Introduction: Integration of electrocardiogram (ECG) tracings into the electronic medical record (EMR) is a challenge in the modern era. Delays in EMR-based ECG visualization negatively impact the care of patients with suspected cardiac disease. We aimed to measure the impact of a standardized process for acquiring and uploading ECG to the EMR on ECG acquisition-to-visualization time (AtV).
Methods: We studied all ECG obtained at our hospital system from 1/1/13-12/31/16, and we stratified the study into baseline (1/1/13-1/31/14), transition (2/1/14-2/28/15), and full implementation (3/1/15-12/31/16) groups. In the baseline group, an ECG was only viewable in the EMR after it was formally read by a cardiologist. In the transition group, technical modifications made it possible for a preliminary ECG to immediately upload into the EMR after acquisition without a cardiologist’s interpretation. In the full implementation group, a standardized process encouraged timely upload to the EMR by setting a 30 minute AtV goal and establishing individual and inpatient unit performance tracking. The primary outcome of AtV was compared across groups with one-way analysis of variance.
Results: During the study period, 628,322 ECGs were obtained (45% baseline, 47% transition, 8% full implementation). Mean AtV was 379 hours in the baseline group, 235 hours in the transition group, and 4 hours in the full implementation group. Compared to baseline, the transition group was associated with a 144 hour decrease in AtV (95%CI 137 - 151 hours, P<0.001) and the full implementation group was associated with 375 hour decrease in AtV (95% CI 362 - 388 hours, P<0.001) (Figure).
Conclusion: A standardized process for ECG acquisition and EMR upload dramatically reduces AtV time allowing for rapid EMR viewing of ECGs. The stepwise improvement in AtV observed in our study stresses the importance of both technical and operational components to this process.