would be better if it were trivial for someone there to pull them up, of course with high reliability).

I'm not feeling around for some opportunity to innovate/improve, I'm just curious about the factors that such a system has to deal with, and which of those factors are less idea than they could be, and why. That it isn't a big opportunity for improvement is useful feedback in general, but it doesn't really address the curiosity.

Re: A Sea Change in Treating Heart Attacks

#49

Post by JshWright »

maxerickson wrote: post #47
JshWright wrote: post #41

Earlier quoted context omitted.

It's a decision because different hospitals have different specialities. Trauma, stroke, cardiac, etc. The most appropriate facility is a combination of what the patient needs, what they want, and the logistics involved (travel time, relative busyness, etc). I call the hospital because I want to make sure they got the transmission and are going to be ready for me when I get there. The transmission and the call are ge…

I get that it isn't a big time taker, so this is just abstract commentary. This is an obvious opportunity for improvement: I call the hospital because I want to make sure they got the transmission . The ideal case would be that you don't even have to think about whether they have the information or not, the system should handle that with very high reliability. You've also taken "decision" differently than I meant it.…

When I say I'm confirming they got it, I mean I'm confirming someone actually looked at it. The fact that it was delivered successfully is indeed reported to me.

The act of transmitting the EKG serves to give the hospital a heads up that I'm coming, and that I think this patient needs care right away. I understand you're suggesting a system where every bit of data my monitor collects is available in every hospital in real-time, so I just have to call them up and reference it. My point is that is that the act of sending the EKG is a really miniscule part of the process. You're talking about 5 seconds over the course of a 30 minute event.

I don't think the tradeoffs in complexity and quiet failure modes would be worth it. If I transmit something, I get a confirmation right then that it did or didn't work. If a passive data aggregation system fails (and I'm used to it 'just working'), then I may not notice that it failed.

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