Telemedical ECGs put into practice
Can you improve patient cardiac care and working practice for GP
clinicians whilst reducing the cost of cardiac care to the NHS? GP,
Dr Jonathan Lieberman, describes how a telemedical ECG service has
done just this at his GP practice in Manchester, UK and outlines the
benefits it has brought to patient, doctor and the NHS.
22 September 2011
When a patient comes into your surgery complaining of chest
pains what do you do? Do you carry out an in-surgery test using a
conventional ECG machine and interpret the results yourself? Or do you
immediately refer them to hospital for an ECG test?
This is a common scenario faced by doctors in general practice.
It is likely that many doctors don’t have access to in-surgery ECG
machines, and those who do probably don’t have skilled ECG
interpreters available to analyse the results which often means a
majority of patients are sent to hospital for diagnostic tests.
Heart disease is one of the United Kingdom’s biggest killers. It
is therefore unsurprising to learn that the cost of diagnosing,
treating and caring for patients with cardiac related problems such
as coronary heart disease (CHD) represents the single heaviest
financial burden on the NHS every year, with an estimated £34
billion spent on cardiac care annually.
Delivering effective yet efficient cardiac care is something the
Department of Health is focusing on and their National Service
Framework for Coronary Heart Disease initiative includes standards
for improving prevention, diagnosis and treatment of CHD. Finding a
single solution that helps reduce the operational and financial
burden of cardiac care on the NHS and delivers distinct benefits to
both patients and their doctors would be the ideal answer.
Diagnosing the problem
Early detection should lead to early action, and moving diagnosis
away from acute hospitals into primary care settings would be the
optimum solution. Developing a more proactive and preventative model
of care in a primary care setting would ease some of the financial
and operational pressures placed upon acute care providers, not only
benefiting patients from a clinical point of view but also frees up
resources in secondary care.
The most common method of diagnosing cardiac conditions is the
electrocardiograph [ECG] and whilst most GP surgeries have access to
ECG machines, the skills required for accurate and detailed 12 lead
ECG analyses can be difficult to maintain outside cardiology or
emergency medicine specialities.
Telemedical ECGs import the same kind of cardiac expertise found
in hospitals into a GP’s surgery, and coupled with a cardiac
monitoring service that expertly interprets the results, it provides
patients with a facility that not only gives them a full on-the-spot
ECG test and assessment, but also cuts out the often lengthy waiting
times that go hand-in-hand with hospital ECG tests.
Telemedicine in primary care — ECGs explained
St Gabriels Medical Centre in Prestwich, Greater Manchester,
provides care for over 8,500 patients. Since 2006 the surgery has
been using telemedical ECG services from Manchester-based
telemedicine specialist Broomwell HealthWatch.
The NHS accredited cardiology reporting service provides quick
expert diagnosis of chest-pain symptoms from trained cardiologists
and has proven to be very popular with both patients and staff at
the surgery. Incredibly easy to use, the service transmits 12 lead
ECGs in just seconds to the monitoring centre where a cardiology
clinician provides an immediate interpretation and returns the
analysis report back to the GP.
Reaping the benefits
The reporting service and telemedical ECGs have greatly benefited
St Gabriels Medical Centre. Although we have access to a
conventional 12-lead ECG machine, staff were not 100% confident in
interpreting the result and introducing the service has eased the
pressure on them.
An additional benefit of the device is its portability. The new
machines are much smaller hand-held devices compared to the
traditional bulky ECG machines, allowing clinicians to use them in
several different rooms within the practice with the potential to be
used for home visits.
Response from patients has been overwhelmingly positive. Being
able to stay within the familiar surroundings of their doctor’s
surgery with faces they recognise and trust means they are more at
ease. Having an ECG done at their local surgery also means they do
not spend time travelling back and forth to hospital, meaning less
hassle and reduced stress.
Taking an ECG
Proof is in the pilot
The burden of ‘frequent flyer’ patients on hospitals is
considerable. Cutting unnecessary emergency admissions and referrals
to outpatient clinics would free up hospital resources and accrue
savings, which could be reallocated to other key areas.
A major two-year pilot carried out by the Greater Manchester and
Cheshire Cardiac and Stroke Network (GMCCSN) revealed that
Broomwell’s ECG service could prevent approximately 63% of referrals
to secondary care if rolled out across the Network. The pilot, which
started in 2007, enabled over 2,000 people to avoid a trip to
hospital, saving the NHS thousands in care costs and eliminating
patient delays, stress and anxiety through quicker, more convenient
Since deploying the telemedical ECG service at the medical
centre, approximately 90% of patients who have come in for a test
avoided going onto hospital and were offered reassurance at the
surgery. Without the service these patients would have been sent
directly to hospital, unnecessarily consuming NHS time and
The successful outcomes of the initiative mean that healthcare
bodies are beginning to realise the potential benefits of
telemedicine and today the monitoring service is in use across 10
PCTs in Greater Manchester, as well as a large number elsewhere.
Telemedicine services are also beneficial as a diagnostic aid for
other medical conditions, as a solution to further reduce cardiac
referrals onto secondary care, saving patients a great deal of
inconvenience and worry and reducing financial burden on the NHS.
Broomwell HealthWatch has recently launched the new Arrhythmia
Watch, which captures and records episodes of arrhythmia as they are
occurring. Worn on the wrist, the Arrhythmia Watch looks like a
conventional sports watch, but can record a 1-lead ECG in just 40
seconds at the press of a button when the wearer feels symptoms of
Once the patient has captured suspected episodes of arrhythmia,
the patient then returns to their GP surgery. The ECG results are
downloaded from the watch and transmitted to Broomwell’s Cardiac
Monitoring Centre, where a team of expert cardiac clinicians
interpret the ECG trace, provide a precise diagnosis and return it
to the GP.
The prognosis for telemedicine
The deployment across Greater
Manchester and numerous other PCTs, positive feedback from
telemedicine initiatives and research data all point to the
overriding benefits of the telemedicine service to the patient,
doctor and to the NHS. Experiences in using a telemedical service
are a further testament to that.
Practice clinicians at the centre have generally been very
positive about telemedical ECGs and agree they are a good diagnostic
aid, which benefits patients and secondary care. However at a
primary level, time and costs can be cause for concern. Performing
ECG tests in-surgery can take up additional staff time and to fully
realise the benefits, PCTs should consider allocating additional
sums to cover the extra nursing time required.
Cardiac telemedicine is an excellent way to ensure that expert
advice is available in a matter of minutes. Having access to instant
diagnostic expertise helps us better perform our role as a doctor
and instant results means the appropriate action can be taken
quickly, helping us to deliver an optimal level of care to our
Prevention, they say, is better than cure. Telemedical services
undoubtedly prevent unnecessary hospital visits for patients who do
not have a life-threatening condition. It also prevents a patient’s
serious condition from worsening by ensuring they receive timely
care. This proactive and preventative model of care has brought the
expertise of cardiologists straight into the heart of primary care,
helping to ensure NHS resources are optimised and used as
effectively as possible whilst giving us the tools to provide the
highest standard of care for our patients.
Dr Jonathan Lieberman
General Practitioner, St Gabriels
Medical Centre, Manchester