Feasibility of an Automated Fast Healthcare Interoperability Resources-based 12-lead Electrocardiogram Mobile Alert System (Preprint)

BACKGROUND Timely information transfer is more important in the emergency care setting because it is associated with the clinical outcome. For patients with time-critical acute coronary syndrome, reporting of electrocardiogram (ECG) findings is the most important component of the treatment process. OBJECTIVE This study aimed to develop and implement an automated Fast Healthcare Interoperability Resources (FHIR)-based 12-lead ECG mobile alert system in an emergency department (ED). METHODS An automated FHIR-based 12-lead ECG alert system was developed. The system aimed to generate alert for potential ST-elevation myocardial infarction (STEMI) patients. A feasibility test was carried out in the ED of an academic tertiary care hospital from November 14 to December 7, 2018. The system generate alert based on 12-lead ECG readings from the device. The alert was transmitted to the physicians both via mobile app and EMR. A retrospective analysis was performed for patients ≥18 years of age admitted to the ED. The automated FHIR-based 12-lead ECG alert system processing interval was defined as the time from ED arrival and 12-lead ECG capture to the time when FHIR-based notification was transmitted. We analyzed the 12-lead ECG process intervals and the clinical characteristics. In this study, a successful transmission is defined as transmit the FHIR-based notification within 5 minutes. RESULTS The automated FHIR-based 12-lead ECG alert transmission system was developed and used the “Observation” FHIR resource. There were 3,812 emergency visits during the study period. A total of 1,581 12-lead ECGs were captured. The FHIR system generated 155 alerts. Alert patient were significantly older, and the percentage of males was higher. Among 155 alerts, 146 (94%) were transmitted successfully. In the group with cardiac-related symptoms, the median interval from arrival to 12-lead ECG capture was 74.4 min (IQR 15.6 – 211.2 min). The median interval was 106.5 min (IQR 28.5 – 251.6 min) in the non cardiac-related symptoms. The group with cardiac-related symptoms, the median of 2.7 min (IQR 2.3 – 2.9 min) from 12-lead ECG capture to FHIR notification. The median of 2.9 min (IQR 2.5 – 3.3 min) in the non cardiac-related symptoms. The median interval of 9 (6%) unsuccessful cases was 69.1 min (IQR 37.6 – 100.7 min) in the group with cardiac-related symptoms. The non cardiac-related symptoms group, the median was 20 min (IQR 10.8 – 34.8 min). CONCLUSIONS We found that an automated FHIR-based 12-lead ECG mobile alert system was feasible in the ED.