The Computerized ECG: Friend and Foe
The following article has been published in the American Journal of Medicine.

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.

The physician reader and the computer see the ECG differently, with advantages and disadvantages for each. The computer makes routine measurements accurately and quickly, thus saving physician readers’ time. It does not tire or fatigue after a long day, it is not distracted by outside pressures, and its performance continues to improve over time.

The computerized interpretation available with the ECG itself may have influence in clinical decision making. However, the computer does have difficulty separating small waves from artifacts, difficulty in making distinctions between similar ECG findings in different diseases, and difficulty in dealing with the myriad other combinations that clinical ECGs may present. Importantly, it also lacks clinical context available only to the reader. These limitations lead to computer interpretation errors that require over-reading and correction.

But, the computer and reader complement each other and together provide for the most accurate ECG interpretations. Both appear here to stay.

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