Can You Add an ECG Image to Medical Records?
Yes, absolutely—a standard 12-lead ECG that has been interpreted by a qualified physician must be made part of the patient's medical record. 1
Documentation Requirements
The ACC/AHA defines an electrocardiogram as "a standard 12-lead ECG, with or without a rhythm strip or other special leads, that has been interpreted by a physician qualified to interpret ECGs and that has been made part of the patient's medical record." 1
Critical Documentation Standards
- Computer interpretation alone is insufficient—an ECG interpreted solely by computer is not recognized as a properly interpreted ECG and should not be the final documentation in the medical record 1
- Physician interpretation is mandatory—a qualified physician must review and interpret the ECG before it becomes part of the official medical record 1, 2
- Clinical context must accompany the ECG—the interpretation should include relevant patient information, symptoms, and clinical findings 2, 3
When ECGs Should Be Added to Records
Class I Indications (Must Be Documented)
- Acute presentations: Chest pain, syncope, dizziness, palpitations, or dyspnea require immediate ECG documentation 1, 2
- Serial ECGs during acute events: Patients with evolving myocardial infarction, unstable angina, or acute arrhythmias need multiple ECGs documented until stable 1, 2
- Post-procedure documentation: After coronary angioplasty, pacemaker insertion, or cardiac surgery, ECGs must be recorded and added to the chart 1, 2
- Medication monitoring: Before and during therapy with cardioactive drugs (antiarrhythmics, chemotherapy agents like doxorubicin, psychotropic medications), ECGs should be documented 1, 4, 2
- Preoperative evaluation: All patients over 40 years old or those with known cardiovascular disease undergoing surgery require preoperative ECG documentation 4, 2
Common Pitfalls to Avoid
- Never rely solely on computer interpretation—always ensure physician over-read is documented 1, 2
- Always compare with previous ECGs when available—failing to do so may result in misinterpreting chronic findings as acute changes 4
- Document serial ECGs when initial findings are equivocal—approximately 5% of patients with normal initial ECGs ultimately have acute MI or unstable angina 2
- Include clinical correlation—ECG interpretation without clinical context can lead to diagnostic errors 2, 3
Practical Implementation
The ECG image itself, along with the physician's interpretation, should be permanently integrated into the patient's medical record system. 1 This ensures: