Welcome to Heart Rhythm Society 2025. My name is John Kammerman, and I am the national leader of Enterprise Cardiology Solutions for Philips Healthcare. I'm Jesse Blatherwick. I'm a clinical specialist for the Diagnostic Cardio Solutions product line. Today, we're going to discuss how the role of the cardiograph is changing significantly. We need to be prepared for this change while we're deciding on what type of devices we're going to buy now to be ready for the future. The resting 12-lead ECG has been a part of our life for a long, long time. It's a very prominently important diagnostic study for a cardiology patient. It almost always begins the cardiology journey for a patient. The first time they start learning that they have heart disease is when they receive their first diagnosis from their 12-lead ECG in many, many cases. It's always been used for diagnosis, also for risk stratification of patients, and also year after year for some patients in monitoring them in their response to the therapies that they're getting. It's a very frequent study that is so common that sometimes we lose sight of its importance. It starts to get to be so routine that we forget that what is happening today might influence something in the future, especially when it's coming at you at 200 ECGs a day, or for a technician, maybe 20 or 30 ECGs per day. So you have to keep this in mind because the quality of data has never been more important, especially with AI on the horizon. Inside of a cardiograph is a beautiful set of data. It's very important because we don't know the future with AI, especially with a 12-lead, that we capture very high-quality, unfiltered data and improve on that as quickly as we possibly can so that we are ready for the future, even programs that will come back and look at the AI, look at the study you did today retrospectively and do a new study on it with a measurement we don't even know of. So something that I want to make you aware of today is that we already have a partnership in this space with a company called Onumana. For the first time ever, we're going to be able to do a 12-lead resting ECG that shows an ejection fraction, something that could only be seen in an ultrasound or other type of imaging study previously. From a single 12-lead ECG, we can see if the patient is showing positive for ejection fraction. This is a whole new way this market is expanding. We don't even know where it's going to go, even though you could walk around HRS today and see how many vendors are applying AI to this very important but very common study type. We have to be ready for the future. Today is the day that we can make very, very good data, very high-resolution, high-quality, and what our teams do matters. So what we'll be discussing today is how a cardiograph can fit into this world and how it needs to be ready for the future. You can see on this screen that this clinician is looking at two different study types on a single screen at the bedside. We'll talk about that a bit later. I would recommend that before purchasing any medical device, could be imaging, electrocardiograph, any medical device, you use a common framework, no matter what it is. I recommend this framework. I think it's very, very helpful. Does this new device, does the new cardiograph change the way that we acquire data? Is it ready for the future? Is it capturing very high-quality, unfiltered, raw data that can be used for something else in the long run? Is my database beautiful? Is it ready to be used by anyone who needs to use it? How is my data being analyzed? Of course, traditionally, ECGs have been analyzed for many, many years. Philips has the DXL algorithm, a nice algorithm across all of our waveform-collecting devices in Philips that analyzes an ECG with the same metrics every single ECG. Analyzation. But we also analyze the workflow before it comes in to our world. We analyze the workflow before it hits the cardiograph. We analyze the workflow before it gets to the physician. And we order it in context so that it's ready for that person to use it in their context quickly and efficiently. So that it can be interpreted. Of course, yes, a physician interprets ECGs, some of them hundreds of times per day. But if we move interpretation to the cardiograph as well and help the clinician understand what they're capturing, we can also help in interpretation at the bedside get a better ECG captured every single time, consistency across the team. Now, I just mentioned across the team. Of course, we're presenting this information almost always through an EMR, also in front of the physician as they're reading so they can share it with other clinicians. It also needs to get to your department directors and hospital administrators. If we have beautiful databases that can be mined, Jesse, in just a little bit, will give us an example of how we can improve data by looking at quality in the databases and making decisions on the front line of who needs to be trained, what programs we need to put in place to be successful. So there's an administrative component to high quality ECG capture that must be concentrated on today because if we're capturing data that is messy, it can mess with your whole future. So we analyze, acquire, interpret, and present. And all of this data is coming into an information management system that can be leveraged now and in the future to improve care. And I want to repeat this problem again. Many hospitals can have many cardiographs across many care settings, hospitals, clinics, urgent care, physician offices, thousands of ECGs being captured per month, hundreds per day in some cases. We have some customers that are capturing over 3,000 ECGs per week across their network. Having the cardiograph as an extension of the ECG management system so they work in conjunction together is exactly how we think. And I think that it's a critical way that we need to consider what we're purchasing and how we're going to deploy new workflows and new environments for our physicians so that we can scale with the future. Jesse? Yeah, so like John mentioned, the EKG, the resting 12-lead, is usually one of the first studies that a cardiac patient will get in the beginning of the cardiac care cycle. Often, as seen kind of in this picture we have beside me, that is where the physician is going to review and start having that conversation, maybe a difficult one, with their patient about what's going to happen down the future and where they need to be referred to and what other studies need to happen. So before we get there, we need to organize a workflow for a clinician. So the technician needs to be told where to go. Jesse, give us some examples of what the Cardiac Workstation 7000 can do. Yeah, so first, and this is actually maybe not brand new to our Cardiac Workstation, but we organize orders down by department so that each individual tech is assigned to a different department. So we have a number of different departments so that each individual tech can go and make sure that they're only seeing orders that are applicable to where they're gonna be. The second thing that we do, we can also, we have find patient tabs so they can search worklists, whole worklists, whole hospital worklists. But even more importantly, we have a barcode scanner that from our main screen, you scan that patient's wristband or barcode, and it will automatically reach out and pull that order down and enter their patient demographics directly into the patient demographics screen, making the workflow as efficient and optimized as possible. So as I mentioned earlier, workflow is a main priority for our new design of the cardiograph. Ergonomics actually have a very big role in the quality of an ECG when it's captured. Yeah, the ability to focus on your patient, focus on the quality of your ECG, and not have to worry about your equipment is really an important factor in getting a good quality ECG, right? So a couple of things that Philips has done with this new workstation, one thing obviously you'll notice, we don't have a keyboard anymore. So it's all virtual touchscreen keyboard. That way we're helping with disinfection issues. You know, that became a huge issue during COVID, obviously. So making it easier to clean between patients, not having to worry about some of those nooks and crannies in the keyboard. Other things that we've done are the ability to kind of swivel the ECG machine, the screen rather, without having to move the whole machine. We have height adjustable trolley here that can go up and down. And some of the stuff that we don't have, we have as optional, actually, that are kind of really seem like small details, but are hugely important, at least in my opinion, being at the bedside, even just having a waste bin with a little top to it, right? That way, hopefully I see less and less my EKG machines with used electrodes all stuck all on the screen. That's one of my banes of my existence is having to deal with that stuff. So just the details that we put into this design, I think is incredibly important to our end users. So our goal is to help anyone at the bedside, whether it's a nurse or a ECG tech, to have an efficient workflow so that they can get the ECG done on time and actually work through the rest of the patients in their work list for the rest of the day. So the beginning of this cycle actually starts way before they even arrive at the patient. Yeah, and some of the other ergonomics that we'll talk about with this picture up here for reference is Philips patented Trident PIM, so our patient interface module. The way that they laid out the leads are to help two things. First, to prevent tangling, right? I don't want to spend five minutes untangling all my leads before I connect to my patient. And the second thing is the way that these leads are laid out are meant to, when I place this on my patient's stomach or chest to get an EKG, they fall in more or less the correct anatomical position. So it's quicker for me to hook up accurately, again, trying to optimize efficiency for our end users. The other thing that we have new to this device is a wireless patient module. And actually on this device, we can connect up to eight wireless modules that you can cycle through and select. So that way, again, thinking about isolation rooms, disinfection, all that kind of stuff, helping aid in the workflow that matters most. Now, these are the things we knew in the past, but when you introduce a new technology like a wireless patient interface module, you can introduce entirely new workflows. Imagine physician offices with a single cardiograph and multiple patients in many rooms and have a single cardiograph roll through that hallway and capture ECGs from that patient. These are the types of things that I think we always see very innovative customers. They figure out new workflows and we show up and talk to them and actually get surprised at the new things that they're doing every single day we work with them. It's all about quality. Yep, so as John mentioned, quality is key, especially with incoming AI and that ability down the road. And actually, it's here now, you know, John mentioned on Humana. But ways that we help you as the end user get good quality EKGs, we have a few different things that we do. First one here, we're showing the lead map, but even more importantly, if you click on that little question mark at the top of the lead map, it gives you step-by-step instructions on how to take a good quality ECG, not just skin prep, but where exactly correct anatomical location those electrodes are supposed to be placed. So oftentimes, if you have a nurse who's working the night shift and hasn't had to do an EKG in years, maybe they forgot how to do it. So making sure that we're providing you the tools to get the best, most accurate EKG possible, like John mentioned, is hugely important for the future. Some other things that we have on our device to help with quality, you'll notice on the screen, we have color-coded waveforms. That way, you can quickly identify by lead which waveform is maybe having the worst artifact and needs to be attended to right away, as opposed to having to look at a maybe messy EKG and have to go around and figure out which electrode needs to be replaced. We're helping you identify it just by lead. The other thing that we do is we have the ability to detect up to 20 different lead reversals. Okay, so if I'm moving quick, it happens all the time. I've done thousands of EKGs, but sometimes I'm moving really quick and I reverse leads real quick and it'll pop up a message on the screen that says, hey, double-check, you might have misplaced V1 and V3. So I have the opportunity at that point to make sure I'm getting the good EKG first time right. You can also see that there's a green light flashing on the front of the patient interface module. When you have a good hookup, you're noise-free, which means you've prepped the patient very well. It tells you exactly when you're ready to capture an ECG. Of course, not every single technician knows which ECG to capture. Sometimes you have to go back in time. Yeah, absolutely, and this disclose function that we have on our devices, we call it disclosure. It can hold up to 20 minutes, the most recent waveform data for that patient. So some things that I would particularly use this for, if I have them working with a pediatric patient, a baby that's squirming and I'm having trouble getting a good clean EKG or a patient that has tremors, I can kind of hold some leads in place and make sure that I get a good clean 10, 15 seconds and then go back to this screen and actually select that 10-second 12 lead from that screen. The other thing that used to happen to me frustratingly quite a bit when I worked in the hospital, I might be in the middle of getting an EKG with a patient and I have a physician barge into my room and I need to get him out now because I'm really trying to deal with my patient. And I might see a four-beat run of VTAC go by and I can't run back to the device in time to capture that. But I can go back in the disclose and I can pick out that arrhythmia, the most important part of that EKG for that patient that I want the cardiologist to see and review. There's also an aspect to this that is very important in that we cannot necessarily control what a technician knows. How does a tech know which EKG to capture? So this is where analytics on the backend system, when we can analyze what happened retrospectively all the way down to the leads, the measurements inside the leads, what the physician changed, what the physician didn't change, and the patient history, we can see and find technicians that might need help identifying the most important EKG. Very important aspect of this. Some other functionality with that disclose feature, we can save events from the main screen. So particularly helpful if I may be in the ER and we have a patient that's in rapid AFib or AFlutter and we want to cardiovert, but I don't want to stop watching my live waveforms. So I can mark an event and then later I can go back and I can see those events and I can type notes. Maybe I'll type, you know, patient given however much amiodarone or something like that so that we know later that's when we push that drug. Sorry. And then of course, the preview screen is incredibly helpful. I can take an EKG, see if I like the quality. If I don't, I just close it and get another one. I don't have to re-enter patient demographics. I don't have to mess with anything else. I can just easily close it and make sure I get that good clean EKG from my patient. Additionally, on our new capacitive touchscreen, we have the ability to pinch and zoom and really interrogate that ECG at the bedside. If you happen to be in the ER or somewhere where the clinician wants to actually do that kind of work. There's also another component to this is that if you're selecting good ECGs before you send them to the physician, you're not overwhelming the physician with duplicate ECGs from the same timeframe. Let's say the last five minutes. We have several layers of things happening between the ECG management system and the cardiograph that keep us from cluttering a physician's inbox, especially in the ED department's workflow. So the role of the ECG management system combined with the cardiograph or cardiology workstation, as we call it now, has totally changed. You can see on this screen that the clinician at the bedside is sorting through multiple ECGs. These are coming from the information management system to the cardiograph at the bedside for review. What's going to happen in the future and actually workflows that we're introducing today within the ECG management system is a physician not only being overwhelmed by the hundreds of normal ECGs coming in or ECGs they're used to. Now, if we're starting to apply AI algorithms, one in the next couple months, that is left ventricle ejection fraction coming from Onumana LVEF AI. This is going to expand forever, right? If we just look at some of these vendors pipelines for what they're going to produce, you're talking about a physician having to look at five, 10, 15, who knows how many AI interpretations from a single 12 lead in the future. We have to have a very smart workflow that doesn't overwhelm physicians, especially physicians that are all actually getting a little overwhelmed today just with the normal resting workflow, especially when they're reading for a large hospital system. Absolutely. So earlier we mentioned analytics. So often when we're chasing quality, we're chasing things that really aren't tactile, right? We're looking at potentially cultural problems within a single hospital's department. What do I mean by that? We can have a single hospital for some reason, every single EKG tech in that entire department takes subpar studies. Why? Quite frankly, they just have a culture that we don't care about ECG. How can you overcome that when that department manager is actually the person that's maybe just allowing that attitude to exist? If we can see from an analytics database, the quality using quality scoring built into our analytics environment for ECGs, exactly who is taking low quality ECGs and approach that through training and whatever you want to put in place, maybe mentoring programs in this case, we can help to improve the quality of an ECG from a different perspective, from hospital administrator, department manager out to the field. Absolutely. And this, I, for several years, supervised the pediatric stress in EKG lab. And this was one of my least favorite issues to have to deal with. My electrophysiologist would come to me and say, hey, look at these EKGs, they're terrible. Or I'd notice as I was going through reconciling orders that there's lead reversals in a lot of them. And so without the analytics behind it, what I would have to do is just go out to the nurses floors and ask them to let me talk to their staff and help explain to them why EKGs are important and how to take a proper EKG. Whereas now if I had a report that was sent to me that said this person consistently does this poorly, then I could go say, look, I have the data here to show you this person is doing this, not a very good job. Let me mentor them, let me train them or let me set them up with somebody who can do it better. So a cardiac workstation collects very high quality, unfiltered data that is comprehensive and is consistently happening throughout your organization on every single system, every single technician. And it goes into the ECG management system where the data can be consolidated and worked on by not only physicians, but hospital administrators to improve quality. So this is an environment that is specifically built, even the dashboards and our analytics system are built to improve quality and help our hospital directors give KPIs to their teams. Let's improve quality by 5% over the next two months across our entire team. Those kinds of things can be easily managed in our analytics environment, which is an Intellispace ECG. But it is definitely not just about devices and software. This is a people game. It's a culture game. It's very, very difficult. This is, we are managing technicians who may have had a really bad day that day or life is just not going well for them. They might not really have the attitude of wanting to be in this particular role and looking to move to different parts of their hospital. This is a very common theme that we hear, customer to customer. We work together. So you're not just looking at our devices. Our team, like Jesse, who's a clinical architect, so to speak, clinical application consultant, will come into your hospital. He needs to know your goals, where you want to go, what your current workflow is, and the more you share with us, the more we turn your workflow around and bring you into a brand new direction, leveraging totally new tools that are not yet available before the Philips Cardiac Workstation. Also, this helps us put processes in place. So nothing happens without a good process in place that's able to be tracked. So this is the entire foundation for improving ECG quality across your entire network. And the platform. It's not a Philips platform. It's a co-created platform with you based on what you're telling us is important to your hospital, what goals and milestones you want to achieve. Now, a lot of us want to achieve the milestone of let's adopt new technology, like AI algorithms coming in today. So we can work with you to set up integrations with third-party vendors, like Onumana, for example, or you can even work with us, with our own algorithms, and we can tune them to appear to your physicians exactly the way they want them to appear. So there are lots and lots of options inside of this solution, but we're here to work with you to tune you a new workflow that accomplishes new things that your departments have never accomplished before. So please, we ask you to think outside the box. Consider this as a very important study. The importance of the study is not even yet known because of what is coming in the future, and we can see that all around HRS today. AI is coming. It needs to be managed in a beautiful workflow. We need to be ready with it, with beautiful retrospective data, and let's go for it. So enjoy your afternoon, and thank you for attending our presentation. Thank you.

AI integration

ECG data

Philips Healthcare

ejection fraction

wireless modules

data management