Smartphone Application for Transmission of

ECG Images in Pre-Hospital STEMI Treatment

Peter Bradley, Michael Durej, Alexander Gessner, Andrew Gould, Imran Khan, Bethany Martin, Marisa Mutty, Erin Myers, and Stephen Patek
Department of Systems and Information Engineering, University of Virginia

Transmission and Data Coverage

Software Design Stack

ECG Photo
Capture
Workflow

Run
Prediction
Algorithm

Update
Indicator

Start
Pinging

Camera View Controller

Our Application
iPhone Operating System

Software Design Notes:

Green boxes are layers of the software
stack
Orange boxes are background processes
that do not require user input
Start Pinging consistently checks
the server to see if there is
connectivity. Ping results are kept in a
database and used by the
applications predictive algorithm
Run Prediction Algorithm runs in
parallel to estimate the probability of
a successful transmission based on
the iPhones current location and the
percentage of successful pings
contained in a one-kilometer radius
Update Indicator uses the results
from the prediction algorithm for
visual feedback to the user
The purple box is the user workflow of
capturing an ECG photo and deciding
whether or not to send it

Coverage Map Notes:

Provided by AT&T
Darkest blue areas on the
map represent 4G LTE
coverage
Light blue areas represent 2G
and 3G coverage.
White areas have zero data
coverage

Transmission Data:
Green points on the map
show where test
transmissions sent to a UVA
server successfully
Red points on the map show
where test transmissions
failed to send to a UVA server

Problem Definition

Project Overview

Currently, ambulances that serve the

UVA hospital are equipped with
proprietary systems that transmit
ECGs over voice networks via modem.
These systems have several
drawbacks:

STEMI: S-T segment elevation

myocardial infarction:
A severe heart attack that kills
heart muscle quickly
Every 30 minute delay in treatment
increases 1-year mortality rate by
7.5%

Expensive upfront and monthly

costs ($30,000+ per ambulance)

Requires surgery in a specialized lab

that is not always open

Low reliability (estimates of 2050% of transmissions are

successful)

UVA Hospital Protocol and Workflow

EMS and physicians work together
to make a pre-hospital diagnosis by
transmitting ECGs from the
ambulance while en route to the
hospital
If the surgical lab is activated while
patient is still in transport, surgery
can begin as soon as possible

Zero feedback for EMS

How likely is a transmission at a
given point in time?

Solution

Has the transmission arrived at

the hospital?

An iPhone app providing an EMT the ability to:

Snap a photo of an ECG printout

Lack of information can cause

confusion over when an EMS provider
should attempt to contact the
hospital. Any delay in diagnosis is
detrimental to the patient.

Compress and transmit the image

Assess whether the transmission of the image at that time will be
succesfully received within two minutes

Emergency Responder User Experience

Screen #1
Automatically opens the
camera tab
Green check indicates
there is a 90% chance
that a transmission will
succeed (threshold is
adjustable in settings)
On-screen instructions
guide EMS how to align
the ECG strip
Users press Click to
Begin when they are
ready to take the picture

Results
We have created an application that is inexpensive, informative, and user-centered while
integrating with EMT protocol.
During testing, users were asked to complete a series of tasks and to rate how easy it was to
complete these tasks on a scale from 1-5
Testing results (table on right) reveal that users generally found the application easy to use
Future work includes:
Transmission testing in many locations throughout Charlottesville to create an ROC
curve comparing the rate of true vs. false positives
Implementing the system at the UVA hospital, on a server protected by firewall.
Training EMS personnel
Creating a business plan to market the application in other areas

Screen #2
After a user takes the
picture, the confirmation
screen appears
If the picture is not
satisfactory, the user can
retake the picture
If the picture is
satisfactory, the user
presses send to initiate
transmission
The user can also exit
capture mode and go
back to the home screen

Question

Screen #3
Transmission status
screen allows users to
know a transmission is
taking place
Displays elapsed time
since initiation
Displays maximum time
allowed for attempting
to transmission
(adjustable in settings)
When a transmission
succeeds or fails, the
user is alerted on
screen and with sound

Iteration 1

Iteration 2

Find the application?

4.6

4.9

Start the camera?

4.8

4.9

Align and take a picture of the 12lead ECG?

4.3

4.2

View the image before sending?

4.7

4.4

Send the image?

4.8

4.9

Find the setting page?

4.7

5.0

5-point scale: 1 = Very Difficult, 3 = Neither Easy nor Difficult, 5 = Very Easy.

Acknowledgments
We would like to thank Dr. David Burt,
director of the Chest Pain Center and
cardiologist at the University of
Virginia Emergency Medicine
Department, as well as Dr. Mark
Sochor, Associate Professor of
Emergency Medicine at University of
Virginia. Their technical expertise and
leadership were crucial to the project.