Current Clinical Strategies Publishing recently sent us some free promo codes for this app, ECG Interpreter(you may have noticed) and we were thrilled by the last app we reviewed by them, ACLS Advisor. So then naturally, we had high expectations for this medical app. ECG Interpreter is relatively inexpensive at $1.99(current price), but with so many ECG apps out there we wanted to know if this app was on par with similar applications and if it met our high expectations.
When you open the app, you’re given a few options to choose from: Start Analysis, Calipers, Saved Results, and ECG Library. I’d have to say, the real meat of the app are the Analysis and ECG library sections, but the virtual calipers are also ingenious (and I’d have to say, a lot easier to get through airport security than my other ones).
The app does a fairly good job of walking you through a step-by-step method of reading ECGs. It’s similar to how you first learned to read radiology images: if you follow the same steps every time, you decrease the probability of missing something. The app walks you through analyzing the following (and in this order): rate, rhythm, axis, hypertrophy, conduction blocks, ischemia / injury / infraction, AV nodal blocks, and finally, miscellaneous syndromes (hyper and hypo-kalemia K, hyper and hypo-calcemia; and myocarditis / pericarditis), supraventricular arrhythmias, and finally ventricular tachycardias. After you walk through all of these questionnaires, it finally summarizes all of your information, and allows you to save the analysis or send it via email.
In their App Store description, this app boasts that not only can it “evaluate the 12-lead ECG” but that it “provides a diagnosis and recommends treatment”. Now, some may have a problem with the details of the treatments recommended (or the lack thereof). For example, when setting the calipers for a HR of 55, the output simply reads “Diagnosis: Bradycardia. Treatment: atropine, pacemaker.” To be fair, not all of the diagnoses are this brief and this app is obviously not a replacement for sound clinical judgment. (I for one would be terrified if I woke up with an HR of 55 and found a team ready at my bedside ready to float a pacer!) According to the developer, the app is based on sound medicine, powered by the ACCI Cardiology Decision Engine, and follows 2009 AHA / ACCF / HRS / WHO guidelines.
So this is the part of the app I thought I’d get the most out of. Who couldn’t use a quick pocket reference of a variety of common and not so common 12-lead ECGs. Au contraire, using this is not as easy as it seems. When you initially click on ECG library, you’re greeted with an endless list of rhythms to choose from. However, clicking them basically takes you to a picture file that has a zoom capable image of an ECG with a typed explanation above it. Sounds good in theory, but not really when you take a closer look at the examples. Too often I found myself scrolling back and forth on the zoomed image to read the cramped text, and then scrolling back down the image to see what they were talking about.
From a user interface perspective, I’d like to be able to see the ECG and read the explanation text at the same time. I know that’s hard to do on an iPhone screen, but other apps have taught ECGs better (see our review on Instant ECG). This app gives out really great information, but I’m just not sure if I’d use it in this format, and I think other apps do a better job.
Another aspect not helping this app’s cause is the fact the screen orientations in every mode are locked. The ECG list is always in portrait, and the ECG images are always in landscape. Needless to say, if you use the app for any decent amount of time, you end up flipping back and forth too frequently. Even though I can magnify the images and drag to whichever lead I want, it comes nowhere close to the ability to look at an actual full size EKG on paper. Also, I would’ve liked the ECG library section of the app to do a better job with the content provided, it really only works as a a quick refresher reference since I already know what to be looking for.
So who would benefit from this app? Like our other ECG app reviews, medical students and residents, particularly those on cardiology rotations would probably benefit the most. If you spend a long amount of time looking at various ECGs and need a reference to remind you of the zebras, it wouldn’t hurt to have this around. Additionally, if you need help remembering the routine for reading ECGs, this app walks you through it in a straightforward fashion. However, if you’re looking for a quizzing or teaching app, this may not cut it for you. If it stays at the low price of $1.99, it would be hard to go wrong either way.