Abstract 29: Innovative iPhone App Enhances Reliable and Economical Transmission of High-quality ECG Images on Standard Cell Phone Networks

Abstract

Introduction: Transmission of pre-hospital ECG images to STEMI treatment centers aids in optimizing STEMI reperfusion times by promoting activation of the STEMI treatment process prior to patient arrival. Several proprietary systems have been designed for this purpose but they are expensive and incur substantial ongoing system costs. ECG photo images may also be sent by personal cell phone but require large file sizes to maintain diagnostic clarity, which results in lower reliability and speed and greater process variability. Hypothesis: A low-cost iPhone app that optimizes speed and reliability of the ECG pre-hospital transmission process could be developed to address many of these issues and provide an acceptable alternative to commercially available systems. Methods: A faculty/student team designed an iPhone app that takes a photo of the ECG, centers the image and reduces image size to < 30 kb with minimal loss of detail. The image is then sent over cell phone networks to a secure server. Successful transmission is noted with visual and audio cues to the user. The app terminates the send cycle after 120 seconds if not successful. Average time to obtain and initiate ECG transmission is 8-11 seconds. Testing: App image transmission was compared to four different photo sizes utilizing three cell phone networks. Fifty standardized physical waypoints were utilized and multiple test cycles were completed at each waypoint, totaling over 1500 separate transmission attempts. Acceptable success was defined as transmission within 120 seconds. Results: Image transmission via the app consistently outperformed standard photo transmission of all size photos with the difference becoming more marked as photo file size increased. This effect was seen within all cell phone networks. The app was significantly faster, exhibited substantially less standard deviation and had less than a 0.5% failure rate at 120 seconds, compared to failure rates of 3%, 71.2% and 15.5% for full-sized photos on the three networks tested. Average transmission times were also documented. (See figure I). Conclusion: The iPhone app outperformed the standard photo-to-email process -even in high signal-intensity suburban environments. Phase II testing is now underway in rural areas and other signal-limited environments.