Many years ago Philips Medical Systems released a module that allow the recording of derived 12 lead ECGs based upon the Dower transform. Dr. Dowers patented method produces an approximation of the 12 lead recording utilizing vectorcardiograph (orthagonal) lead placement. Marquette then released a bedside module for their 7000 series of patient monitors that allowed the acquisition of a true 12 lead utilizing a standard 10 lead cable. Philips followed suit with their own true 12 lead acquisition module. Both modules work with their respective monitoring systems and provide a method of acquiring scalar 12 lead acquisition to their respective ECG management systems.
At the time, the state-of-the-art for ECG acquisition was a large rolling platform pushed from room to room. The advantages of having the patient continuously connected were evident especially when proper limb lead placement was observed to allow subsequent serial comparison of the tracing. While not inexpensive, these modules which range in price from $2500-$4000 have offered an alternative to conventional 12 lead acquisition. The downside for the modules aside from the acquisition cost is the loss of charge capture revenue for the ECG. While the 12 lead transmits to the ECG management system, the order information, provided there was order information does not as there is no communications pathway in place for the ECG order. Thus the patient monitoring 12 lead has actually created a major loss of revenue.
What was needed was something that offered convenience while preserving the charge capture mechanism. Recent ECG technology has allowed the electrocardiograph to be miniturized to the point where on no longer has to push a large machine from bed to bed. Given that the goal of the so-called longitudinal patient record has always been to provide a paperless environment, the newer on-screen reading methodology and integration allowed ECG machines to simply acquire ECGs.
Recently new technology has become available that affords the flexibility of a quick and inexpensive ECG device without losing the charge capture mechanism. Surveys show that bedside monitoring ECG only get charged about 10% of the time. For an ED that performs 500 ECG per month that works out to be 450 lost charges. At an average reimbursement of $25 per ECG, this amounts to an annual loss of $135,000. Add to that the initial costs of the 12 lead module and it becomes clear that from an economic point of view, the handheld clearly wins.
This particular handhelf is made by Mortara and supports both XML and DICOM outputs to allow transmission and storage to an Electronic Medical Record (EMR) system. It received orders directly from the EMR via Modality Worklist (MWL) so there is no extra HL7 orders component required. The unit can be programmed to print the initial unconformed report to the laser printer in the ED via the wireless network connection.
Its a fact that the genesis of the patient monitor acquired 12 lead module was for a manufacturer to tie in patient monitoring sales to cardiology management system sales and vice-versa. The convenience of not having to duplicate precordial lead positions is offset by the fact that limb lead electrodes whould be in the same location that other routine ECG (non Mason-Likar placement), and thus one should be placing electrodes on the ankles and wrist positions anyway. In addition, this data if stored at all, is typically in a proprietary format and not easily accessible by the electronic medical record system.
We created a graph out of the data and presented it below to highlight the 3 different methods and their associated costs:
What was needed was something that offered convenience while preserving the charge capture mechanism. Recent ECG technology has allowed the electrocardiograph to be miniturized to the point where on no longer has to push a large machine from bed to bed. Given that the goal of the so-called longitudinal patient record has always been to provide a paperless environment, the newer on-screen reading methodology and integration allowed ECG machines to simply acquire ECGs.
Recently new technology has become available that affords the flexibility of a quick and inexpensive ECG device without losing the charge capture mechanism. Surveys show that bedside monitoring ECG only get charged about 10% of the time. For an ED that performs 500 ECG per month that works out to be 450 lost charges. At an average reimbursement of $25 per ECG, this amounts to an annual loss of $135,000. Add to that the initial costs of the 12 lead module and it becomes clear that from an economic point of view, the handheld clearly wins.
This particular handhelf is made by Mortara and supports both XML and DICOM outputs to allow transmission and storage to an Electronic Medical Record (EMR) system. It received orders directly from the EMR via Modality Worklist (MWL) so there is no extra HL7 orders component required. The unit can be programmed to print the initial unconformed report to the laser printer in the ED via the wireless network connection.
Its a fact that the genesis of the patient monitor acquired 12 lead module was for a manufacturer to tie in patient monitoring sales to cardiology management system sales and vice-versa. The convenience of not having to duplicate precordial lead positions is offset by the fact that limb lead electrodes whould be in the same location that other routine ECG (non Mason-Likar placement), and thus one should be placing electrodes on the ankles and wrist positions anyway. In addition, this data if stored at all, is typically in a proprietary format and not easily accessible by the electronic medical record system.
We created a graph out of the data and presented it below to highlight the 3 different methods and their associated costs:
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