Docs Going Digital

Edition: April 2003 - Vol 11 Number 04
Article#: 1517
Author: Michael Paquin

Healthcare continues to move from paper-based records to digital formats. That’s why your customers are looking for new products to enhance the process of digitizing information. A variety of new methods for handling both back and front office transactions are emerging, allowing healthcare providers to shift effectively to electronic medical records (EMR).

The Need for Digital Solutions

A key challenge that medical professionals face as they progress into the 21st century is coping with the largest population of elderly people in its history. The crescendo of the ‘graying of America’ has tremendously increased the number of required healthcare treatments, specifically for cardiovascular disease. According to the 2001 Heart and Stroke Statistical Update issued by the American Heart Association, the number of deaths caused by cardiovascular disease has increased in part because the elderly U.S. population continues to increase as a percentage of the total population.

Cardiovascular diseases account for about 950,000 deaths annually, representing the No. 1 cause of death in the United States. With the exception of one year, cardiovascular diseases have been the number one cause of death in this country since 1900. Presently, 60.8 million Americans have one or more types of cardiovascular diseases, according to current estimates, with one in five males and females having some form of cardiovascular disease, including:

• High blood pressure: 50 million1.

• Coronary heart disease: 12.4 million1.

• Myocardial infarction: 7.3 million1.

• Angina pectoris: 6.4 million1.

• Stroke: 4.5 million1.

• Congenital cardiovascular defects:

1 million3.

• Congestive heart failure: 4.7 million1.

According to Managed Care Trends by Medical Data International, 30 million ECGs are performed every year to detect and effectively treat cardiovascular disease. By 2001, more than 72 million ECGs are expected to be performed per year. This makes the ECG one of the most requested diagnostic tests. Medical professionals must find ways to reduce the costs associated with performing this testing due to the increasing influence of managed care and the pressure to reduce these types of expenses.

Digital diagnostic technologies, specifically ECG instrumentation, can help treat patients more effectively by ensuring that physiological data is accurately obtained, documented, protected and easily transferred electronically. Such instrumentation can offer the users of these devices a dramatic reduction in the amount of time and money required to maintain patients’ health records. Digital ECG devices enable physicians to impart a faster, more accurate diagnosis than previous instrumentation.

Digital Diagnostics

Traditional ECG technology has not changed dramatically in 40 years. While sufficient for collecting a patient’s physiological data, it cannot be easily integrated into the digital arena. Inevitably, electronic medical records will become the industry standard and physicians will require ECG results to be stored digitally into these records. The current process of scanning records into the EMR requires large storage capabilities (600k), which are significantly reduced by the use of digital storage (16k).

Seventy percent of healthcare organizations will have at least one digital device in their organization by 2004, predicts Mark Anderson, healthcare IT futurist with AC Group Inc. in Spring, Texas.

Digital diagnostic solutions virtually eliminate the need for storing hard copies of patient records. They can help healthcare providers reduce required storage space as well as the labor to organize and maintain patient records. When fully utilized, digital diagnostic devices add functionality and flexibility to the entire ECG analysis process, allowing physicians to access them quickly, accurately and less expensively.

Today’s digital diagnostic ECGs have a software user interface that mimics the operation of a traditional ECG machine. The end result is a clear, high-resolution image that maintains its fidelity and is easily reproduced any time, any place. (Scanned tests are typically poor in quality and lead to the increased risk of misinterpretation during evaluation.)

The digital ECG is stored in a local computer or a central network. Physiological information is instantaneously stored and easily accessible for future viewing and editing across the network. Users have the ability to view patient data in a variety of ways, offering a zoom in/zoom out approach. The ECG can also be made available through the network to satellite locations.

The digital ECG costs significantly less than a traditional machine and is more compact. Additionally, it saves money by enabling a patient’s diagnostic information to be digitally transmitted. E-mail eliminates the need to fax ECGs from one physician to another and provides a crystal clear image. End-users enjoy the capacity to e-mail entire patient records – including comprehensive analysis – anywhere in the world.

Implementing Digital Diagnostics

The only way to ensure that the exam room of the future will be thoroughly integrated is to purchase equipment for both the back and front office that is capable of such integration. Even if integrated information solutions are not immediately feasible, healthcare organizations can make a small investment now in technology, such as the digital ECG.

When implementing digital diagnostic equipment, providers should make sure that their computers and equipment have the following provisions:

• USB/serial ports.

• Modem for fax and Internet


• Current software from a manufacturer with a proven track record.

• An open architecture to enable communication with other programs.

Digital ECG instrumentation that uses Microsoft’s ActiveX for Healthcare Controls provides an effective choice for environments that intend to implement electronic medical records in the future, but have not yet done so. The open architecture of ECG and otherdiagnostic software provided with ActiveX allows the program to be easily integrated with other software applications, including current and emerging EMR products.

“Microsoft architecture enables healthcare organizations to integrate and share information across the enterprise from any device,” says Ahmad Hasheem, M.D., Ph.D, worldwide healthcare industry manager, Microsoft.

ActiveX allows for file storage that includes both text and graphics. The graphics are completely reproducible as they are recorded. This is particularly important because some file formats, such as .tif and bitmaps, are not exactly reproduced and limit the physician’s ability to accurately diagnose the patient.

What’s in Store

Unlike traditional medical devices, the digital devices of the future will have the built-in capability to take the patient’s blood pressure, temperature, pulse oximetry, ECG, Holter test, spirometry and stress test, as well as perform testing such as vision, and then record all of results automatically into the electronic medical record.

Medical professionals will soon be able to offer an exam room with computers that accept and store all of this diagnostic information. Physicians can use these systems to further enhance the patient experience and quality of care. During periods in which patients wait for the doctor to examine them, they can peruse HealthWatch or WebMD or check their e-mail account. They could take a proactive approach to their own healthcare needs by investigating such topics as weight loss or other concerns.

Medical practices and healthcare organizations can immediately reap the benefits and advantages of digital ECGs. The key to a successful implementation is to begin archiving transactions in the office digitally. Once this begins, the transition will be smooth and successful. By taking this approach, doctors can take what will someday be a consequential financial commitment and break it down into smaller, more gradual investments.

1 National Health and Nutrition Examination Survey III (NHANES II), 1988-94, CDC/NCHD and the American Heart Association.

2 A person is considered to have high blood pressure when he or she has a systolic pressure of 140mm HG or greater, and/or a diastolic pressure of 90mm HG or greater, or is taking antihypertensive medication.

3 National Health and Nutrition Examination Survey II (NHANES II), 1976-80, CDC/NCHS and the American Heart Association.

Michael D. Paquin is president of the Midmark Diagnostic Group and a board member of Microsoft Healthcare Users Group and a member of HIMSS. He has over 28 years experience in the medical industry and has been an initiator of ActiveX integrations for healthcare and medical diagnostic manufacturers. While with the Midmark Diagnostic Group, Mr. Paquin has been successful in winning three Industry Awards for his product concepts – MSHUG 1999, TEPR 2000 and there owned Frost & Sullivan Market Engineering Product Innovation Award for 2000.