Models for optimization of telecardiology services

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Models for optimization of telecardiology services
A.Kastania, S. Demarias, G. Loudos, E. Magos, J.
Dimakopoulos, M. Paavonen, C. Davos,
C. Boudoulas, S. Kossida Foundation for
Biomedical Research of the Academy of
Athens Bioinformatics Group Soranou Efesiou 4,
11527Athens, Greece
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• A telecardiology service includes
• (i)real time transmission of electrocardiograms,
• (ii)transmission of cardiac images and patient
  data to provide help at distance from a
  specialized cardiologist in diagnosis and therapy
  of cardiac diseases
• (iii)provision of distance help in the therapy of
  patients who have emergency cardiac diseases
• (iv)information to the cardiologists who make the
  referral for the results of the tests
• (v)distant control and security of the biomedical
  devices

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• Tele-electrocardiography
• Tele-electrocardiography extends the
  capabilities of the acquisition machines of the
  electrocardiograms (ECG) to allow real-time
  transmission of electrocardiograms (ECGs) of a
  patient using a network to an expert
  cardiologist. At the expert cardiologist location
  two different policies can be applied for the
  normal cases patient data can be automatically
  stored and for the abnormal cases patient data
  can be forwarded to a distant expert
  cardiological centre.

Electrocardiogram (ECG) transmission Communication
mode is real time. Patient vital data are
transmitted. Transmission rate varies from 9.6 to
384 kbps. Typical networking architectures may be
PSTN, GSM, ISDN or satellite. Equipment
requirements include PC/modem, flatbed scanner,
document camera and ECG device, or mobile phone
and ECG device.
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• Tele-echocardiography
• Echocardiography is a precious diagnostic tool
  for cardiologists to determine problems of the
  valves of heart. The echocardiograms can be
  digitised at local places, transmitted for
  evaluation in a distant medical centre or
  hospital and stored using DICOM format in optical
  disks. Digital networks can be combined with
  portable devices, which can be used as extensions
  in the stethoscopes in order to transmit heart
  sounds.

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• Cardiac arrhythmias detection
• The existing techniques used to detect cardiac
  arrhythmias are Holter, Rtest and telemetry. Real
  time monitoring and control of cardiac
  arrhythmias is feasible via provision of distant
  control services using ECG sensors.
• When a cardiac arrhythmia is detected a message
  including the ECG signal and the related medical
  images of the patient (in the interior only) is
  send to the distant monitoring server.
• The local system has a wireless sensor ECG and a
  local computer. The distant system has a central
  computer and a distant telemonitoring system (for
  diagnosis and image presentation).

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• Telecardiology using sensors

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• Mobile telemedicine units

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• The telecardiology systems can be classified by
  telephase and teleservice. The first
  indicates the medical moment the system is
  devoted to (e.g. prevention, diagnosis, therapy,
  treatment) and the second refers to the offered
  healthcare service (e.g. teleconsulting,
  telemonitoring, telereferral).

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• In recent years, several telecardiology
  applications have been successfully implemented
  over wired communication technologies like POTS,
  and ISDN. However, nowadays, modern wireless
  telecommunication means like the GSM and GPRS and
  the UMTS mobile telephony standards, as well as
  satellite communications, allow the operation of
  wireless telemedicine systems freeing the medical
  personnel and/or the subject monitored bounded to
  fixed locations.

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• Telecardiology platforms synthesis
• Some medical devices allow extraction of an
  initial diagnosis for the electrocardiography
  signal that is stored within them, with various
  different interpretations and before its
  transmission to the distant expert. The various
  different users can use heterogeneous computing
  platforms via the DCOM model which provides the
  mechanisms for interoperability in computing
  environments with different operating systems,
  programming languages and network protocols.

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• Standards to design a telecardiology model
• A number of standards' solutions may be
  applicable on cardiologic biomedical devices.
  European standardization efforts in computer
  electrocardiography resulted to IEC
  60601-2-51/AAMIEC 11 for safety and performance
  requirements and to the SCP-ECG, the Standard
  Communication Protocol for Computerized
  electrocardiography (CEN ENV 1064 AAMI EC71) used
  for the digital storage and transmission of ECG
  data.

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• Standards to design a telecardiology model
• The SCP-ECG is a rigorous standard that
  assures the complete information management. On
  the other hand, DICOM is a standard which allows
  to manage satisfactory all the types of
  cardiologic exams, in particular for
  echocardiography DICOM image is used for ECG and
  Holter the DICOM waveform is a possible selection
  and for pressure holter the DICOM SR (Structure
  Reported Documents) is a solution.

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• Standards to design a telecardiology model
• The IEEE 1073 is a standard for medical device
  communications that defines the entire seven
  layer communications requirements for the
  "Medical Information Bus" (MIB). The IEEE/MIB
  standards attempt to standardize physiological
  patient data and the HL-7 message protocol
  attempts to create a data interchange standard
  for the most common medical information managed
  by a hospital information system.

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?.?. Kastania, Telemedicine models for primary
care.Stud Health Technol Inform. 200410489-98.
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?.?. Kastania, Telemedicine models for primary
care.Stud Health Technol Inform. 200410489-98.
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?.?. Kastania, Telemedicine models for primary
care.Stud Health Technol Inform. 200410489-98.
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• Optimization of a telecardiology service
  incorporates quality and reliability assurance of
  telemetry. A telecardiology information system
  must guarantee the Quality of Services and the
  capability to collect and evaluate the results of
  telecare.

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• Drawing from a widely cited 1990 IOM report, the
  committee agreed that
• Quality of Care
• is "the degree to which health care services for
  individuals and populations increase the
  likelihood of desired health outcomes and are
  consistent with current professional knowledge"
  (IOM 1990c, p. 21)

TO BE MEASURED VIA QUESTIONNAIRES DESIGN
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IN ADAPTATION PROCESS
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IS QUALITY GOOD ENOUGH?
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• The steps for measuring software reliability are
  defined by the IEEE/ANSI Standard 982.2.
• Software reliability can mean different things to
  different people in different situations.
• Code must be reliable from the surprisingly
  divergent viewpoints of software developers,
  testers and users.

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• Extended study, evaluation and implementation of
  the previously mentioned models and standards is
  carried out in the Foundation for Biomedical
  Research, Academy of Athens in collaboration with
  Intracom and Netsmart in the framework of the
  Project e-Hrofilos a strategy for improvement
  of quality and reliability of Telecardiology
  funded by the Regional Operational Program in
  Attica from National and European Union
  Resources.

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Models for optimization of telecardiology services
A.Kastania, S. Demarias, G. Loudos, E. Magos, J.
Dimakopoulos, M. Paavonen, C. Davos,
C. Boudoulas, S. Kossida Foundation for
Biomedical Research of the Academy of
Athens Bioinformatics Group Soranou Efesiou 4,
11527Athens, Greece