P.J. Lees

Continuous ECG monitoring in the management of pre-hospital health emergencies

For the last five years, a system for the management and coordination of pre-hospital health emergency has been in regular use at the Emergency Coordination Centre of Heraklion, as part of HYGEIAnet, the Regional Health Information Network of Crete. Approximately 20,000 emergency episodes per year are currently being logged in the system. The need for better support of cardiac cases (about 20% of the total) prompted the extension of the system to include the continuous acquisition of 12-lead ECGs and their real-time transmission to the coordination centre for evaluation by an expert. The 12-lead ECG module has been developed and integrated in the existing system with special attention to the provision of an easy user interface so that the extra work required to the ambulance personnel is negligible. The overall system has been carefully tested and is now in daily use.

Open ECG: A European project to promote the SCP-ECG standard, a further step towards interoperability in electrocardiography

Integrating the numerous available ECG devices to the citizens electronic health record is a major challenge for the users of ECG interoperability standards, since most ECG devices implement protocols and file formats in ways that hinder the open interchange of ECGs and hamper ECG analysis, processing, and serial comparison. The mission of the OpenECG portal is to foster the consistent implementation of interoperability standards in computerized electrocardiography. A help desk and a planned on-line validation and conformance testing service for the SCP-ECG standard assist manufacturers requesting feedback on their implementations. Additionally, tutorials, visualization tools, converters, and annotated ECG samples are expected to provide the framework for the systematic diffusion of standards in the everyday practice and pave the way towards interoperability in all ECG examinations.

Developing manufacturer-independent components for ECG viewing and for data exchange with ECG devices: can the SCP-ECG standard help?

In the context of HYGEIAnet, the regional health-telematics network of Crete, the Center for Medical Informatics and Health Telematics Applications (CMI-HTA) has explored the capabilities of several ECG devices and management systems. The focus was placed on the SCP-ECG (Standard Communications Protocol for computer-assisted Electrocardiography) standard, which defines a uniform format for the processing and storage of digital ECG recordings and specifies a means by which ECG devices and systems may exchange information. The development of a multi-manufacturer ECG viewer took more effort than expected. Although the SCP-ECG guidelines are sound and useful as far as they go, the protocol leaves too many degrees of freedom in a number of areas, so that the development of generic SCP-based software is, in practice, a difficult task. Moreover, the manufacturers degree of compliance with the SCP standard may be unclear, while there is no recognized body or institution that is able to certify the level of conformance.

Integrated teleconsultation services in cardiology

Integrated regional networks provide an infrastructure for the deployment of accountable, accessible and secure teleconsultation services. In addition, the use of clinical protocols, combined with the automated retrieval of relevant health data, can improve the effectiveness and efficiency of teleconsultation sessions. In the context of HYGEIAnet, the regional health telematics network of Crete, integrated teleconsultation services based on clinical protocols are being developed to support the remote screening of patients with suspected heart problems, aiming not only to benefit the patient but also to contribute to the optimum use of health care resources.

ECG in your hands: a multi-vendor ECG viewer for personal digital assistants

In the context of HYGEIAnet, the regional health network of Crete, numerous information systems have been developed to support the management of patient related data. In all these systems the digital acquisition and storage of clinical examinations and various vital signs play a major role in the provision of continuity of care to each patient in the region through the integrated electronic health record (IEHR). In such environment, personal digital assistants (PDAs) can be of great value to doctors on the move. The long-term goal is to extend the access to e-Health and m-Health services and to the citizens multimedia IEHR through the use of such devices. PDAs have already been used worldwide for the display and editing of textual information, while their graphic capabilities are also continuously improving. The development of new software components for the display of specific multimedia clinical information on PDAs should speed up our long-term goal. As a first step, a multi-vendor ECG viewer for PDAs has been developed and successfully evaluated by cardiologists and general practitioners.

Preliminary results from the deployment of integrated teleconsultation services in rural Crete

Teleconsultation services for cardiology patients have been installed and have been in routine use since December 2000, connecting a primary health centre in rural Crete to a regional hospital. Since efficiency and effectiveness are key factors in the acceptance of the service, integration of the services with the primary health record, support of clinical protocols and guidelines, and continuous evaluation of the services are primary foci of the overall effort. This paper discusses our evaluation approach and presents preliminary results from the utilization of the service between December 2000 and June 2001. The presented results are encouraging, suggesting that the wide deployment of the service will benefit not only the patients but also the GPs, the cardiologists and the health care system.

Remote access to medical records via the Internet: feasibility, security and multilingual considerations

This paper investigates the use of Internet technology to provide secure multilingual access to the medical records of a cardiology clinic. Information extracted from the medical record archive is used to create mini-Webs of interlinked pages that may be viewed using a standard browser. The main features of the reported project are its multilingual nature-of particular significance in Europe, the provision of strict secure measures, and the support of usage profiles. Medical data may be viewed either in Greek-the language in which the data are stored-or in English, through an automated translation process. Security measures are as follows: (1) a password is required for access; (2) all transactions are logged (3) the patients name and medical data are never transmitted together; (4) mini-Webs are deleted when the transaction is complete, (5) the remote user never has direct access to the central database.

Support of daily ECG procedures in a cardiology department via the Integration of an existing clinical database and a commercial ECG management system

Background: In the context of HYGEIAnet, the regional health telematics network of Crete, a clinical cardiology database (CARDIS) has been installed in several hospitals. The large number of resting ECGs recorded daily made it a priority to have computerized support for the entire ECG procedure.

A year in the life of the OpenECG network

The OpenECG network formed in 2002, is a European initiative with global reach, which aims to lower the barriers for ECG interoperability and make digital ECGs available as part of the integrated electronic health record. Currently, SCP-ECG, the European standard for ECG record communication and storage, has been implemented by some manufacturers. However, these implementations are not consistent with each other, hindering ECG exchange, processing, and serial analysis. Furthermore, the presence of alternative ECG storage formats, proprietary or open, raises issues of harmonization and quality assurance. In the first year of its life, the OpenECG network numbers 105 committed members, while its portal and associated help desk have already provided valuable information and development support to several manufacturers and integrators. Recently, the OpenECG certification service has become available to members who may submit their ECG records for interoperability validation and SCP-ECG conformance testing. Still, only the first step for the OpenECG network has been taken. Future plans involve contributing to the definition of integration profiles for ECG-related examinations and addressing issues related to quality assurance of eHealth services in general.

Simulator of patient traffic in a cardiology department for testing the integration of an ECG management system with an existing clinical database

In the context of HYGEIAnet, the regional health network of Crete, a clinical cardiology database called CARDIS (CARDiology Information system) was installed in several hospitals. To fill the need for a computerized ECG management system, a collaboration was organized between ICS-FORTH and Mortara Instrument Inc., aimed at integrating the Mortara E-Scribe/NT software with CARDIS. In order to test the combined system before installation, a computer program was developed to simulate patient traffic in a cardiology department. The program was run for three simulated months, and a total of around 2,000 ECG recordings were archived for access from CARDIS. During the testing period, a number of software problems were identified and corrected. The same approach could be used for testing other database components, with a view to precluding the loss of real clinical data as a result of software malfunction.