Abstract:
The system of the present application includes computerized diagnostic ECG that is tailored for the EMR. The system and method of the present application provides several new approaches to the computerized ECG based on information available from the EMR through an EMR portal. Some of these information items include: Test indication and reason for performing the ECG, previous ECGs as a measure of the patient&#39;s “normal” baseline; electrolytes, and drugs known to cause cardiac toxicity/prolonged QT. Based on these inputs, the computerized ECG analysis will behave differently, including the formation of reports, the ancillary information supplied with the ECG and the interpretation itself.

Description:
FIELD 
       [0001]    The present disclosure generally relates to electrocardiogram (ECG) analysis. More specifically, the present disclosure relates to integrating ECG analytics with electronic medical records (EMR). 
       BACKGROUND 
       [0002]    In current systems, EMRs simply place the image of an ECG report into a patient record as part of a list of other tests. Sometimes only the interpretation is provided without an image. Furthermore, there is no interaction with the ECG image nor is there any optimization of the analysis based on what is available via the EMR. Also, due to the advent of the EMR, the editor of the ECG is migrating from the cardiologist to the practitioner—the one who is actually making care decisions based on the ECG. 
         [0003]    The format of the computerized ECG has not changed since it was introduced over 30 years ago. This is despite the fact that reasons for doing an ECG have changed as well as its relative value versus other diagnostic tools now available, such as electrocardiography, nuclear imaging, and other. Nevertheless, any change in the format of the ECG cannot be too provocative since it is universally recognized as an ECG: and interpretable in its current form across the world. Moreover, most electro-cardiographers believe they can, in a matter of seconds, holistically recognize a particular ECG as being related to a specific diagnostic finding. As a result, anything that interferes with that process of recognition should be considered off limits. It is desirable to speed up the process and make the ECG report more useful for both the prescribing, physician and over-reading, cardiologist. In any case, given the adoption of the EMR, the availability of ancillary information such as lab results in the EMR and other additional information, the advent of inexpensive as well as portable diagnostic imaging devices, the increased focus on cost-containment and the diminishing reimbursement for the cardiologist in editing the ECG—the computerized ECG needs to be updated. 
         [0004]    Attempts to include such information as patient history in the computerized ECG have been attempted using the electrocardiograph. However, information entered at the electrocardiograph is notoriously inaccurate. Age or patient name information is incorrect 15% of the time. Thus, most computerized ECG programs do not rely heavily on this information otherwise the program would be prone to error. 
         [0005]    Referring to  FIG. 1 , existing ECG reports  100  evolved out of a 3 or 6 channel ink writer, equipped with a dot matrix printer that could only supply alphanumeric information at the top of the report  100 . The ECG report  100  example in  FIG. 1  illustrates a 6-channel ECG report  100 , the 6-channel ECG  105  illustrating a number of ECGs taken from a single patient. The ECG report  100  also includes patient information and ECG data  110  above the 6-channel ECG  105 . Thus, current systems are very similar to what existed 30 years ago: that is, black and white characters at the top of the ECG report  100  with black waveforms superimposed over a pre-printed grid. Ironically, all current systems continue to present information in this manner, even if it is being supplied as part of an EMR. 
       SUMMARY 
       [0006]    The system of the present application includes computerized diagnostic ECG that is tailored for the EMR. The system and method of the present application provides several new approaches to the computerized ECG based on information available from the EMR through an EMR portal. Some of these information items include: Test indication and reason for performing the ECG, previous ECGs as a measure of the patient&#39;s “normal” baseline; electrolytes, and drugs known to cause cardiac toxicity/prolonged QT. Based on these inputs, the computerized ECG analysis will behave differently, including the formation of reports, the ancillary information supplied with the ECG and the interpretation itself. Furthermore, quality control procedures when associating clinical data with a patient record within an EMR system ensures the accuracy and quality of data that is included with the ECG that is required to obtain accurate computerized analysis results and overcome limitations of prior attempts to do this at the electrocardiograph. 
         [0007]    In one embodiment of the present application, A system for electrocardiogram (ECG) analysis, comprising: a processor configured to receive ECG data and electronic medical record (EMR) through an EMR portal, data potentially correlated with the ECG data, and to analyze the ECG data and EMR data, and a display operatively connected to the processor and configured to convey an ECG report comprising the EMR data. 
         [0008]    In another embodiment of the present application, a graphical user interface (GUI) including a display and an input device as a method for providing, electrocardiogram (ECG) data in an electronic medical record (EMR), the method including receiving ECG data and electronic medical record (EMR) data, correlating the EMR data with the ECG data, analyzing the ECG data and EMR data, and conveying an ECG report in the GUI, wherein the ECG report includes the EMR data and the ECG data. 
         [0009]    In another embodiment of the present application, A system for electrocardiogram (ECG) analysis, including, an ECG monitor configured to collect ECG data from a patient, an electronic medical record (EMR) database configured to store EMR data for the patient, a processor configured to receive the EMR data, and retrieve the ECG data from the ECG monitor through a portal, wherein the EMR data is correlated with the ECG data, and the processor is further configured to analyze the ECG data and EMR data, and a display operatively connected to the processor and configured to convey an ECG report in a graphical user interface, wherein the ECG report includes the EMR data and the ECG data. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0010]      FIG. 1  is a graphical representation of a graphical user interface (GUI) of the prior art; 
           [0011]      FIG. 2  is a graphical representation of a GUI according to an embodiment of the present application; 
           [0012]      FIG. 3  is a graphical representation of a GUI according to an embodiment of the present application; 
           [0013]      FIG. 4  is a graphical representation of a GUI according to an embodiment of the present application; and 
           [0014]      FIG. 5  is a graphical representation of a GUI according to an embodiment of the present application. 
           [0015]      FIG. 6  is a system diagram illustrating an ECG/EMR system according to an embodiment of the present application. 
           [0016]      FIG. 7  is a system diagram illustrating an ECG/EMR system according to an embodiment of the present application. 
       
    
    
     DETAILED DESCRIPTION 
       [0017]    In the present description, certain terms have been used for brevity, clearness and understanding. No unnecessary limitations are to be applied therefrom beyond the requirement of the prior art because such terms are used for descriptive purposes only and are intended to be broadly construed. The different systems and methods described herein may be used alone or in combination with other systems and methods. Various equivalents, alternatives and modifications are possible within the scope of the appended claims. Each limitation in the appended claims is intended to invoke interpretation under 35 U.S.C., §112, sixth paragraph, only if the terms “means for” or “step for” are explicitly recited in the respective limitation. 
         [0018]    In the following detailed description, reference is made to the accompanying drawings that form a part hereof, and in which is shown by way of illustration specific embodiments that may he practiced. These embodiments are described in sufficient detail to enable those skilled in the art to practice the embodiments, and it is to be understood that other embodiments may be utilized and that logical, mechanical, electrical and other changes may be made without departing from the scope of the embodiments. The following detailed description is, therefore, not to be taken as limiting the scope of the invention. 
         [0019]    The system and method of the present application improves the operation of the current ECG and EMR systems in a number of ways: human over-reading is improved when the over-reader is aware of a patient&#39;s condition—the EMR coupled with the computerized ECG enables this; also in general, ECG interpretation should be guided by the reason for the test which would now be reliably available from EMR; and if serial ECGs are the same in current systems, then the current systems will consistently make the same mistake. Instead of correcting each one of these, the system and method of the present application may pull forward the previous edited and/or corrected interpretation onto the current report from an EMR portal; certain drugs and electrolyte values impact how the ECG should be interpreted; by interacting with the report through the EMR portal, the report is not cluttered, but instead provides information when values are not within normal bounds; and ECGs acted upon as part of care decisions can be edited by the prescribing physician within the EMR. 
         [0020]    The technical effect and advantage is that the computerized ECG will be more accurate and tailored for the reason it was obtained. Again, the system and method of the present application improves the operation of ECG monitoring and EMR practice by making current systems more reliable and accurate. The current systems are also improved in that every prescribing physician uses the ECG but sonic actually do not understand the implications of the test. If the test is tailored to the reason why the prescribing physician ordered it, then it will be more valued by the physician. EMRs are becoming the center of data entry, and departmental systems are being replaced by inferior EMR applications that present the ECG. By providing a superior solution that can plug, into the EMR through the EMR portal, both the EMR and the ECG are improved. 
         [0021]      FIG. 2  is an example of an ECG report  300  of the present application. Referring to  FIG. 2  and  FIG. 6  simultaneously, this ECG report  300  and the subsequent reports discussed herein are displayed for a user on a graphical user interface (GUI)  614 . The reason for the test on the test indication  305  is obtained from the EMR database  610  for the monitored patient  616 . The ECG data values  315  illustrate in quantitative values what is shown in the ECG data  335 . Any of these data values  315  may be highlighted in a variety of ways (e.g., different color, different text, underline, bold) to alert a user of an abnormal value. Current electrocardiograph systems do not highlight abnormal values as such. The ECG report  300  includes a clinical findings section  310  that may include a number of tools, including the ECG data values section  315 , and ECG results section  320 , and a MD confirmation button  325 . It is contemplated that any of these sections and/or buttons may be “turned off” by a user using the user interface  210  so that the ECG report  300  is configurable by the user. The position and size of each of these sections may also be configurable by the user. It is also possible for a user to set the ECG report  300  such that values in the ECG data values section  315  that are abnormal may be highlighted, but without comment in the ECG results section  320  as to the meaning of the deviation or abnormality. In the example of  FIG. 2 , if the QT/QTC value is highlighted and therefore abnormal, then perhaps the “prolonged QT” result may be removed from the ECG report  300 . This would be helpful for addressing a specific measurement such as QT, which has become something like a “disease” when you say it is prolonged when really, for some instances, a user may merely want to identify that the measurement is abnormal but no clinical conclusion should be made based on this information. 
         [0022]    Still referring to  FIG. 2  and  FIG. 6  simultaneously, the ECG report  300  further includes a patient demographics section  330  that may include such patient information as name, birthdate, age, sex, race, weight, medication history, or any other standard patient information that is included in the EMR. As discussed previously, the test indication  305  allows the user to see the reason why the ECG is being obtained, and the time and date of such acquisition of the ECG. The confirmation button  325  alerts the user whether the data values and the results have been confirmed by the attending physician. Of course, the actual ECG data  335  is included in the ECG report  300 . The ECG monitor settings include gain and filter settings for the ECG monitor  605 . In current systems, the ECG monitor settings are oftentimes ignored, and it is contemplated that the system and method of the present application may highlight or flag this ECG monitor setting button  345  if the settings are outside of a predetermined range for both gain and filter. Last, the administrative record section  340  provides information in a barcode or other known scan and identification methods that allows the record to he located, as well as provide information regarding who created the record. 
         [0023]    Referring now to  FIG. 3  and  FIG. 6 , typically there are two physicians who use these types of ECG reports  300 : the prescribing MD and the over-reading cardiologist. The prescribing MD may ask for the ECG data  335  to be taken for a specific purpose. The cardiologist provides a traditional over-read of the ECG data  335  but does not necessarily address the specific reason why the test was done. Therefore, in this embodiment of the present application, there are two areas for a clinical report: a conventional reading in the clinical findings section  310 , and one that addresses the specific reason why the test may have been performed. At the bottom right of the ECG report  300  in  FIG. 3  is another set of text in the Clinical Decision Support Box  350  that directly answers the reason for performing the ECG test, or in other words, a conclusion on the cardiac condition of the patient. The Clinical Findings Section Box  310  may include the standard ECG interpretation, while the Clinical Decision Support Box  350  directly answers the question: “Can this patient undergo surgery?” 
         [0024]    Referring now to  FIG. 4  and  FIG. 5 , the next concept that is supported by the system of the present application is to illustrate to the user of the ECG the patient&#39;s baseline normal. Current systems have serial comparison capabilities, but do not provide, a user with the appropriate tools to evaluate the serial ECG to current ECG data. 
         [0025]    Still referring to  FIGS. 4 and 5 , an ECG serial report  400  is illustrated. First referring to  FIG. 4 , a user may select a previous set of ECG data  435  to view in the ECG serial report  400 . This previous ECG data  435  will also be accompanied by a test indication  405  and clinical findings section  410  just as at the time it was collected as described in  FIG. 2 . This ECG data  435  may then be compared to current ECG data  335  as illustrated in  FIG. 5 . Here, in the ECG serial report  400 , the ECG serial data  435  is included in an ECG serial box  450  that further includes the test indication  405 , identifying the time and reason for the collection of this ECG data  435 . Furthermore, still referring to  FIG. 5 , the ECG results box  320  will include a status of the ECG serial data  435  and also a change statement  425  regarding the difference in interpretation from the ECG data  335  and the ECG serial data  435 . It should be further noted that in any of these embodiments described above, the ECG reports  300 ,  400  may be configured in various colors and the shapes, position and presentations of the boxes may be altered slightly to accommodate display configurations, and to accommodate user specification. 
         [0026]    In this embodiment, given that the change status  425  is at the top of the ECG serial report  400 , the system may also pull forward the previous ECG results  320  that were confirmed by the MD. In order to do this, system must create a space on the ECG serial reports  400  that is reserved for the ECG report  300  that an MD would like to use when the ECG report  300  is pulled forward. In this case, the ECG serial box  450  is this space for previous ECG reports  300  and the ECG serial data  435 . 
         [0027]    Referring now to  FIG. 6 , a system  600  of the present application is illustrated. Here, a patient  616  is being monitored by an ECG monitor  605 . It should be understood that the ECG monitor  605  can be any monitor known in the art, portable or otherwise, that includes capabilities for collecting ECG data from the patient  616  and displaying the same. Furthermore, the ECG monitor  605  is configured to communicate with an EMR database  610 . The EMR database  610  in the system  600  is also one known in the art. The computing system  612  includes a graphical user interface  614  that is capable of displaying any of the graphical user interfaces described in the previous figures. The computing system  612  is in communication with both the ECG monitor  605  and the EMR database  610 . It should be further noted that the computing device  612  and the graphical user interface (GUI)  614  may be included within either of the ECG monitor  605  or the EMR database  610 , in further embodiments. In other words, the computing device  612 , which will be described in greater detail in  FIG. 7 , may be implemented in either one of the other two components of the system  600 , namely the ECG monitor  605  or the EMR database  610 . In one embodiment, a user accesses the GUI  614  on the computing device  612  through an application that accesses the EMR database  610 . In other words, the GUI:  614  is a representation of an EMR of the patient  616  accessed from the EMR database  610 . The EMR database  610  pulls ECG data from the ECG monitor  605  through an EMR portal. It is contemplated that other embodiments could operate in reverse, that is, the GUI  614  being a representation of a patient  616  ECG data accessed from the ECG monitor  605 , the ECG monitor accessing EMR data for the patient  616  through a portal as well. 
         [0028]      FIG. 7  is a system diagram of an exemplary embodiment of a computing system  200  for providing ECG analysis for EMR. The computing system  200  generally includes a processing system  206 , storage system  204 , software  202 , communication interface  208  and a user interface  210 . The processing system  206  loads and executes software  202  from the storage system  204 , including a software module  230 . When executed by the computing system  200 , software module  230  directs the processing system  206  to operate as described herein in further detail in accordance with the system described in  FIG. 6 . 
         [0029]    Although the computing system  200  as depicted in  FIG. 7  includes one software module in the present example, it should be understood that one or more modules could provide the same operation. Similarly, while the description as provided herein refers to a computing system  200  and a processing, system  206 , it is to be recognized that implementations of such systems can be performed using, one or more processors, which may be communicatively connected, and such implementations are considered to be within the scope of the description. 
         [0030]    The processing, system  206  can comprise a microprocessor and other circuitry that retrieves and executes software  202  from storage system  204 . The processing system  206  can be implemented within a single processing device but can also be distributed across multiple processing devices or sub-systems that cooperate in executing program instructions. Examples of processing system  206  include general-purpose central processing units, application specific processors, and logic devices, as well as any other type of processing device, combinations of processing devices, or variations thereof. 
         [0031]    The storage system  204  can comprise any storage medium readable by processing system  206 , and capable of storing software  202 . The storage system  204  can include volatile and nonvolatile, removable and non-removable media implemented in any method or technology for storage of information, such as computer readable instructions, data structures, program modules, or other data. Storage system  204  can be implemented as a single storage device but may also be implemented across multiple storage devices or subsystems. Storage system  204  can further include additional elements, such as a controller capable of communicating with the processing system  206 . 
         [0032]    Examples of storage media include a random access memory, read only memory, magnetic disks, optical disks, flash memory, virtual memory, and non-virtual memory, magnetic sets, magnetic tape, magnetic disk storage or other magnetic storage devices, or any other medium which can be used to store the desired information and that may be accessed by an instruction execution system, as well as any combination or variation thereof, or any other type of storage medium. 
         [0033]    User interface  210  can include a mouse, a keyboard, a voice input device, a touch input device for receiving a gesture from a user, a motion input device for detecting non-touch gestures and other motions by a user, and other comparable input devices and associated processing elements capable of receiving user input from a user. Output devices such as a video display or graphical display can display and interface further associated with embodiments of the system and method as disclosed herein. The speakers, printers, haptic devices, and other types of output devices may also be included in the user interface  210 . 
         [0034]    The user interface  210 , as described above, may be located on the computing system  200 ,  612 , or on either of the ECG monitors  605  or EMR database  610 . The user interface  210  includes the graphical user interface  614 , and allows the user to set the parameters for each of the ECG reports  300 ,  400  that the user requests the system to create, and further receives those ECG reports  235  from the user interface  210 . 
         [0035]    As described in further detail herein, the computing system  200  receives ECG data  220  and EMR data  225  at the communication interface  208 . The ECG data  220  and the EMR data  225  is then processed by the processing system  206  in order to create the ECG reports  235  as described in detail previously in this application. The ECG Reports  235  are then outputted by the user interface  210  through the GUI  614  display in a computing device  612 , or any other device capable of supporting the GUI  614  as further described in this application. In embodiments, the communication interface  208  operates to receive the ECG and EMR data  220 ,  225  from other devices to which the computing system  200  is communicatively connected. Such devices include, but are not limited to, the ECG monitor  605  and EMR database  610  of  FIG. 6 . As discussed above, the computing system  200  may receive the EMR data  225  from the EMR database  610 , and pull the ECG data  220  through a portal from the EMR database  610 . It should be understood that the ECG data  220  may include any ECG data collected from a 12-lead ECG device from a patient. The EMR data  225  can be any information typically included in the patient&#39;s electronic medical record. 
         [0036]    In the foregoing description, certain terms have been used for brevity, clearness, and understanding. No unnecessary limitations are to be inferred therefrom beyond the requirement of the prior art because such terms are used for descriptive purposes and are intended to be broadly construed. The different configurations, systems, and method steps described herein may be used alone or in combination with other configurations, systems and method steps. It is to be expected that various equivalents, alternatives and modifications are possible within the scope of the appended claims.