Accurate, real-time ECG diagnosis for remote clinics in India

M3 India Newsdesk May 26, 2019

In the Sunday Series today we get to you a popular article from the archives which throws light on a sophisticated technology that is helping with instant ECG diagnosis in real time and saving lives. where otherwise the average time between symptoms and treatment of heart attack is over 6 hours.

The World Health Organisation reports that heart attacks are the leading cause of disability and death in India accounting for 1.5 to 3 million deaths every year. The WHO estimates that 35% of these deaths occur in younger patients. In India the average time it takes a patient with ongoing heart attack to get treated is 360 minutes, far cry from the golden hour of 60 minutes, resulting in higher mortality. 

Dr. Charit Bhograj, Cardiologist and founder of Tricog, says that almost 50 per cent of people with massive heart attacks do not reach the hospital on time and 79 per cent clinics do not have ECG machines in India. Tricog, founded in 2015, uses artificial intelligence and medical expertise to diagnose ECGs in real time. 

In 2009, after coming across a critical patient, he realised that the access to diagnostic care in the case of heart attacks determine your survival. It was also necessary for the diagnosis to be done quickly so that more lives could be saved. Once a heart attack is diagnosed quickly, it can be contained through simple and cheap medications like a Streptokinase injection which is available free of cost in a government hospital, he said.

What is the technology?

The Tricog is a small hardware, a communication device, is attached to a MAC 600 ECG machine by General Electric. The company provides both ECG machine and Tricog communicator to the doctors/clincs once they opt for the service . The ECG recorded by the machine is transferred via 2G/3G/4G or Wifi connectivity to cloud using the Tricog communicators. The advanced algorithms based on artificial intelligence do the initial analysis of the ECG and provide immediate diagnosis in about 5 to 6 mins. These algorithms get better as more ECGs are recorded in the system. 

All their diagnosis is sent to respective teams in the hospital via SMS, Email and diagnosis on the Tricog App. As a secondary check, the 24x7 medical team headed by a Cardiologist and consisting of doctors with a Post Graduate Diploma in Community Cardiology (PGDCC), is available at the Medical Hub in Bangalore. 

These doctors analyse the ECG and provide immediate diagnosis, the whole process taking about 10 minutes. In case of critical ECG's,Tricog’s medical team informs the Hospital or the Clinics about the ECG diagnosis via a call. 

Dr. Sudha speaks about ways in which she deals with them. Firstly, on the basis of the diagnosis, the medical team at Tricog speaks to the doctor on ground to administer medication that can suppress the heart attack. Secondly, they use the ‘Hub and Spoke’ model where they alert about the critical cases reported from a nursing centre or health centres to a referral hospital that can treat the patient efficiently.

However, Dr. Sudha also mentions some limitations that they face. Since, they are not present at the location of the treatment, they need to be careful about what they can recommend as doctors. 

Is there any feasibility?

Any medical institution can avail the service by paying Rs. 6000 per month for a package which consists of about 100 ECG reports. Anything beyond the 100 ECGs would cost somewhere about Rs. 50 per ECG. The package is inclusive of the ECG machine provided along with the Tricog communicators which are FDA approved. 

How clinics can use of this technology

Doctors who are using this technology think that it saves time, is cheap, and adds value and accuracy in diagnosing patients. Dr. Anil Shah, Physician and Cardiologist, has been using Tricog since its launch in 2015 for a faster diagnosis of his patient’s ECGs. He believes that the time lost in diagnosis can put a person’s life at stake. The Tricog technology is also helping him manage patients when there is a rush in the clinic, he says.

For Dr. S. N Patil and Dr. Praveen Hollannavar, the real time diagnosis and the machine being portable are big positives. “The fact that this machine can be carried to the patient’s bedside is a plus point. Since, all of us get the ECG diagnosis reports on email, it is also helpful for us doctors to consult with each other,” he said.  

Dr. Sudha Ram Mohan, Anaesthetist and the Medical Operations Director at Tricog, says that they work on 3000 ECGs a day and out of these at least 110 to 120 are critical cases. Currently, Tricog has its installations across 1800 hospitals, clinics and diagnostic centres. Over the last 4 years, they claim to have diagnosed over 1.5 million ECGs, 50,000 plus critical cases and established their presence in over 12 countries.

But, it’s not everywhere that doctors can easily adopt this technology without being shown how to, especially in village clinic and hospitals. To tackle this, the service technicians visit and explain the doctors, nurses and other staff on how to operate the technology.

Dr. Bhograj claims that almost 1% of all cardiac diagnosis in India is by Tricog. They are also planning to expand by introducing new features like Echocardiography, Holter Cardiography, Treadmill Test among others. He hopes that despite having roughly about 4000 Cardiologists in India, the disease can be effectively managed. “We help doctors, we don’t want to replace them,” he says.


This article was originally published on 11.03.19.

This story is contributed by Angarika Gogoi, a Bengaluru-based freelance writer and a member of, a pan-India network of grassroots reporters.

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