Why Cardiologists and Why mVisum?
In the consumer world, mobile devices are hot. Reviewers drool over Apple's iPhone, the Palm Pre and BlackBerry handhelds. As she watched the evolution of smartphones, Shroff started to envision ways in which they could be used to help DCVAMC's staff do their jobs better and more effectively.
After some research, perusing the available smartphone applications and the mobile platforms on which they run, Shroff decided on mVisum and BlackBerry. She saw huge potential in the app for cardiologists and their patients. RIM's proven security safeguards built into its BlackBerry Enterprise Server (BES) also made BlackBerry devices a natural choice--though Shroff was quick to note that neither she nor the VA is not stuck on BlackBerrys by any means. (Shroff and the cardiologists using mVisum all employ BlackBerry 8820 devices.)
mVisum for BlackBerry EKG Screen Shots
Dr. Shroff and her team at DCVAMC launched mVisum in January 2009. mVisum helps cardiologists remotely diagnosis heart-attack-types and quickly communicate with relevant people who are working to help the patient. mVisum can vastly decrease the time it takes to get patients into appropriate treatment by making high-quality--and secure--EKG readings available to cardiologists on their smartphones. This way, they don't necessary need to be inside the hospital. In the past, DCVAMC staff had to first locate--and occasionally wake up--off-site "interventional cardiologists" and then determine the quickest and most efficient way to distribute EKGs for diagnoses. One other upside: mVisum can also potentially reduce hospital stays for patients, saving time and money for all involved, and getting those patients home faster.
To sum up a fairly complex subject, there are various types of heart attacks, most of which require immediate treatment or else the chances of full recovery drastically decrease.
The American Heart Association (AHA) defines a ST-elevation myocardial infarction (STEMI) as:
"A severe heart attack caused by a prolonged period of blocked blood supply that affects a large area of the heart. These attacks carry a substantial risk of death and disability and call for a quick response by many individuals and systems."
A STEMI requires a "door-to-balloon time" of 90 minutes. This is the total time between when heart-attack patients arrive at the medical center admittance desk and when accurate diagnosis is made and treatment administered. If it takes longer, recovery rates drop dramatically. In general, the faster heart attack patients--especially victims of STEMIs--are tended to and treated, the less damage to the heart tissue and the better chance for a positive outcome, according to the VA.
mVisum securely delivers high-quality electrocardiogram (EKG) images, as well as built-in messaging capabilities, to cardiologists who are away from the hospital. It's both simple to use and fully compliant with the Health Insurance Portability and Accountability Act (HIPAA).
mVisum integrates with a few existing DCVAMC systems, including the organization's GE MUSE server, a cardiology information system, its VistA digital imaging system, and the DCVAMC's BES. This is important for the continuity of information. For example, an EKG taken in one of the center's hospital rooms is simultaneously transmitted via MUSE to the VistA imaging system and the mVisum server on site. The BlackBerry server then retrieves that EKG when the appropriate cardiologists logs into the app and requests it. No EKG or other sensitive information is ever stored on physicians' BlackBerrys.
DCVAMC's Automated EKG Process with mVisum
As for costs, mVisum says it depends on the nature and size of the configuration. Though not providing specifics, she said the price was "reasonable." Interested parties should contact mVisum directly for more information.
Clinical Verification of mVisum at DCVAMC
The DCVAMC's two main objectives in launching mVisum were to maintain security and preserve image quality while providing remote access to EKGs, Shroff says. On one hand, the DCVAMC must legally protect its patients' personal medical information. And on the other, provided you shore up the security angle, an EKG on your phone is worthless if it's not readable or (worse) serves up inaccurate results, according to Shroff.
"We put a lot of emphasis on patient security, but in reality it's much more important to save their lives," Shroff says "There's no way you could do something like this and not prove that it works. Like a new drug, it must go through trials before approval. That's the same concept that needs to be applied here."
So that's exactly what Dr. Shroff and her team did for mVisum's clinical verification. DCVAMC cardiologists retrieved and analyzed 506 EKGs via BlackBerry smartphone with the following results:
* 505 of the 506 EKGs were transmitted from the mVisum server to doctors' BlackBerry devices without any issue.
* EKG transmission time was less than 3 minutes in 95% of cases.
* Acute STEMIs were correctly diagnosed in all cases.
* Cardiac rhythm was correctly interpreted in about 90% of all cases.
* Cardiac conduction was correctly interpreted in about 98% of all cases.
Shortly after the trials were deemed a success, Dr. Shroff and her team went live with mVisum in January 2009.
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