ECG results acceptance by medical professionals

PracticalMac

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Original poster
Jan 22, 2009
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Houston, TX
Since I got my AW4 I have seen 2 different doctors.

My first visit was in December and she was quite new to the ECG feature (she had a 3). She observed it positively but still went about her usual routine (check a minor issue I have). She did a quick read on net medical sites, which she said are pretty "cool" (ie: less than neutral) on the device ("not approved" seems to be the term). She was part of a large system and informed me there was no method to send her AW ECG results (and private email may have been against policy).

This week saw another, this time a specialist (advice for better health). He was more curious and fascinated about it. Again the quality of data (1 point) is not as accurate as the 12 point systems, but he did like it. I was surprised when he told me there was no way for me to send him the AW ECG results even though he was a private practice.

I think in both cases the medical establishment has not taken advantage of watch type ECG monitors, let alone to what even simple pulse monitors (eg: fitbit).

Some article on internet also seem to have dim to neutral views of Watch ECG value.
I put a few links:

Apple's latest ECG-monitoring watch: 12 things to know
Should People Worried About Heart Conditions Buy the New Apple Watch?
Why Doctors Shouldn’t Dismiss the Apple Watch’s New ECG App
 

Azathoth123

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Sep 13, 2018
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Fountain City
1855CA8E-DD22-437E-B1D4-1FAA71B7ABEE.png



You can export the ECG as a pdf file and share via email, message, etc from the share sheet.

Are your doctors telling you that they can’t receive a pdf?

Attached are instructions via an article on iMore (credit), it’s a little more detailed than the Apple support document.
 
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Azathoth123

macrumors 6502a
Sep 13, 2018
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I’d be throwing the BS flag on this. I suppose they can’t take a check either, lol.

Maybe they don’t want to use data that they didn’t collect themselves (and therefore didn’t charge you for), that I could understand, kind of.
 
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PracticalMac

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Maybe they don’t want to use data that they didn’t collect themselves (and therefore didn’t charge you for), that I could understand, kind of.

That is what I also think. One of the links basically say the same, that it is not of a certain standard, thus "useless, and dangerous to accept".
Liability issue comes to mind. If Doc makes recommendation for AW ECG that is not correct, the Doc is liable.
I think that is silly.
 

oeagleo

macrumors 6502a
Feb 5, 2016
696
407
West Jordan, Utah
View attachment 829100


You can export the ECG as a pdf file and share via email, message, etc from the share sheet.

Are your doctors telling you that they can’t receive a pdf?

Attached are instructions via an article on iMore (credit), it’s a little more detailed than the Apple support document.

Not to rain on your parade here, but generally doctors make quite a bit more money by giving you one of the 12 lead ECG's, than they do by your sending them a .PDF. Follow the money.
 
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Ledgem

macrumors 68000
Jan 18, 2008
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Not to rain on your parade here, but generally doctors make quite a bit more money by giving you one of the 12 lead ECG's, than they do by your sending them a .PDF. Follow the money.
Hmm... not sure about the guys in private practice, but when I order an ECG I don't get any extra money from it.

I'll address two points:

1) About acceptance of the Apple Watch ECG: a single-lead ECG is pretty much just a rhythm strip. It's not useless, but there is so much more information on a 12-lead ECG, and so many more conditions that can be detected. If I have serious concerns about what's going on with your heart, you're going to get a 12-lead ECG. And yes, the Apple Watch is still relatively new and it's not yet standardized, so I'd probably still want to get a 12-lead even if we were just confirming a rhythm disturbance. I can tell with a 12-lead ECG if the measurement was poor, but I don't know what sort of signal amplification and data smoothing the Apple Watch is performing. I think there's a lot of processing going on, too, because these are some of the cleanest-looking ECGs I've ever seen.

2) About receiving the ECG in PDF. This one may sound silly, but there's actually a fair number of things standing in the way that make this slightly complicated.

Standard email isn't the no-brainer it sounds like. Firstly, many physicians use email for contact within their organization or with other professionals. Mixing patient emails into there can be troublesome. Additionally, discussing sensitive patient data through email can be legally perilous; for my hospital, we can send patient data amongst other staff members at the same hospital, where the messages are encrypted and never hit the internet, but it's forbidden to send anything to an external email address. Those messages aren't encrypted, and the security of other email servers can't be guaranteed, making you liable for breaking HIPAA (patient privacy) laws. From another communications standpoint, a message through email to one doctor is a message that other healthcare workers can't see, which is fine for a solo practitioner (rare as they are these days), but a problem for a healthcare system. Lastly, some patients abuse personal communications, and providing an email address is just making yourself vulnerable.

The work-around is using the electronic medical record system for both internal and external communications. Some of you may have seen this: your doctor's office or hospital has you log in to a website where you can do things like viewing lab results, scheduling appointments, and/or messaging your doctor(s). In all of the record systems I've used, those communications can be viewed by anyone with electronic access to your record, and they don't just go to your doctor; it can be screened by a nurse first, or end up in the inbox of a covering physician if the doctor you were trying to reach happens to be away. It's far superior to email, in that regard. The problem is that not all offices or hospitals have systems like that set up (or the options may be disabled), and not all of those systems accept attachments.

Many medical systems are still adjusting to the reality of modern communications, and it goes beyond the software side of things. How staff are organized to handle the communications, how time is allocated for it... all of these things are still being worked out. So please, don't be too hard on your doctors. It's unlikely to be a problem they can fix on their own, and while the solutions may be available, they need to be implemented thoughtfully. There's more going on with the back-end than may meet the eye.
 

DontGetTheCheese

macrumors regular
Nov 22, 2015
235
139
The guy above hit the most salient points, HIPAA and patient communication. It’s also possible in some places that attachments are restricted, even blocked entirely, just to eliminate as much risk as possible from viruses and the like.

Medical data and HIPAA is well and truly boned for getting things done. And yet, Anthem can lose everyone’s personal information with almost no consequences.

If Apple has one area that they can truly transform health care with, it’s the app, but it’s a long way from that at this point.
 

oeagleo

macrumors 6502a
Feb 5, 2016
696
407
West Jordan, Utah
The guy above hit the most salient points, HIPAA and patient communication. It’s also possible in some places that attachments are restricted, even blocked entirely, just to eliminate as much risk as possible from viruses and the like.

Medical data and HIPAA is well and truly boned for getting things done. And yet, Anthem can lose everyone’s personal information with almost no consequences.

If Apple has one area that they can truly transform health care with, it’s the app, but it’s a long way from that at this point.

I understand both of the above points, but I once had a physician (no longer doing business with him) that every time I went in for anything, he would run a battery of tests, he even ran a 12 lead EKG for a cyst on my back. When I asked him about that, and why I needed blood, and urine samples every time I went in, he replied that he couldn't make any money if he didn't do the tests.
So, moral of the story is not ALL physicians are as conscientious as some. :)
 

PracticalMac

macrumors 68030
Original poster
Jan 22, 2009
2,786
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Houston, TX
Not to rain on your parade here, but generally doctors make quite a bit more money by giving you one of the 12 lead ECG's, than they do by your sending them a .PDF. Follow the money.

I am not saying the AW as the only source. Go right ahead, do a 12 point.
What AW does it provides a record when it happens, which probably will not occur during a 12 point.

Took years of trying to finally catch my issue (short of wearing a harness for a week), and the AW was what successfully did it. Apparently the heart is not as clockwork like as school text books make out, but the are not a threat to health.


Hmm... not sure about the guys in private practice, but when I order an ECG I don't get any extra money from it.

I'll address two points:

1) About acceptance of the Apple Watch ECG: a single-lead ECG is pretty much just a rhythm strip. It's not useless, but there is so much more information on a 12-lead ECG, and so many more conditions that can be detected. If I have serious concerns about what's going on with your heart, you're going to get a 12-lead ECG. And yes, the Apple Watch is still relatively new and it's not yet standardized, so I'd probably still want to get a 12-lead even if we were just confirming a rhythm disturbance. I can tell with a 12-lead ECG if the measurement was poor, but I don't know what sort of signal amplification and data smoothing the Apple Watch is performing. I think there's a lot of processing going on, too, because these are some of the cleanest-looking ECGs I've ever seen.

2) About receiving the ECG in PDF. This one may sound silly, but there's actually a fair number of things standing in the way that make this slightly complicated.

Standard email isn't the no-brainer it sounds like. Firstly, many physicians use email for contact within their organization or with other professionals. Mixing patient emails into there can be troublesome. Additionally, discussing sensitive patient data through email can be legally perilous; for my hospital, we can send patient data amongst other staff members at the same hospital, where the messages are encrypted and never hit the internet, but it's forbidden to send anything to an external email address. Those messages aren't encrypted, and the security of other email servers can't be guaranteed, making you liable for breaking HIPAA (patient privacy) laws. From another communications standpoint, a message through email to one doctor is a message that other healthcare workers can't see, which is fine for a solo practitioner (rare as they are these days), but a problem for a healthcare system. Lastly, some patients abuse personal communications, and providing an email address is just making yourself vulnerable.

The work-around is using the electronic medical record system for both internal and external communications. Some of you may have seen this: your doctor's office or hospital has you log in to a website where you can do things like viewing lab results, scheduling appointments, and/or messaging your doctor(s). In all of the record systems I've used, those communications can be viewed by anyone with electronic access to your record, and they don't just go to your doctor; it can be screened by a nurse first, or end up in the inbox of a covering physician if the doctor you were trying to reach happens to be away. It's far superior to email, in that regard. The problem is that not all offices or hospitals have systems like that set up (or the options may be disabled), and not all of those systems accept attachments.

Many medical systems are still adjusting to the reality of modern communications, and it goes beyond the software side of things. How staff are organized to handle the communications, how time is allocated for it... all of these things are still being worked out. So please, don't be too hard on your doctors. It's unlikely to be a problem they can fix on their own, and while the solutions may be available, they need to be implemented thoughtfully. There's more going on with the back-end than may meet the eye.

Thanks! Confirmed what I suspected.
As I said in my OP, the medical establishment has not developed a way to accept such results.
Probably will as more people ask for it. I will let my doctors know.
 

Solver

macrumors 65816
Jan 6, 2004
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USA
I suspect if a person was bitten by a some strange animal and got real sick, someone would be able to electronically send the doctor a resulting digital picture of that animal
 

JT2002TJ

macrumors 65816
Nov 7, 2013
1,068
471
There is an avenue for receiving information, but the physicians are unlikely to be aware. You would need to speak with the Medical Records department (or in a clinic, it may be a person). They would be able to scan in the PDF, or possibly even receive it electronically (email, disc, flash drive, fax) and include it into the chart. This is the same way clinics/hospitals receive clinical chart information from other clinical offices/hospitals.

Clinicians (unless they are part of an IT or Medical Records committee) are usually unaware of how it all works. They just know where to go in the EMR/EHR to view documents attached to the record to make their clinical decisions.

HIPAA is not an issue for receiving information from a patient. If you chose to send your personal data anyway you want, that is on you, it is your data. Once a clinical practice/hospital/insurance company receives it, at that point they are responsible for HIPAA. If you email the Medical Records office with your personal information, they are not liable for a breach. Once their email server receives it, employees are not allowed to send it out of their email domain, unless encrypted.

Basically, you spoke to the wrong person. It needs to be someone from IT or Medical Records. Once it is in there it is up to the practitioner to decide if the information is clinically relevant or not.

I work in health care Quality/Regulatory Affairs. We often have to submit clinical data to outside regulatory agencies like the Department of Health, NCDR, STS, NSQIP, ACC,... I am more on the IT side of Quality.
 
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Ledgem

macrumors 68000
Jan 18, 2008
1,885
716
Hawaii, USA
I understand both of the above points, but I once had a physician (no longer doing business with him) that every time I went in for anything, he would run a battery of tests, he even ran a 12 lead EKG for a cyst on my back. When I asked him about that, and why I needed blood, and urine samples every time I went in, he replied that he couldn't make any money if he didn't do the tests.
So, moral of the story is not ALL physicians are as conscientious as some. :)
I have some thoughts about that, as well. The comment about making money was, I hope, made sarcastically or in jest. As for ordering test that seemingly have little to do with what's going on, it's either a form of old school medicine (modern medicine dictates a more thoughtful approach to ordering tests that means you're looking at least one step ahead of the test, which can often dictate whether the test should be ordered in the first place) or defensive medicine. Being efficient is hard and heaven help you if you miss something, because then you've opened yourself up to a lawsuit. It's easier to just order everything without thinking, because at least that way if you end up in a court of law they can't accuse you of having overlooked anything... but it's a lot more wasteful and can cause actual harm.

I suspect if a person was bitten by a some strange animal and got real sick, someone would be able to electronically send the doctor a resulting digital picture of that animal
In those situations you're probably going to be in a hospital or physically at a clinic. I've had patients and/or family members show me pictures of things like rashes that they had taken with their own phones, but there would be no way for them to directly get it into the medical record. Within that hospital system I could have gotten it into the record if they had transferred it to my device, but it wouldn't have been all that useful.
 

sslade6752

macrumors member
Jul 16, 2015
72
48
Exactly!

I told them I can email, they said they cant "receive".
No reason why not.

My primary care doctor has a patient portal where I can send a msg with a file upload. All my doctors don’t have a public accessible email but I have the email of some of their assistants. My primary care thinks it’s neat but my cardiologist didn’t want to look at it
 

tgara

macrumors 65816
Jul 17, 2012
1,002
2,769
Connecticut, USA
Exactly!

I told them I can email, they said they cant "receive".
No reason why not.

Like someone mentioned above, many doctors offices (including mine) can't accept emailed information, but they do take faxes. It's not their fault, it's government regulations on patient privacy due to HIPPAA. That said, my doc also uses a patient portal (accessed via the web or through an app on a mobile device) and I can send information to them that way.

Regarding the ECG, I saw my doc last week as a followup, and he noticed I was wearing my S4 watch. He told me about views of the Apple Watch Heart study, and at least one doc's opinion is that it is the worst heard device ever. Read it here:

https://www.medpagetoday.com/blogs/revolutionandrevelation/78684
 

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  • What Did the Apple Heart Study Really Find? | Medpage Today.pdf
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PracticalMac

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Jan 22, 2009
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Houston, TX
Regarding the ECG, I saw my doc last week as a followup, and he noticed I was wearing my S4 watch. He told me about views of the Apple Watch Heart study, and at least one doc's opinion is that it is the worst heard device ever. Read it here:

https://www.medpagetoday.com/blogs/revolutionandrevelation/78684

Reading first half:
A majority (219,179, 52%) of the people in the study were under age 40. Among those
people, a mere 341 (0.16%) were notified of an "irregularity," and of these, only nine
(0.004%) actually had atrial fibrillation
. Were 97% of those younger people receiving alerts
scared unnecessarily?
What were the results in elderly people?
Of 24,626 people ages 65 or older, 3.14% were notified of an "irregularity," and of these,
only 63 people (0.26%) actually had atrial fibrillation.
But the device sent an alert to 775
people! Were 90% of elderly people who received an alert scared unnecessarily?

SO a 99.84% normal heart beat diagnosis under 40
96.86% over 65 normal heart beat diagnosed

That is a phenomenally accurate result!

The AW says the results are not conclusive and see a Doc, it does not even attempt to be an reliable diagnosis.

Bottom line, it is better to catch Afib before it becomes an emergency event.
May promote people to be more aware of heath.
 
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hull22

macrumors member
Jan 16, 2011
69
37
Seattle, WA
Exactly!

I told them I can email, they said they cant "receive".
No reason why not.
Doctors office do not like receiving confidential patient information via unsecured email. It would be a HIPAA violation. (I see now that this was already noted above).

Plus, doctors bill for reading EKGs, monitors, all testing. There's no way to bill for an apple watch tracing at the moment. Imagine hundreds of patients sending in PDFs to review. They're gonna do all that for free? No.
 

PracticalMac

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Doctors office do not like receiving confidential patient information via unsecured email. It would be a HIPAA violation. (I see now that this was already noted above).

Plus, doctors bill for reading EKGs, monitors, all testing. There's no way to bill for an apple watch tracing at the moment. Imagine hundreds of patients sending in PDFs to review. They're gonna do all that for free? No.

What is stopping a doc from ordering an EKG?
I never said the AW should be the ONLY source, and it would be an incompetent doctor who would only rely on AW.
I would not be surprised if a Doc could charge $ for looking at an AW EKG anyway.
 

dangerfish

macrumors 6502a
Aug 28, 2007
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Why do you even want to send an AW EKG to a doctor? It's of no diagnostic use. If it says you're in Afib, the doc is still going to order a 12 lead. No healthcare provider is going to make a treatment decision based on a single lead EKG. The feature is there to alert you, the patient, to the presence of a potential issue for which you might want to seek professional medical advice.
It's like a Check Engine light on your car. It there for YOU to know that there might be a potential issue so that you seek further care. The car shop is not going to make any repair decision based on a warning light (the AW EKG). They will run much more sophisticated tests to determine the actual issue.
 

Newtons Apple

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Mar 12, 2014
22,757
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Jacksonville, Florida
Out of curiosity I printed a copy of mine and showed it to my doctor at my regular visit. He said it looked great but would want more if I were having any hearth problems. He showed me another patient's EKG from his EKG hardware and there is world of difference between one channel and 12.

He did say he had a patient that found out he had a rapid heartbeat in the middle of the night due to wearing his AW to bed. The patient and doctor had no idea but is now being treated.
 

Drowssap

macrumors newbie
Feb 16, 2019
11
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I believe AW is presenting a rhythm strip known as a lead 2, this is used in all medical emergency's in the field and during CPR. Defibrillators all use a rhythm strip lead 2, AW also provides a multiple choice questioner as to the symptoms you were experiencing when you recorded your ECG, This is equally as important for diagnostics.
 

MisterSavage

macrumors 68020
Nov 10, 2018
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Why do you even want to send an AW EKG to a doctor? It's of no diagnostic use. If it says you're in Afib, the doc is still going to order a 12 lead. No healthcare provider is going to make a treatment decision based on a single lead EKG.

Of course they're not going to make a diagnosis on it but you honestly think a doctor wouldn't want to see data of when the event was happening? Especially if it's something intermittent?
 
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