title: Novel technical solutions for wireless ECG transmission & analysis in the age of the internet cloud.
abstract: Current guidelines recommend early reperfusion therapy for ST-elevation myocardial infarction (STEMI) within 90 min of first medical encounter. Telecardiology entails the use of advanced communication technologies to transmit the prehospital 12-lead electrocardiogram (ECG) to offsite cardiologists for early triage to the cath lab; which has been shown to dramatically reduce door-to-balloon time and total mortality. However, hospitals often find adopting ECG transmission technologies very challenging. The current review identifies seven major technical challenges of prehospital ECG transmission, including: paramedics inconvenience and transport delay; signal noise and interpretation errors; equipment malfunction and transmission failure; reliability of mobile phone networks; lack of compliance with the standards of digital ECG formats; poor integration with electronic medical records; and costly hardware and software pre-requisite installation. Current and potential solutions to address each of these technical challenges are discussed in details and include: automated ECG transmission protocols; annotatable waveform-based ECGs; optimal routing solutions; and the use of cloud computing systems rather than vendor-specific processing stations. Nevertheless, strategies to monitor transmission effectiveness and patient outcomes are essential to sustain initial gains of implementing ECG transmission technologies.
authors.affiliation: School of Nursing at University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: ssa33@pitt.edu.
authors.forename: Salah S
authors.initials: SS
authors.lastname: Al-Zaiti
authors.forename: Vladimir
authors.initials: V
authors.lastname: Shusterman
authors.forename: Mary G
authors.initials: MG
authors.lastname: Carey
mesh_terms: D042241:Early Diagnosis; D004562:Electrocardiography / Q000379:methods*; D006801:Humans; D020407:Internet; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000517:prevention & control*; D017216:Telemedicine / Q000379:methods*; D014481:United States; D059015:Wireless Technology
keywords: Acute coronary syndrome; Electrocardiogram; Prehospital; ST-elevation myocardial infarction; Telemedicine