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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

#11

Post by athenot »

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…

There are already several HIPAA-compliant messaging apps that take care of that.

Re: A Sea Change in Treating Heart Attacks

#12

Post by stephengillie »

maxerickson wrote: post #9
tgokh wrote: post #8

Earlier quoted context omitted.

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.

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.

Re: A Sea Change in Treating Heart Attacks

#13

Post by JshWright »

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 (…

Interesting... I would have assumed Germany would be a bit more advanced in prehospital care.

Here in the US (in a rural/suburban area outside a smallish city in upstate New York), the flow would look more like:

A paramedic recognizes a potential MI and takes a 12-lead EKG. If it is indeed a STEMI, then we'll call the ER and transmit the EKG and other vitals (via a cell modem embedded in the monitor). If the ER doc agrees with my diagnosis, then the cath lab is activated.

I'll have a couple large bore IVs in place before we arrive at the hospital, and when we get to the hospital, the patient stays right on our stretcher as we bypass the ER entirely at take them directly to cath.

Re: A Sea Change in Treating Heart Attacks

#14

Post by JshWright »

tgokh wrote: post #8
stephengillie wrote: post #5

Earlier 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,…

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...

Re: A Sea Change in Treating Heart Attacks

#15

Post by loco5niner »

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…

HIPPA... Germany...

Re: A Sea Change in Treating Heart Attacks

#16

Post by JshWright »

stephengillie wrote: post #10
tgokh wrote: post #8

Earlier quoted context omitted.

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…

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...

Re: A Sea Change in Treating Heart Attacks

#17

Post by JshWright »

maxerickson wrote: post #9
tgokh wrote: post #8

Earlier quoted context omitted.

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.

Why would you want to send it anywhere other than the hospital you're heading to?

Re: A Sea Change in Treating Heart Attacks

#18

Post by JshWright »

agumonkey wrote: post #3
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 (…

For the curious, differences between {N}STEMI http://imgur.com/HbREzfo

Hmm... ST depression often means there is ST elevation somehwere you can't see. ST depression is generally a 'reciprocal' change, and there will be elevation on the opposite side of the heart.

A 'standard' EKG looks at the front, bottom, and left side of the heart. If the area of the heart affected by the heart attack is on the right or back side, then you won't see elevation, but you may see the reciprocal depression.

EDIT: s/almost certainly/often/

Re: A Sea Change in Treating Heart Attacks

#19

Post by maxerickson »

JshWright wrote: post #17
maxerickson wrote: post #9

Earlier quoted context omitted.

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.

Why would you want to send it anywhere other than the hospital you're heading to?

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).

Re: A Sea Change in Treating Heart Attacks

#20

Post by [deleted] »

__z wrote: post #6
stephengillie wrote: post #5

Earlier 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.

[deleted]
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