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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