ENAS – The ECG Navigation System: Intelligent Distribution of ECG Data
The acute myocardial infarction and chronic heart disease still occupy the first places of the mortality statistics in Germany. According to the current guidelines of international professional societies, in case of a heart attack it is important to stretch the clogged coronary artery with the help of a balloon catheter as soon as possible and if necessary to stabilize it with a stent. The rapid intervention requires an optimal collaboration and communication between the emergency services on-site and specialized intervention centers.
On the initiative of the Cologne infarction model (KIM) and in close cooperation with Fraunhofer Institute for Software and Systems Engineering ISST in Dortmund and the University Hospital in Cologne the ECG Navigation System (ENAS) was developed. ENAS is a practical system that allows a safe and early diagnosis of myocardial infarction and a simplification of the further supply process via a telemetric analysis of the ECG, thus optimizing the acute care of heart attack patients.
Once the emergency has made the suspected diagnosis of acute myocardial infarction, usually the closest of the five intervention clinics with 24 hours of cardiac catheterization standby 365 days a year will be informed by phone right from the operation site.
The definitive alerting of the clinical cardiac catheter team takes place once the ECG diagnosis and admission options (cardiac catheter free? – intensive care unit bed available?) are finally clarified. Especially this process empirically claims not few minutes of the critical time interval for the patient until the reopening of the occluded infarct vessel.
The emergency medical organization management described here will be completely taken over by ENAS. ENAS enables an intelligent distribution of ECG and decision-support data, according to information logistics principles. To this, well known and established technologies such as fax and SMS are used to build up a stable and reliable communication chain.
Once the emergency has made the suspected diagnosis of heart attack, a derivation of the ECG must be carried out within ten minutes, that means an ECG must be written. At the touch of a button, the ECG is transmitted on the information logistics ENAS infarction headquarters. This is a newly developed software for connection of ECG devices and intelligent distribution of ECG requests. Using a rule-based system it is decided which intervention clinic and what physicians within this clinic should receive the requests. Hereto the data is processed in such a manner that they can be accessed via smartphone. The respective duty doctor can now check whether the suspected diagnosis of acute myocardial infarction is confirmed and clarify if necessary whether the capacities in the intensive care unit of his clinic are free. For his reply back to the ambulance a confirmation on his smartphone screen is enough. The information logistics ENAS infarction headquarters sends this information without delay to the emergency personnel of the respective rescue transport vehicle (RTW), who can drive the fastest route to the appropriate clinic as far as there is an acute emergency.
The peculiarity of ENAS is a return to the business requirements. Due to the low technological requirements even older systems can be connected to the information logistical ENAS infarction headquarters. Having regard to the local cost pressures no extra investments for acquiring new equipment must be made.
Since 1 February 2013, ENAS is in the pilot phase. Initially to this, three rescue transport vehicles in Cologne were connected to the system. The University Hospital of Cologne acts in the context of this test as a key intervention center. Objective is to evaluate the influence of ENAS to the existing technical processes, what technical hurdles possibly arise and if the time to the cardiac catheterization procedure can be shortened.