ECG results acceptance by medical professionals

[russell_314]

The dumbest arguments against the ECG IMO are "It's not as accurate as a 12 lead" and "It can give false positives". Only in the medical profession would they say you shouldn't use a device that could save your life because it might give a false indication of danger. It's ECG is not a diagnosis to get treatment but rather a test to say "Hey you might want to get tested because you might have a problem"

Let's take out smoke detectors and fire alarms because they're known for false alarms and sometimes they don't even go off in a real fire. We wouldn't want the fire department going to multiple false alarms just to save a few lives.

 

[DeepIn2U]

Hmm... not sure about the guys in private practice, but when I order an ECG I don't get any extra money from it.

I'll address two points:

1) About acceptance of the Apple Watch ECG: a single-lead ECG is pretty much just a rhythm strip. It's not useless, but there is so much more information on a 12-lead ECG, and so many more conditions that can be detected. If I have serious concerns about what's going on with your heart, you're going to get a 12-lead ECG. And yes, the Apple Watch is still relatively new and it's not yet standardized, so I'd probably still want to get a 12-lead even if we were just confirming a rhythm disturbance. I can tell with a 12-lead ECG if the measurement was poor, but I don't know what sort of signal amplification and data smoothing the Apple Watch is performing. I think there's a lot of processing going on, too, because these are some of the cleanest-looking ECGs I've ever seen.

2) About receiving the ECG in PDF. This one may sound silly, but there's actually a fair number of things standing in the way that make this slightly complicated.

Standard email isn't the no-brainer it sounds like. Firstly, many physicians use email for contact within their organization or with other professionals. Mixing patient emails into there can be troublesome. Additionally, discussing sensitive patient data through email can be legally perilous; for my hospital, we can send patient data amongst other staff members at the same hospital, where the messages are encrypted and never hit the internet, but it's forbidden to send anything to an external email address. Those messages aren't encrypted, and the security of other email servers can't be guaranteed, making you liable for breaking HIPAA (patient privacy) laws. From another communications standpoint, a message through email to one doctor is a message that other healthcare workers can't see, which is fine for a solo practitioner (rare as they are these days), but a problem for a healthcare system. Lastly, some patients abuse personal communications, and providing an email address is just making yourself vulnerable.

The work-around is using the electronic medical record system for both internal and external communications. Some of you may have seen this: your doctor's office or hospital has you log in to a website where you can do things like viewing lab results, scheduling appointments, and/or messaging your doctor(s). In all of the record systems I've used, those communications can be viewed by anyone with electronic access to your record, and they don't just go to your doctor; it can be screened by a nurse first, or end up in the inbox of a covering physician if the doctor you were trying to reach happens to be away. It's far superior to email, in that regard. The problem is that not all offices or hospitals have systems like that set up (or the options may be disabled), and not all of those systems accept attachments.

Many medical systems are still adjusting to the reality of modern communications, and it goes beyond the software side of things. How staff are organized to handle the communications, how time is allocated for it... all of these things are still being worked out. So please, don't be too hard on your doctors. It's unlikely to be a problem they can fix on their own, and while the solutions may be available, they need to be implemented thoughtfully. There's more going on with the back-end than may meet the eye.

This sounds like a lot of BS.

1. What exactly does 12 points of ECG do vs 1? Care to elaborate since you're already answering this yet vaguely.
2.

we can send patient data amongst other staff members at the same hospital, where the messages are encrypted and never hit the internet, but it's forbidden to send anything to an external email address. Those messages aren't encrypted, and the security of other email servers can't be guaranteed, making you liable for breaking HIPAA (patient privacy) laws.

Why is it your INTERNAL emails are encrypted if they would NEVER reach the internet ... BUT external emails would not be encrypted?! There would be no need to encrypt internal emails if your email server is not connecting to the internet ... but if you're using Gmail for business or O365 for business then most likely the service is configured for encrypted emails within your Tennant.

If using an internal traditional email server (Exchange, Lotus Notes or Groupwise) then it CAN be configured to encrypt emails in various ways - including a certificate.

Sounds like your exchange or email server admin does NOT know what the hell their doing and I'd like to see such state LAW that prevents any practitioner from sending emails to external party for use for their practice. Notice receiving emails doesn't seem to be of the same concern by your reply.

Just doesn't seem cohesively right. Like what if you had to communicate to another hospital for a transplant? In another state? What about insurance documentation and checks? These are not internal so how are you communicating with the right documents?

an aside: "many physicians use email for contact within their organization or with other professionals. " seems like a breach of privacy if your client is unaware of this being done, since by your own words ... 'discussing sensitive patient data through email can be legally perilous' ... but what do I know about this practice.

Sorry I don't mean to attack YOU ... just the logic in general seems off. It's not like the industry is in the dark ages or completely paper based, just seems the setup and restrictions are in place by those that are not aware of correctly setting up, or restrictions by the org that is just unaware of proper project planning for change or the fear of change gets huge legal battles. You've pretty much said this with items in the back end are more than what meets the eye.

 

[dangerfish]

1. What exactly does 12 points of ECG do vs 1?

The ability of the AW to perform and EKG is an AMAZING advancement in technology. It will save lives
But and EKG on an AW is NOT the same as a 12 Lead EKG that would be done in a hospital or doctors office.

The AW will not detect a heart attack. It says so right there in the app when you launch it. It cannot detect ischemia or infarct.
A 12 Lead EKG looks at the heart electrically from multiple angles. The AW only looks at it from one (Lead 1).
For instance, if you were having an inferior MI (myocardial infarction or heart attack) you would see changes in Leads II, III and aVF on a 12 Lead EKG. The AW would show nothing despite a very serious heart condition. What about an anterior MI? Same thing. AW would show nothing. And is useless to detect many, many other cardiac abnormalities.
AW can detect Afib (atrial fibrillation) which is an abnormal heart rhythm. That's a great thing that it is able to do. That feature is there to serve as a "warning light" so that you call your doctor for further evaluation. The doctor doesn't need to see it. All you have to do is call your doctor and say "My AW says I have Afib." The doctor will then say "Come in so we can run more tests." There is nothing the AW is going to tell them to help diagnose or treat you. Now, the doctor may find it interesting and cool that your AW was able to detect the Afib, but that's about it. A single Lead EKG is of no diagnostic or therapeutic value beyond its intended ability to warn you that an abnormal heart rhythm may be present and that you should contact your doctor for further evaluation.

 

[hull22]

The dumbest arguments against the ECG IMO are "It's not as accurate as a 12 lead" and "It can give false positives". Only in the medical profession would they say you shouldn't use a device that could save your life because it might give a false indication of danger. It's ECG is not a diagnosis to get treatment but rather a test to say "Hey you might want to get tested because you might have a problem"

Let's take out smoke detectors and fire alarms because they're known for false alarms and sometimes they don't even go off in a real fire. We wouldn't want the fire department going to multiple false alarms just to save a few lives.

Your logic is flawed. All screening tests have costs, risks, benefits to consider. One might say having chest x-rays saves lives by finding early signs of lung cancer. By your logic, everyone should have a chest x-ray every year to screen for lung cancer. Then everyone at all ages should get a PSA, colonoscopy, mammogram, etc because it saves lives. In fact, hypertension is as much a public health risk for heart attack, stroke and death. Should everyone be purchasing a blood pressure cuff and monitor their blood pressure at home daily?



https://www.ncbi.nlm.nih.gov/pubmed?term=30088016
Screening for Atrial Fibrillation With Electrocardiography: US Preventive Services Task Force Recommendation Statement.

IMPORTANCE:
Atrial fibrillation is the most common type of cardiac arrhythmia (irregular heartbeat), and its prevalence increases with age, affecting about 3% of men and 2% of women aged 65 to 69 years and about 10% of adults 85 years and older. Atrial fibrillation is a major risk factor for ischemic stroke, increasing risk of stroke by as much as 5-fold. Approximately 20% of patients who have a stroke associated with atrial fibrillation are first diagnosed with atrial fibrillation at the time of stroke or shortly thereafter.

OBJECTIVE:
To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for atrial fibrillation with electrocardiography (ECG).

EVIDENCE REVIEW:
The USPSTF reviewed the evidence on the benefits and harms of screening for atrial fibrillation with ECG in adults 65 years and older, the effectiveness of screening with ECG for detecting previously undiagnosed atrial fibrillation compared with usual care, and the benefits and harms of anticoagulant or antiplatelet therapy for the treatment of screen-detected atrial fibrillation in older adults.

FINDINGS:
Most older adults with previously undiagnosed atrial fibrillation have a stroke risk above the threshold for anticoagulant therapy and would be eligible for treatment. Anticoagulant therapy is effective for stroke prevention in symptomatic persons with atrial fibrillation and high stroke risk. However, the USPSTF found inadequate evidence to determine whether screening with ECG and subsequent treatment in asymptomatic adults is more effective than usual care. At the same time, the harms of diagnostic follow-up and treatment prompted by abnormal ECG results are well established and include misdiagnosis and invasive testing. Given these uncertainties, it is not possible to determine the net benefit of screening with ECG.

CONCLUSIONS AND RECOMMENDATION:
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrillation with ECG. (I statement).

 

[DeepIn2U]

The ability of the AW to perform and EKG is an AMAZING advancement in technology. It will save lives
But and EKG on an AW is NOT the same as a 12 Lead EKG that would be done in a hospital or doctors office.

The AW will not detect a heart attack. It says so right there in the app when you launch it. It cannot detect ischemia or infarct.
A 12 Lead EKG looks at the heart electrically from multiple angles. The AW only looks at it from one (Lead 1).
For instance, if you were having an inferior MI (myocardial infarction or heart attack) you would see changes in Leads II, III and aVF on a 12 Lead EKG. The AW would show nothing despite a very serious heart condition. What about an anterior MI? Same thing. AW would show nothing. And is useless to detect many, many other cardiac abnormalities.
AW can detect Afib (atrial fibrillation) which is an abnormal heart rhythm. That's a great thing that it is able to do. That feature is there to serve as a "warning light" so that you call your doctor for further evaluation. The doctor doesn't need to see it. All you have to do is call your doctor and say "My AW says I have Afib." The doctor will then say "Come in so we can run more tests." There is nothing the AW is going to tell them to help diagnose or treat you. Now, the doctor may find it interesting and cool that your AW was able to detect the Afib, but that's about it. A single Lead EKG is of no diagnostic or therapeutic value beyond its intended ability to warn you that an abnormal heart rhythm may be present and that you should contact your doctor for further evaluation.

Thank you for the in-depth explanation ... I value this as I'm sure others here do! Also thank you for my previous post not taking offence to it as some others potentially would ... most grateful.

I feel any detection from 1 lead should be considered as valuable. Never before does the common consumer/person had Afib detection available at any given time for such a minimal cost to them.

I've had a history of growth murmur - age 12-13 and recent afib (5x in the course of a minute while just sitting down responding aggressively to a very angry personal email ~ work) late last year. My heart is healthy though. Still it caused some concern as something I've always ignored growing up through the ages (I'm 46 next month) is scaring me: sharp pain in my chest in the heart ~ it feels ~ at random times lasting for 15 mins give/take to the point were I must NOT move or very shallow breathing is required for this movement limiting pain to subside. Happens every few months or years without rhyme or reason.

One thing I love doing during an ECG (12 Lead EKG) is slowing my heart rate during the scan ... down from 62bpm to 32-39bpm and then the doctor assistant has to redo the scan another 3 times because I just become so calm lol.

 

[russell_314]

Your logic is flawed. All screening tests have costs, risks, benefits to consider. One might say having chest x-rays saves lives by finding early signs of lung cancer. By your logic, everyone should have a chest x-ray every year to screen for lung cancer. Then everyone at all ages should get a PSA, colonoscopy, mammogram, etc because it saves lives. In fact, hypertension is as much a public health risk for heart attack, stroke and death. Should everyone be purchasing a blood pressure cuff and monitor their blood pressure at home daily?



https://www.ncbi.nlm.nih.gov/pubmed?term=30088016
Screening for Atrial Fibrillation With Electrocardiography: US Preventive Services Task Force Recommendation Statement.

IMPORTANCE:
Atrial fibrillation is the most common type of cardiac arrhythmia (irregular heartbeat), and its prevalence increases with age, affecting about 3% of men and 2% of women aged 65 to 69 years and about 10% of adults 85 years and older. Atrial fibrillation is a major risk factor for ischemic stroke, increasing risk of stroke by as much as 5-fold. Approximately 20% of patients who have a stroke associated with atrial fibrillation are first diagnosed with atrial fibrillation at the time of stroke or shortly thereafter.

OBJECTIVE:
To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for atrial fibrillation with electrocardiography (ECG).

EVIDENCE REVIEW:
The USPSTF reviewed the evidence on the benefits and harms of screening for atrial fibrillation with ECG in adults 65 years and older, the effectiveness of screening with ECG for detecting previously undiagnosed atrial fibrillation compared with usual care, and the benefits and harms of anticoagulant or antiplatelet therapy for the treatment of screen-detected atrial fibrillation in older adults.

FINDINGS:
Most older adults with previously undiagnosed atrial fibrillation have a stroke risk above the threshold for anticoagulant therapy and would be eligible for treatment. Anticoagulant therapy is effective for stroke prevention in symptomatic persons with atrial fibrillation and high stroke risk. However, the USPSTF found inadequate evidence to determine whether screening with ECG and subsequent treatment in asymptomatic adults is more effective than usual care. At the same time, the harms of diagnostic follow-up and treatment prompted by abnormal ECG results are well established and include misdiagnosis and invasive testing. Given these uncertainties, it is not possible to determine the net benefit of screening with ECG.

CONCLUSIONS AND RECOMMENDATION:
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrillation with ECG. (I statement).

"All screening tests have costs"

You could have ended it there because you hit the nail on the head. The only risk involved is the insurance company might have to pay out of pocket. If the afib kills you it's cheaper for the insurance company.

Oh talking about chest x-rays women ages 25-39 are recommended to get them every 1-3 years. You know why, because cancer usually means long drawn out treatment that costs $$$ even if it is eventually fatal.

 

[Ledgem]

This sounds like a lot of BS.

1. What exactly does 12 points of ECG do vs 1? Care to elaborate since you're already answering this yet vaguely.

You're asking what else I can see with a 12-lead ECG versus a single lead? Things like whether someone is having a heart attack, if a certain region of the heart isn't receiving adequate blood supply, if one part of the heart is unusually enlarged, if there are problems with the "electrical wiring" somewhere in the heart... none of that data can be properly inferred with a single lead.

There are entire books written about entirely about ECGs, so forgive me if this seems vague but explaining how it all works and what it looks like is well beyond what I'm willing to write on a web forum. I'd guess that there are some nice websites that give at least brief explainers on it, and if you have the interest, I'd encourage you to follow your curiosity and read about it.

Why is it your INTERNAL emails are encrypted if they would NEVER reach the internet ... BUT external emails would not be encrypted?! There would be no need to encrypt internal emails if your email server is not connecting to the internet ... but if you're using Gmail for business or O365 for business then most likely the service is configured for encrypted emails within your Tennant.

I don't know the specifics. Maybe the encryption occurs automatically because it's all internal and the keys are known, or maybe the email itself isn't encrypted, but it's held on a server that is encrypted.

Sounds like your exchange or email server admin does NOT know what the hell their doing and I'd like to see such state LAW that prevents any practitioner from sending emails to external party for use for their practice. Notice receiving emails doesn't seem to be of the same concern by your reply.

Just doesn't seem cohesively right. Like what if you had to communicate to another hospital for a transplant? In another state? What about insurance documentation and checks? These are not internal so how are you communicating with the right documents?

It's not a state law, it's federal. The law is the Health Insurance Portability and Accountability Act.

Email encryption is hard... you sound fairly knowledgeable about it, and so I'm somewhat surprised that you're not mentioning anything about that. I can't claim to be a professional in that area, but I've looked into trying to get my own personal emails encrypted, and I've read a bit about the state of email encryption in general. It's a difficult problem.

You, as the patient, can send me what ever information you want, because you're exposing your own privacy to the world. But if data is stolen through my actions, I am liable for the breach. Breaches like these - usually in the form of lost laptops containing patient data - have cost healthcare institutions several hundreds of thousands of dollars in fines.

As for communication between institutions, records are either sent via mail (printed) or fax. Archaic by modern standards, but considered to be more secure (or at least, secure in a foolproof manner). Some electronic medical record systems can communicate with each other across hospitals but we don't usually know what system other hospitals are using, so the other forms are relied upon.

an aside: "many physicians use email for contact within their organization or with other professionals. " seems like a breach of privacy if your client is unaware of this being done, since by your own words ... 'discussing sensitive patient data through email can be legally perilous' ... but what do I know about this practice.

There's a difference between discussing medical matters between medical professionals and having your information on what is likely to be an insecure and unencrypted email server that could be viewed by random people. But you're correct, if I blab your details to a colleague and it's not related to treatment then I could be in breach of your privacy. It's for a similar reason that you can find news articles about doctors and nurses being reprimanded and even fired for viewing the medical records of celebrities they're not involved in the care of. Privacy is taken seriously within the healthcare field.

 

[Strider64]

I turned off my AW ECG as it reported a heart condition 10 hours later and to top it off it pop up a screen asking me if I wanted to dial 911? Around that the "supposed" time of the "heart condition", I was lugging around a heavy tripod and camera taking pictures of Birds-In-Flight. The watch said I was at rest and that my heart rate was high. Complete nonsense and it isn't the only inaccurate app on my watch as the watch is always saying that I am meeting my stand goal. I have to admit I don't stand as often as I should, so I know that can't be accurate. In my opinion Apple is setting themselves up for a lawsuit, but I guess that is why they have a team of lawyers.

 

[PracticalMac]

Why do you even want to send an AW EKG to a doctor? It's of no diagnostic use.

Literally dead wrong here.

It's value is early detection and a recorded time of events.
Some heart issues are sporadic and transient.
In addiction doctor visits may not cause the triggers for an event.
So even if not "official" results, it is better than being dead.
[doublepost=1555509020][/doublepost]

I turned off my AW ECG as it reported a heart condition 10 hours later and to top it off it pop up a screen asking me if I wanted to dial 911? Around that the "supposed" time of the "heart condition", I was lugging around a heavy tripod and camera taking pictures of Birds-In-Flight. The watch said I was at rest and that my heart rate was high. Complete nonsense and it isn't the only inaccurate app on my watch as the watch is always saying that I am meeting my stand goal. I have to admit I don't stand as often as I should, so I know that can't be accurate. In my opinion Apple is setting themselves up for a lawsuit, but I guess that is why they have a team of lawyers.

The AW uses motion of arm to guess at activity. If your arm is still holding the equipment even though you are walking it may still think you are of low activity.

And the stand goal is approximately 1 min, so is easy to earn simply be standing up. Again the AW guesses what is happening by movement. That said, I have noticed the stand goal is rather accurate, perhaps 90% accuracy.