Nova Scotia patients and clinicians benefit from integrated ECG system

In recent years, Nova Scotia has built a province-wide, integrated system for storing and sharing electrocardiograph (ECG) results – the only jurisdiction in Canada to achieve this milestone. With ECG data available electronically, healthcare providers no longer have to wait for patient data to be entered or faxed. That’s meant the province’s cardiologists, along with other authorized clinicians, can access results anywhere, anytime – enabling them to make faster diagnoses.

“There’s been a noticeable improvement in turnaround time,” said Paul Verboom, senior systems analyst at Nova Scotia Health Authority (NSHA). He noted that tests can be done at any one of 35 sites around the province (including the IWK Health Centre), and clinicians can access patient results at their convenience from any location.

Leigh Brennan, senior systems analyst at NSHA, observed that cardiac technologists have experienced an evident improvement in their workflow, especially at centres that were previously paper-based.

“It was quite a lengthy procedure just to process an ECG,” with many steps – including filling out accompanying paperwork, filing and sending to the appropriate clinician. “We found that with less paper, there was reduced potential for errors (which could result from manual data entry) and reports were being read much faster by the physicians,” she said.

During the process of planning and designing the system, a conscious decision was made to use MUSE technology, supplied by GE Healthcare, to ensure that all 12-lead electrocardiograph machines could be easily connected.

After training on the new electronic solution, called the Nova Scotia Electrocardiology System (NSES), much of the work was automated.

Sandra Colavecchia, NSHA information management and technology manager for medical imaging, indicated that the system first went live in 2013 and that it took about a year to ensure that each of the 35 sites was connected. Today, across the province’s healthcare system, approximately 1,000 ECG test results flow into the MUSE system each weekday and about 500 a day on weekends.

Results from Holter monitors – portable monitors that are attached to patients and carried around for 24 to 48 hours – are linked into the network, as are stress test results. Historical ECG data, dating back to 1995, was also integrated into the MUSE system, allowing physicians to compare new results with older tests when needed.

The MUSE system has also been integrated with the hospital information systems (HIS) used across Nova Scotia, meaning that orders can be generated directly from health information systems to the ECG cart, so the information is there for the technologist.

The ECG images that are generated – essentially waveforms – are saved in the centralized MUSE database and as PDF files in a PACS archive. Moreover, the results are sent back to the HIS for distribution to the ordering physician. The bottom line is that the data can be quickly obtained by clinicians when and where they need it.

Researchers have also benefited from the computerized MUSE system. To date, the archive has accumulated about 2.6 million ECGs, creating a valuable resource for clinicians and researchers.

Prior to the system being implemented, bundles of paper test results would be delivered to researchers. Now, they receive anonymized computer data. They don’t have to handle paper files or re-enter data, which has meant savings in time and effort and improved accuracy and efficiencies.

Verboom noted that for other jurisdictions seeking to create an integrated ECG system, it’s important to make sure there is a common identifier for patients. That way, results for patients with similar names or health card numbers won’t be confused.

“We invested a fair bit of time in this,” said Verboom. With multiple sites participating across the province, and hundreds of thousands of patients, it was important to ensure that systems were in place to detect differences among similar looking records and IDs.

Complicating this further is the treatment of patients from out of province, which can sometimes occur. For instance, Nova Scotia and Ontario both have patient IDs with the same number of digits. A computerized system has to be able to detect and flag rare instances where different patients present with the same names and numbers.

“You also need the right people skills for this,” said Verboom. Staff involved must have familiarity with patient demographics and database tools, he explained.

The successful development of Nova Scotia’s Electrocardiology System has led to an improved experience for patients, healthcare providers and researchers and contributed to a more effective healthcare system. More importantly, it has created the potential for improved patient outcomes as providers have access to more timely and comprehensive results to better support clinical care decisions.