Electrocardiogram report system: the importance of decision-making tools

• Published in: Journal of electrocardiology Vol. 69; p. 87
• Main Authors: Gomes, Paulo R., Paix, Gabriela M., Lima, Emilly M., Marcolino, Milena S., Ribeiro, Leonardo B., Chequer, Graziela, Alkmim, Maria B.M., Macfarlane, Peter W., Ribeiro, Antonio L.
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 01.11.2021; Elsevier Science Ltd
• Subjects: Cardiology; Clinical decision making; Electrocardiography; Medical diagnosis; Primary care; Telemedicine
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2021.11.019

Background The electrocardiogram (ECG) is an easy-to-perform, non-invasive and low-cost exam, used from a primary care center to the intensive care unit. Reporting ECG findings can be an exhaustive task in cardiology services. There are several systems dedicated to the management of ECG exams, but few include decision-making tools to support the cardiologist. We aimed to develop a new ECG system designed to manage a large tele-ECG service, supporting the cardiologist to give an accurate report. This work was conducted at the Telehealth Center of the Hospital das ClAnicas of the Federal University of Minas Gerais (CTS-HC-UFMG), which has performed more than 4.3 million ECGs since its implementation in 2006. The CTS-HC-UFMG maintains a 24-hour ECG online service that receives and reports an average of 3.000 exams per day performed in primary care centers and emergency units. Methods A new web-based ECG reporting system was developed, based both on user experience and logical diagnostic processes. The cardiologist analyzes the exam as a whole and identifies abnormal patterns that lead to a final diagnosis. He/she should choose the ECG diagnosis in a hierarchic list, based in AHA/ACC/HRS/1SCE standardization. Only ECG diagnosis compatible with the current information are available to be chosen, although the other diagnosis must meet prerequisites to include them. A detailed final report is generated automatically, based on a selected diagnostic, combining multiple statements. The system was extensively tested and refined until it was released in 2018 May. The telecardiology service is audited periodically by a senior cardiologist, who reviews a sample of the ECG those in disagreement with the gold standard evaluation are reviewed with the attending physician. The effectiveness of the new ECG system is evaluated by comparing the rate of disagreement before and after the implementation of the new system. Results More than 1.000.000 ECG have been analyzed after the implementation of the new system. All cardiologists evaluated positively. Dataset is composed of 4313 audits in the old system and 2213 in the new version. The disagreement rate fell from 14.7% (Q1-Q3:11.0-17.3), in the period before the implementation (2015-2017) to 8.6% (7.2-9.5) after the implementation (2018-2019), p = 0.004. Conclusions A new web-based ECG reporting system was developed and successfully improved the accuracy of ECG reporting in a busy tele-ECG service. A user-friendly interface and the ability of mimicking the process used by the cardiologist to find a diagnosis are factors related to the success of this new ECG system.