Electronic Decision Support in Diagnosis of Heart Disease

Cardio-vascular disease (CVD) is the leading cause of death and disability in New Zealand accounting for approximately 40% of deaths. Since 1999, government health strategy has included CVD as one of the top public health priorities. Early detection and intervention are important factors in the control of CVD. In New Zealand, evaluation of chest pain is the most common symptom for patients presenting to a cardiology service. Investigation of chest pain typically includes assessment by a specialist cardiologist and an Exercise Tolerance Test or ETT. Software enables the entire assessment and ETT to be delegated to suitably trained and experienced nursing staff, resulting in significant benefits to patients and reduced costs. This paper discusses how the need for the system was conceived, the results of the initial two-year pilot programme, and how further developments have been less successful than anticipated, largely due to organisational factors.