Where do you get ECGs interpreted?
Your options for reporting ECGs in private practice, why the machine’s report is not enough, and how to handle urgent findings.
The short answer
Either you interpret the ECG yourself, if you are competent to, or you send it to a reporting service run by cardiologists or cardiac physiologists, or to a colleague with the right expertise. Don’t rely on the machine’s computer-generated report: the professional body for cardiac scientists (SCST) says these can be inaccurate and should be checked by a clinician, who then becomes the author of the report. Whoever reports it, you remain responsible for acting on the result, so agree turnaround times and an urgent route before you record your first ECG.
Key points
- You can report ECGs yourself if you are competent, or use a cardiologist, cardiac physiologist or remote reporting service.
- The SCST says computer-generated reports may be inaccurate and should not be relied on alone. The clinician who signs one becomes its author.
- An urgent finding such as an unsuspected acute MI or complete heart block needs a phone call, not a report in a queue.
- In England, recording a 12-lead ECG does not by itself need CQC registration for diagnostic and screening procedures.
- Every ECG in the record should carry a report, and someone must act on it.
Your options
| Option | Suits | Points to check |
|---|---|---|
| Report it yourself | GPs confident in ECG interpretation, and routine resting ECGs | Your competence, a written report in the record, and audit of your reports |
| A colleague with expertise | Practices with a GP or nurse with a cardiology interest | Clear responsibility for the report and agreed turnaround |
| Private cardiologist | Complex or abnormal traces, and when you want advice as well as a report | Fees, turnaround and whether you can discuss the findings |
| Remote ECG reporting service | Practices recording ECGs regularly | Who reports (qualifications), turnaround, how urgent findings are phoned through, indemnity and data protection |
Many modern ECG machines can send the trace digitally to a reporting service, and the report comes back by portal or email. Ask to see a sample report before you sign up.
Questions to ask a reporting service
- Who reports the ECGs, and what are their qualifications?
- What are the routine and urgent turnaround times, and are they guaranteed?
- How and when will you phone me with an urgent finding?
- Does the report follow a recognised standard, such as the SCST reporting guidance?
- Can I discuss a report with the person who wrote it?
- Where is the data stored, and is there a data processing agreement?
- Is the service registered with the relevant regulator, and does it hold its own indemnity?
Why the machine’s report is not enough
The Society for Cardiological Science and Technology (SCST) publishes ECG reporting standards. On computer-generated reports it says research shows they may not be accurate, and authoritative bodies recommend they should not be relied on for clinical decisions. They can prompt you to consider something you had missed. But an ECG with a computer report should get the same scrutiny as one without, and the clinician who signs it becomes the author of the report. If the computer report is wrong or incomplete, amend or replace it.
The same applies to AI-based interpretation services. The CQC notes that if a provider does not independently review an AI supplier’s analysis, the supplier may itself be carrying on a regulated activity. Either way, you are responsible for what you do with the result.
Urgent findings
If a patient is unwell in front of you, treat them as an emergency and don’t wait for a report. For ECGs sent away, the SCST standards say that where a report shows something such as an unsuspected acute myocardial infarction or symptomatic complete heart block, the reporting clinician should make urgent contact with the person who requested it, and that urgent verbal communication takes priority over the written report.
So before using any service, agree:
- the phone number it will call with an urgent finding, and who answers it when you are not working
- what counts as urgent, and the expected turnaround for routine reports
- what the patient has been told about how and when they will hear
Regulation and scope
In England, the CQC’s scope guidance says you do not need to register for diagnostic and screening procedures just because you use a 12-lead ECG. Ambulatory monitoring and exercise testing are different. Ambulatory ECG is not in the CQC’s list of excluded tests, and treadmill tests for clinical purposes are not exempt, so check with the CQC before offering them. In Scotland, Wales and Northern Ireland, check with HIS, HIW or RQIA.
If you use a remote reporting service, ask about its own registration and whether it holds UKAS accreditation for physiological services (IQIPS).
Recording well
A report is only as good as the trace. Whoever records ECGs should be trained in electrode placement, patient preparation and recognising artefact. The SCST publishes a separate standard for recording a 12-lead ECG. Keep the machine serviced and calibrated.
Records and follow-up
The SCST recommends that every ECG filed in a patient’s record bears a report. File the trace and the report together, record who reported it, and record the action you took. Tell the patient the result as agreed, and share significant findings with their NHS GP with consent. See sending notes to the NHS GP.
Include reporting fees in your pricing. See charging separately for tests. For the equipment itself, see what equipment you need.
Keeping quality up
If you report your own ECGs, the SCST recommends regular audit, such as having a sample independently reviewed. It is a simple, useful piece of evidence for your appraisal and for CQC. See clinical audit.
Frequently asked questions
How long do reporting services take?
It varies by service and urgency. Ask each for its routine and urgent turnaround times in writing, and plan follow-up appointments around them.
Can I rely on a cardiology report without reading the ECG myself?
You can rely on a competent report, but you are still responsible for acting on it in the context of the patient in front of you.
Does my indemnity cover me for interpreting ECGs?
It is part of general practice, but tell your provider if ECGs, ambulatory monitoring or cardiac screening will be a significant part of your service.
Should I buy an ECG machine at all?
Only if your services need it often enough. If you rarely need one, referring for an ECG may be safer and cheaper.
