Northeast Georgia Medical Center

June 23, 2015

A medical relay race: using cloud and mobility to shave minutes off the time needed to treat heart attacks

The Northeast Georgia Medical Center (NGMC) is rated the number two hospital system in the US, is the leading heart hospital in the state of Georgia and is recognised as a technology innovator in the field of emergency cardiac care. Its excellence in cardiac care has made it a magnet facility for heart attack emergences across 17 counties, creating a high volume of emergencies travelling long distances for care.

Contact-to-balloon time

Time to treatment is a matter of life and death in cardiac emergencies. Each minute lost from onset to treatment correlates to cardiovascular damage and higher mortality. Cardiologists speak of the “first medical contact-to-balloon time”—the precious window in which to collect patients, analyse symptoms, place patients in the hands of the cardiology team and complete a catheterisation.

A historical challenge to rapid treatment has been exchange of information between linear silos in the emergency cardiac process. Paramedics collect the patient. They drive to the ER. They relate symptoms to the ER staff. The ER makes a diagnosis. They relay the information to the cardiologists. The patient is transferred to cardiology. Only then is the cardiology team assembled and treatment begun.

Precious time is lost at each step. The paramedics may have left for another call before the catheterisation team has been assembled. Patient information may be lost or garbled in a non-collaborative, siloed sequence of treatment.

Secure and compliant

Data security is important to all businesses. But in healthcare, protection of patient data is a matter of federal law. Furthermore, all Protected Health Information such as cardiac patient vital signs must meet exceptionally strict security standards for access, audit, authentication and transmission. Because some lifesaving information could not be securely conveyed, key data were often omitted—as a result, patients could be endangered.

A team approach to problem solving

NGMC has looked to cloud and mobility technologies to address and manage these challenges. “We treat the whole process like a relay race,” says Jason Grady, a paramedic and regional coordinator at NGMC.  

NGMC’s cardiac teams collaborate to review every heart attack case, and, as part of this process, paramedics, cardiologists and personnel from the ER and catheterisation laboratory (“cath lab”) gathered to find a solution. 

Each member of the team contributed unique perspectives. EMTs needed the ability, while in transit, to input key data that could be received by all members of the chain of treatment. ER personnel needed to know whether to route the patient directly to the cath lab. Cardiologists needed to understand the condition of the patients they would treat. The system needed to link to central patient information databases. And the solution needed to be highly secure and HIPAA compliant.

Cloud and mobility

Together, the NGMC team decided on a solution that combined cloud and mobility technologies. 

The entire team might use mobile devices to discuss the patient before the ambulance arrived. Receiving personnel at the ER could contribute their own diagnoses, or the patient might be routed directly to the cath lab. The cardiologists would have their team assembled, equipment ready and key patient information in front of them when the patient arrived.

Compliant and safe

“There was caution around the concept because it called for a paradigm shift,” Mr Grady observes. “We are absolutely committed to protecting a patient’s information, but the fact that we’re regulated adds a risk dimension. This approach was so far outside the box that, when we presented it to the people who make us HIPPA1 compliant, they were very hesitant at first. But we notified the cloud provider and they provided us with a security certificate that satisfied our compliance department. So the hurdle was compliance, not technology.”

Cloud—design on the fly

The cloud-based system required little integration and minimal training for busy personnel. The subsequent three-month roll-out while compliance issues were addressed helped introduce a change in culture that has had dramatic results. The ability to mix and match existing industry-standard technology used to transmit electrocardiograms with a custom design in the cloud turned out to be powerful. Many critically ill heart patients can now bypass the ER and go directly to the cath lab, saving valuable time.

Cloud saves lives

As a result of this and other initiatives, NGMC is currently operating at about half of the national standard of 90 minutes “door-to-balloon” time. Information transfer is more complete, more reliable and more secure. The entire process has become more time-efficient for all participants.

As often happens with cloud and mobility, the unforeseen opportunities turn out to be the most interesting. The new data collected in the emergency response process are giving NGMC insight into the critical need to compress time between a cardiac incident and the first medical contact. Dr Jeff Marshall, an NGMC cardiologist, says that “knowing extra data does save lives, but the data we’re getting for out-of- hospital arrests helps us to build the case for avoiding delay.” That means both educating patients to recognise symptoms and call for assistance and enabling bystander assistance through training in hands- only CPR.

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