mHealth Research Digest with Cole Zanetti, DO

Reducing the time to treat for patients with cardiac related symptoms could be life saving.  Connecting physicians who can accurately diagnose ECG tracings and patients before they enter the hospital would have a huge impact on timeliness.

We have reported on sophisticated system to transmit ECG tracings wirelessly from ambulances in Baton Rouge, LA that was demonstrated a decreased time to balloon angioplasty, and thus presumably better outccomes.

Recently, a team of researchers from Basxkent University in Turkey developed a system to evaluate the accuracy of diagnosing abnormal 12 lead ECGs in the prehospital setting using ubiquitous mobile media messaging (MMS) on cellphones. 


The team assessed the success of the transfer of images, the speed of interpretation and the accuracy of interpretation between selected groups of providers.  The groups consisted of Emergency Room physicians using paper ECG to interpret, a separate group of cardiologists also using paper ECG to interpret and a third group of cardiologists using ECG images sent via mobile text message for interpretation. The team used a consensus reading from two cardiologists in the core laboratory as the reference for correct interpretation.  Each group of health providers received no additional information about the patients they were evaluating beyond the ECG.

The ECGs of 305 patients who were admitted to the emergency department with cardiac complaints were used.  The ECGs that were texted were photographed with the camera of a Nokia N93 mobile phone. The images were sent by an ER physician using a JPEG via multi-media messaging system to an identical mobile phone carried by a cardiologist and were interpreted on the screen of that mobile phone.

Results/Key Findings: 

Quality of transmission

  • 100% of images where successfully transmitted.  Of the images that were sent 90.8% were of good quality 9.2% where of moderate quality.

Duration of interpretation

  • The mean duration of time of ECG interpretation for the core laboratory was 9.95s, for the cardiologist interpreting the paper ECGs 10.06s, for the emergency medicine specialist interpreting the paper ECGs 10.04 s, and the cardiologist interpreting on the mobile phone screen 59.70s.

Accuracy comparison

  • The Cardiologists using paper ECGs to interpret made significantly less major errors than the emergency medicine specialist and the cardiologist interpreting from the mobile device.  There was no statistical difference between errors made between the ER doctor group and the mobile device interpreting cardiologists.
  • Grade 4 errors- A significant disagreement that would change immediate management from the baseline interpreter group.
Cardiologist interpreting from paper Emergency room doctor interpreting from paper Cardiologist interpreting from mobile device
14 Grade 4 errors 29 Grade 4 errors 26 Grade 4 errors


The researchers concluded that the “Transmission of ECG images acquired via the camera of a mobile phone as a MMS and interpretation of these images on the mobile phone screen is an affordable and simple practice of telecardiology and can be used as an aide in ECG consultation.”.

In this study, it appears that an ED physician did as well a cardiologist restricted to a cell phone. It would be interesting to repeat the study with higher resolution cameras or mobile devices with larger, higher resolution screens.

Authors: Muhammet Bilgi, M.D., Betu Gullalp, M.D., Tansel Erol, M.D., Hakan Gullu, M.D., Ozlem Karagu M.D., Hakan Altay, M.D. and Haldun Muderrisoglu, M.D

Institution:  Basxkent University, Ankara, Turkey

Original Abstract: Pub Med