App outperforms email for sending ECG images

An experimental cellphone app that transferred echocardiogram (ECG) images from emergency personnel to hospitals proved to be faster and more reliable than emailing images, according to an oral abstract presented May 17 at the American Heart Association’s Quality of Care and Outcomes Research scientific sessions in Baltimore.

Delays in care for patients who present with STEMI may lead to poor outcomes. The ability to achieve a door-to-balloon time for these patients of 90 minutes or less is considered a quality indicator, making technologies that speed up assessment and treatment welcome additions. One approach is sending ECG photos via email to hospital physicians to jumpstart the STEMI treatment process.

But that typically requires a commercial system that may be expensive, with upfront and ongoing costs, observed David R. Burt, MD, of the University of Virginia School of Medicine in Charlottesville, and colleagues. Alternatively, images could be transmitted by cellphone if a way to overcome to problem of large file sizes could be developed.

In a faculty-student collaboration, Burt et al designed an iPhone app that could take a photo, center the image and reduce the size to less than 30 kb with what they described as a minimal loss in detail. The image then could be sent using cellphone networks to a secure server.

They tested the app using more than 1,500 transmission attempts with four photo sizes over three cell phone networks—Sprint, AT&T and Verizon—in an urban area. They defined acceptable success as transmission within 120 seconds.

Compared with standard email photo transmission, the app was significantly faster, with a lower failure rate at 120 seconds. The iPhones transmitted images in four to six seconds compared with 38 to 114 seconds for actual-size email images and 17 to 48 seconds for large-size email images. The failure rate at 120 seconds was less than 0.5 percent for the app compared with 3 percent, 15.5 percent and 71 percent for full-size photos sent by email on the three networks.

“In many places, it may be feasible to transmit vital ECGs over commercial cellphone networks, saving money, and allowing areas without commercial ECG transmission systems to still connect pre-hospital emergency medical services with STEMI treatment centers,” Burt said in a release.

The researchers now are testing the app in rural areas and places where cellphone signals are limited.