An Automated Fast Healthcare Interoperability Resources-Based 12-Lead Electrocardiogram Mobile Alert System for Suspected Acute Coronary Syndrome.
PURPOSE
For patients with time-critical acute coronary syndrome, reporting electrocardiogram (ECG) findings is the most important component of the treatment process. We aimed to develop and validate an automated Fast Healthcare Interoperability Resources (FHIR)-based 12-lead ECG mobile alert system for use in an emergency department (ED).


MATERIALS AND METHODS
An automated FHIR-based 12-lead ECG alert system was developed in the ED of an academic tertiary care hospital. The system was aimed at generating an alert for patients with suspected acute coronary syndrome based on interpretation by the legacy device. The alert is transmitted to physicians both via a mobile application and the patient's electronic medical record (EMR). The automated FHIR-based 12-lead ECG alert system processing interval was defined as the time from ED arrival and 12-lead ECG capture to the time when the FHIR-based notification was transmitted.


RESULTS
During the study period, 3812 emergency visits and 1581 12-lead ECGs were recorded. The FHIR system generated 155 alerts for 116 patients. The alerted patients were significantly older [mean (standard deviation): 68.1 (12.4) years vs. 59.6 (16.8) years, p<0.001], and the cardiac-related symptom rate was higher (34.5% vs. 19%, p<0.001). Among the 155 alerts, 146 (94%) were transmitted successfully within 5 minutes. The median interval from 12-lead ECG capture to FHIR notification was 2.7 min [interquartile range (IQR) 2.2-3.1 min] for the group with cardiac-related symptoms and 3.0 min (IQR 2.5-3.4 min) for the group with non-cardiac-related symptoms.


CONCLUSION
An automated FHIR-based 12-lead ECG mobile alert system was successfully implemented in an ED.
['Hur|Sujeong|S|https://orcid.org/0000-0003-1335-576X', 'Lee|Jeanhyoung|J|https://orcid.org/0000-0002-1011-5368', 'Kim|Taerim|T|https://orcid.org/0000-0002-8149-1205', 'Choi|Jong Soo|JS|https://orcid.org/0000-0003-3108-406X', 'Kang|Mira|M|https://orcid.org/0000-0002-7842-0035', 'Chang|Dong Kyung|DK|https://orcid.org/0000-0001-8925-4629', 'Cha|Won Chul|WC|https://orcid.org/0000-0002-2778-2992']
D054058:Acute Coronary Syndrome D000368:Aged D001331:Automation D004562:Electrocardiography D004566:Electrodes D004636:Emergency Service, Hospital D005260:Female D000073892:Health Information Interoperability D006801:Humans D008297:Male D008875:Middle Aged D017216:Telemedicine D013997:Time Factors
electrocardiogram Health information interoperability ST elevation myocardial infarction health information exchange workflow