I'm looking for a pocket sized ECG device

04.09.2017
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It is often heard from industry that doctors do not accept, and even seek to block, new technology. My impression from the ESC was a different one and confirmed my opinion that more medical practitioners should be consulting the industry and be involved in these developments.

This year, the ESC is being run all under the slogan: 40 Years Of Percutaneous Coronary Intervention (PCI). Yet the words "digital health" and "big data" creep their way into many talks as if self evident, and seem to represent the really big theme of our time.

And so it is hardly surprising that Dr. Eric J. Topol in his speech at the opening of the ESC spoke about nothing else. This tall and charismatic speaker captivated the audience with stories about the wireless future of medicine. He talked about ECG devices about the size of two USB sticks which, working together with a small pad onto which a few fingers are placed, would then be able within 30 seconds to produce a complete ECG and send it to a smartphone where it can be evaluated. He mentioned self-learning programs which in their ECG assessment capacity are already able to go shoulder to shoulder with a practised cardiologist.

Presenting kidney stones on the smartphone

Eric Topol lives his vision and does not just talk about it. The auditorium followed him with excitement when he talked about an acute illness, which he was forced to endure with unspeakable pain, and I held my breath briefly when he vividly presented his self-examination done via mobile phone and an ultrasound head connected to it.

His treating physician was probably at the time more than irritated when Topol presented several kidney stones to him by smartphone. The subsequent CT could evidently have been dispensed with, since it turned out that Topol and his cell phone were proven correct. His salvaged kidneys were able to be scrutinised by the well-entertained audience on the huge screen at the ESC.

One big disappointment

The euphoric members of the audience then were greatly disappointed when following the lecture they poured into the ESC's industry halls and looked around for the promising innovations and devices. I was disappointed in any case.

First of all, my searching took me to Medtronic, which did not really understand my interest in having an ECG device made to fit in a pocket. Instead, they offered me a device that consisted of a chest strap with an accompanying watch. Continual recording for three days is thus made possible. They dwelled on and underlined the fact that the display of the watch is able to display the current ECG. If necessary, the patient can also bookmark this as an event.

It's certainly a nice device, but does the ECG display on the watch screen imply that the patient performs the evaluation himself? Or does it serve no purpose at all, being rather more of an optical highlight? Or are such watches intended for people who can differentiate between a sinus rhythm and atrial fibrillation?

The old image of large ECG devices

The advantages did not reveal themselves to me and the device did not offer itself as a substitute for the device that I was actually looking for, yet no one really knew about.

Conceptually the idea of the ECG watch could be taken further, and you would soon have a kind of SmartWatch as an alternative option for patients who previously only had an implantable event recorder.

A watch which is capable of continuously recording an ECG which is evaluated by a program and, when deemed necessary, sends an alert to the treating physician during important events. Instead, the old image of ECG devices dominated – the smallest of which being the size of a tablet.

By the same token, the option of a smartphone-echo combination seems at first thought to be a logical consequence of current developments. Phillips offered precisely one such combination. One snag: the transducer is only compatible with Android devices, and in my case only and perhaps with an adapter. The iPhone user has no option for networking. Testing it with one's own device was not possible anyway, since the software for the device is only available in combination with the purchase of the device.

The price is too high

The live demonstration conducted on a living object was nevertheless convincing on the whole. Very good image quality, all the functions you need for a good overview. Only that, in addition to the purchase price unfortunately you would need to have a new mobile phone, should your own not be compatible.

The sharpest competitor worth mentioning in the field of echocardiography is GE, which I chose as the second point of contact because of the great visitor volume at their stand.

With its product Vscan, GE has made moves in the direction of producing a 'gown-pocket echo' and therefore unfortunately does not plan on developing mobile phone-connectable transducers. The advantage of GE's combination is certainly data security. There are nowadays a lot of apps that are known to collect and steal all the data from our phones. So how does the situation look in terms of patient data security?

The GE device sends the collected data via WLAN to, for instance, the clinic-cloud, where the images can be stored. The problem of readability has been fixed, which means images can now run via DICOM.

Small, fast and low cost: No investment going on in this area

Unfortunately, Siemens was not able to put something up against this. Investment is increasingly going into large-scale devices there. Only one  echo device of hand-held size dimensions was able to be examined at their stand; the remaining space was filled up with home-cinema sized screens. The sector "small-fast, little-effort-and-little cost" is apparently the target of no investment.

I was extensively informed about and I was told why I absolutely need large volume record keeping, complicated calculations and assessments. From the point of view of the representative, everyday cardiac clinical work consists only – or at least largely –  of complex questions and assessments prior to medical interventions, yet we were somehow not able to agree on this point.

The use of devices small enough to fit into a gown pocket would, in his opinion, be restricted to countries that cannot afford better technology. Too bad, I can only say.

Do doctors not adopt new technologies?

Industry is constantly telling us that doctors are not taking up new media and technology and would even often block it. My impression today was different to that, and confirms my opinion that more practising medical practitioners should be drawn in to consult the industry and be integrated into developments there.

At the end of the day an employee from CardioSecur suddenly stood inconspicuously beside our Doccheck stand and, while she was discussing things with our team, I stared at her cell phone, which she held in her hand and was obviously recording her ECG.

The app records the ECG, evaluates it, and makes recommendations, such as urgent visiting the doctor, based on its own reference ECGs. The ECG can also be sent by e-mail to a treating physician; the costs of the ECG cables with its four electrodes are manageable. Setting it up is  simple and quick. So too should medicine of the future be.

Friendly greetings from Klaudia Gavrilis.

Image copyright: Pezibear/pixabay/CC0

Article last time updated on 04.09.2017.

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