Abstract: A system and method for review and analysis of electrocardiograms includes an application server computer system in communication with a plurality of client computers. In a preferred embodiment, the server computer provides notification and access of a patient cardiac study report to an electrocardiograph technician for review and comment. The technician assigns an academic fellow electrophysiologist to review the study report. The server computer provides notification and access of the study report and the technician's annotation to the assigned fellow for review and comment. The fellow then assigns an attending physician to review the study report. The server computer provides notification and access of the study report and the previous annotations to the attending physician for review and comment. The physician completes the study. The computer system automatically generates and forwards a referral letter to the requesting physician and attends to billing for the cardiac monitoring services.