Who do you want reading your EKG?

I know what you’re thinking, punk. You’re thinking “did he fire six shots or only five?” Now to tell you the truth I forgot myself in all this excitement. But being this is a .44 Magnum, the most powerful handgun in the world and will blow you head clean off, you’ve gotta ask yourself a question: “Do I feel lucky?” Well, do ya, punk?
- Harry Callahan (played by Clint Eastwood) in “Dirty Harry”

AliveCor recently announced the launch of their AliveInsights EKG interpretation service where patients decide who interprets the single-lead EKG generated by AliveCor’s EKG iPhone case. If the patient feels fine with a technician and wants a response in 30 minutes, they can get their answer if they elect to pay $2. If that same patient wants a board-certified US cardiologist to interpret their tracing and are are willing to wait up to 24 hours, they can elect to cough up $12 instead.


Gee, which would you take?

My bet is that AliveCor is guessing people will accept the cheaper alternative. But will prescribing doctors?

It is an interesting model. I learned from Dr. Dave Alpert, the inventor of the AliveCor iPhone case, that board-certified cardiologists get to keep $10 of the interpretation fee for providing the service — no insurance forms to fill out, no worry about a technical fee for the patient. Just a plain cash payment model.

Perhaps what is most interesting to me is how incredibly disruptive this model is to our current medical model.

But there are other concerns for doctors who might elect to “prescribe” an AliveCor case to their patients.

If the patient elects to pay $2 and a technician misreads the EKG, is the prescribing physician legally responsible for adverse outcomes that might occur? Who is responsible if a cardiologist misreads the transmitted EKG — the prescribing physician or the interpreting physician (presuming they are not always the same individual)?

These are interesting questions to ponder as this service launches. Certainly other issues are likely to arise where the lines of patient responsibility become blurred. Still, I like the fact that AliveCor is moving head on into this space. It sets an exciting opportunity for patients to have more control over their health concerns, and if this helps them, then all the better.

So as Harry Callahan said, “Feel lucky, punk?”

Wes Fisher is a cardiologist who blogs at Dr. Wes.

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  • Steven Reznick

    In the early mid 1980′s when the American College of Cardiology was a relatively new organization and community hospitals had few fellowship trained cardiologists, most of the EKGs in the hospital were read by general internists, family physicians and cardiologists who were internists who took extra cardiology training before the board established parameters. It was extremely lucrative and frankly it took a death of someone on the panel to get a replacement in. As Board Certified fellowship cardiologists entered the arena the JCAHO pushed the hospitals to use only certified cardiologists. There was a backlash and ultimately the author of the EKG training book Dr Marriott constructed a competency exam. Those who passed it stayed on the panel and those who failed resigned. The three best scores were from a nephrologist and 2 general internists. The panel did far better than the fellowship trained cardiologists who were placed on the panel to meet JCAHO recommendations.
    The single lead EKG will tell you about rhythm and maybe axis. The responsibility for interpretation should ride with the reader and anyone in the income stream. The plaintiffs counsel will find the deep pockets and clarify the issues.

    • whoknows

      What would make the most sense to you then as far as EKG reading?

      • Steven Reznick

        In 2013-4 a board certified cardiologist if available. An electrophysiologist if available. The training at the internal medicine and family practice level is different today than 30 years ago and there are plenty of board eligible board certified cardiologists around to officially read EKGs. Due to the delay in the panel officially reading them we all still read our own and await the official interpretation which often comes hours to days later

        • whoknows

          Personally i think that an internist is capable of reading an EKG unless there is something particularly unique about the EKG or clinical presentation of the patient. But as you say, training these days, may not be adequate for internists. But that is hard to swallow after all that training, I would be surprised if they were not adequate at reading EKG’s. Not sure if you have seen younger trained doctors that are not comfortable.

          • Steven Reznick

            In todays litiginous world with a plethora of board certified cardiologists in most areas they are the logical ones to read EKGs on a panel. I did not say that internists do not know how to read EKGs or that they do not read them well. Based on length of training and experience in todays world if a board certifed cardiologist is available I believe that is best .

          • medicontheedge

            The article refers to single, limb leads ECGs, people!!!! Why on earth would one need a “board vertified cardiologist” to interpret THAT?

          • medicontheedge

            Give me one. I’ll interpret it for ya.

          • Steven Reznick

            The article refers to single lead EKGs the discussions have been about reading 12 lead EKGs.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    The Terms of Use on AliveCor website are pretty straightforward. They, and their interpretation service providers, are not responsible for anything. It’s the prescribing doc that is responsible.
    “Analysis and diagnosis based on Your data can only be accomplished by Your physician” and “AliveCor and the Clinical Interpretation Service make no guarantees of the accuracy or clinical significance of the interpretation of Your data”

    On a different note, is reading random EKGs a good use of a board certified cardiologist’s time and expertise?

    • T H

      It is the health food version of ‘This supplement is not intended as a medication and the claims have not been evaluated by the FDA.’

      And yes, BC cardiologists like easy cash just like the rest of us.

  • ninguem

    Same old story in medicine.

    These tele-EKG firms want to skim off some easy dollars and leave the primary doc on the hook for any malpractice.

  • T H

    Single lead EKG? Which one would they pick? The one that runs closest to the wallet?

  • Sharon

    Depends on your Myer’s Brigg’s results :)

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Probably not very well, for cars. However for technology products it has been working very well. There is a “hold harmless” and “no warranty” clause (in all caps) in every technology contract. So far, so good…. for the vendors.

  • Sharon

    I’m sorry; my comment wasn’t intended for here, and I unsuccessfully tried to delete it….

  • T H

    Agreed. If the FDA is attempting to shut down 23andMe, they’ll go after (should go after) AliveCor.

  • medicontheedge

    Listen: a single “limb lead” ECG is NOT now, or ever has been, a tracing that anyone, Tech or Doctor, could use to “interpret” anything other than the basic rhythm… it is NO WAY intended to “diagnose” anything that is not glaringly abnormal on the single lead. S-T elevation, profound, heart blocks, abnormal premature beats, etc will be evident only. And a “technician” with the proper training and experience can certainly “read” that. And then instruct the “customer” to either call 911 or their provider.

  • medicontheedge

    THAT is what people are missing here: a single limb lead is mpost certainly “readable” by anyone who s trained and experienced. Paramedics IN THE FIELD are interpreting 12 leads and initiating treatment based on their interpretation.
    This is nothing more than self=interest and fear-mongering by big mucky mucks who want to puff their chests out.
    Shoot, Doc’s in my ED come to ME to help interpret paced rhythms, because I have more experience than they have.

  • heartdoc345

    I’m sure it’s a lot more cost effective than event monitors and Holter monitors for outpatient diagnosis of arrhythmias – and could save a lot of unnecessary ER visits if in the right hands