The Computerized ECG: Friend and Foe

Computerized interpretation of the electrocardiogram (ECG) began in the 1950s when conversion of its analog signal to digital form became available. Since then, automatic computer interpretations of the ECG have become routine, even at the point of care, by the addition of interpretive algorithms to portable ECG carts. Now, more than 100 million computerized ECG interpretations are recorded yearly in the United States. These interpretations have contributed to medical care by reducing physician reading time and accurately interpreting most normal ECGs. But errors do occur. The computer cannot be held responsible for misinterpretations due to recording errors, such as muscle artifacts or lead reversal. But, in many abnormal ECGs, the computer makes its own errors-sometimes critical-in its incorrect detection of arrhythmias, pacemakers, and myocardial infarctions. These errors require that all computerized statements be over-read by trained physicians who have the advantage of clinical context, unavailable to the computer. Together, the computer and over-readers now provide the most accurate ECG interpretations available.