title: Speed and accuracy of text-messaging emergency department electrocardiograms from a small community hospital to a provincial referral center.
abstract: BACKGROUND
  Currently, transmission of electrocardiograms (EKGs) from a small emergency department (ED) to specialists at referral hospitals can be a time-consuming and laborious process. We investigate whether text messaging by use of short message service (SMS) of EKGs from a small hospital to consultants at a large hospital is rapid and accurate.
  
  
  METHODS
  This study involved a one-month prospective evaluation of consecutive EKGs recorded in a small community ED. Investigators obtained de-identified photographs of each EKG via a mobile phone camera. Each EKG picture, along with a brief patient clinical history, was sent via SMS to on-call emergency physicians located at a large referral care site. All images were evaluated solely on a mobile phone. The primary outcome was the proportion of SMS that were received within two minutes of being sent. As a secondary outcome, the intra-rater evaluation of the initial EKG and the SMS EKG image were compared on 13 standardized features. The tertiary outcome was cost of text messaging.
  
  
  RESULTS
  A total of 298 patients (14.6%) had 409 EKGs performed and a total of 926 SMS were sent. 921 SMS (99.5%, 95% confidence interval (CI) 98.7-99.8%) arrived within two minutes with a median transmission time of nine seconds (interquartile range (IQR) 3-32 s). Between the gold standard original EKG, and the interpretation of the texted image, six out of 409 (1.5%, 95% CI 0.6-3.3%) had any differences recorded, across all 13 categories. Overall, the study cost 4.1 cents per texted image.
  
  
  CONCLUSIONS
  Systematic text messaging of ED EKGs from a small community hospital to a referral center is a rapid, accurate, portable, and inexpensive method of data transfer. This may be a safe and effective strategy to communicate vital patient information.
authors.affiliation: Department of Emergency Medicine, St Paul's Hospital, Canada frank.scheuermeyer@gmail.com.
authors.forename: Frank Xavier
authors.initials: FX
authors.lastname: Scheuermeyer
authors.affiliation: Department of Emergency Medicine, St Paul's Hospital, Canada.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Grunau
authors.affiliation: Department of Emergency Medicine, Mount St Joseph's Hospital, Canada.
authors.forename: Timothy
authors.initials: T
authors.lastname: Findlay
authors.affiliation: Department of Emergency Medicine, St Paul's Hospital, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Grafstein
authors.affiliation: Department of Emergency Medicine, St Paul's Hospital, Canada.
authors.forename: Jim
authors.initials: J
authors.lastname: Christenson
authors.affiliation: Department of Emergency Medicine, University of Calgary, Canada.
authors.forename: Eddy
authors.initials: E
authors.lastname: Lang
authors.affiliation: Department of Emergency Medicine, University of Alberta, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Rowe
authors.affiliation: Department of Emergency Medicine, Vancouver General Hospital, Canada.
authors.forename: Kendall
authors.initials: K
authors.lastname: Ho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040421:Cell Phone; D004562:Electrocardiography / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D010781:Photography / Q000379:methods; D011446:Prospective Studies; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods*; D013686:Telemetry / Q000295:instrumentation* / Q000592:standards*; D060145:Text Messaging; D013997:Time Factors
keywords: Telecardiology; emergency medicine