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Three Questions to Ask When Integrating ECG Technology Into Your Practice

Two clinicians talking while one holds an iPad.

Many practices think ECGs just need to be “good enough.” The problem is that “good enough” ECG technology is not good enough to trust with your patients’ hearts. An ECG is usually the first test a doctor will use to assess patient complaints related to the heart. With that in mind, an ECG may be the most important thing you do today.

When was the last time you thought through the best way to implement, manage and connect your ECGs? If it’s been a while, here are some questions to get you started down the right path.


If you overlook the fundamentals in conducting proper ECGs, your resulting interpretations, diagnoses and patient treatment plans may be fundamentally impacted as well. Don’t forget to cover the basics, such as: 

  • Proper prep and placement: It’s easy for busy clinicians to rush or overlook these critical steps. Good prep consists of:
    • Clearing away hair to improve electrode contact
    • Removing lotions, powders and oils, which can leave a film
    • Drying skin for better electrode attachment
    • Abrading skin to remove dead skin cells, which do not conduct well

It's worth a few extra moments to ensure staff are using best practices to address these preventable sources of artifact. Doing so can lead to better results the first time, reducing the need for repeat tests.

  • Device Settings: Configuration settings and device capabilities can lead to ECG data that is distorted. Worse yet, they can remove authentic waveform data you need to interpret. For example:
    • Filtering: Make sure your ECG devices are equipped and set to follow ACC, AHA and HRS adult and pediatric guidelines¹ to limit ECG filtering and disclose the settings on the report.
    • Pacemaker Detection: Pacemaker electrical stimulation occurs for very brief durations. Some devices are better equipped to manage this than others. Check the devices or ask the manufacturer:
      • Does the ECG modify authentic pacemaker spikes or introduce non-authentic information on the waveforms?
      • Is the user responsible for inputting presence of a pacemaker, and if so, how does this impact the display and interpretation?


Connectivity isn’t one size fits all. A practice with ECG technology connected to the EMR may have a very different workflow than a practice that doesn’t. Whether you print hard copies, output a PDF or have full EMR integration, here are a few ways to find the right workflow for you:

  • Get clinical, IT and other stakeholders together. What workflow do clinicians want? What are the “hard stops” from an IT perspective to share data securely? What does your office manager see as the biggest shortcoming of your current device/process? Clearly delineating all this information upfront is important not just to make the right request(s) of your vendor, but also to decide which trade-offs are and are not acceptable for the whole group. 
  • Be clear on who is using the device, and for what purpose. Perhaps your medical assistants need to be able to conduct tests, but rights to edit data in the EMR should be reserved for physicians. Make sure the whole team is accounted for so your new system manages user rights both securely and appropriately.
  • Voice cyber security concerns early and often. Your practice needs to secure the devices on your network your way. Ask your vendor what encryption methods are used to protect PHI, and whether the solution supports your existing security policies for cyber hygiene, scans, upgrades and patches.
  • Count clicks. (Your clinicians will thank you.) As powerful as EMR integration can be, too often it results in longer workflows for clinicians. Count the clicks your clinicians are making today, and make sure that number goes down with the new solution. Otherwise, you may be opening yourself up to workarounds or, worse, outright rejection from users.
technician with a patient

3. WHAT IF...? 

If you’re like most practices, EMR connectivity is table stakes when evaluating new ECG technology. But more EMR integration isn’t necessarily better for everyone. A few “what if…” questions can go a long way in selecting the right solution. For example:

  • If you launch ECGs directly from your EMR, what happens if the EMR server is down for maintenance? Make sure there is a back-up workflow that doesn’t rely entirely on the EMR.
  • What if you need ECG software support? Which vendor do you contact? Although the ECG application launches from the EMR, the EMR vendor is not necessarily the right contact for ECG support.
  • What if you need a STAT ECG? If you need to pull up a patient in the EMR before you can initiate a test, STAT isn’t really STAT. Is there an option to run the test without this step in time-critical situations?
  • What if you need software updates? If the software is fully integrated into the EMR, are your ECG updates only rolled out when your EMR system is updated? Work with your vendor and IT to find the right cadence.


Key Takeawaythe connectivity path you choose should not lock you into one and only one workflow.

Selecting ECG devices may never be the most exciting part of your job. But an accurate, diagnostic quality ECG could save a patient’s life today. Don’t trust your patients’ hearts to “good enough” ECG technology. By paying attention to the basics, finding the best workflow and asking the right questions, you are starting down the path to the best decision for your patients and your clinicians.

Interested in learning more on integrating ECGs into your practice? Be sure to check out our helpful infographic to find out why “good enough” ECG technology isn’t good enough for your patients' hearts.


1. Kligfield, et al. Recommendations for the Standardization and Interpretation of the Electrocardiogram Part I: The Electrocardiogram and Its Technology. An AHA/ACC/HRS Scientific Statement. Circulation. 2007;115:1306-1324