Background: Currently,   transmission of electrocardiograms (EKGs) from a small emergency department   (ED) to specialists at referral hospitals can be a time-consuming and   laborious process. We investigate whether text messaging by use of short   message service (SMS) of EKGs from a small hospital to consultants at a large   hospital is rapid and accurate. 

Methods: This study involved a one-month prospective evaluation of   consecutive EKGs recorded in a small community ED. Investigators obtained  de-identified photographs of each EKG via a mobile phone camera. Each EKG   picture, along with a brief patient clinical history, was sent via SMS to   on-call emergency physicians located at a large referral care site. All   images were evaluated solely on a mobile phone. The primary outcome was the   proportion of SMS that were received within two minutes of being sent. As a   secondary outcome, the intra-rater evaluation of the initial EKG and the SMS   EKG image were compared on 13 standardized features. The tertiary outcome was   cost of text messaging. 

Results: A total of 298 patients (14.6%) had 409 EKGs performed and a   total of 926 SMS were sent. 921 SMS (99.5%, 95% confidence interval (CI)   98.7-99.8%) arrived within two minutes with a median transmission time of   nine seconds (interquartile range (IQR) 3-32 s). Between the gold standard   original EKG, and the interpretation of the texted image, six out of 409   (1.5%, 95% CI 0.6-3.3%) had any differences recorded, across all 13   categories. Overall, the study cost 4.1 cents per texted image. 

Conclusions: Systematic text   messaging of ED EKGs from a small community hospital to a referral center is   a rapid, accurate, portable, and inexpensive method of data transfer. This   may be a safe and effective strategy to communicate vital patient   information.

Authors: Frank Xavier Scheuermeyer, Brian E Grunau, Timothy Findlay, Eric Grafstein, Jim Christenson, Eddy Lang, Brian Rowe, Kendall Ho