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1st Workshop: Bridging the Interoperability Gap in ECG Devices

10-12 October 2002, KNOSSOS Royal Village, Hersonissos, Greece

Preface

Papers provided in this proceedings were compiled for and presented at the first OpenECG workshop: "Bridging the interoperability gap in ECG devices" in Knossos Royal Village, Crete, Greece from October 10-12 2002. OpenECG is a project belonging to the Thematic Network subprogram of the Information Society Technologies (IST) program.
Electrocardiography is a major non-invasive test for detection of cardiac diseases. More than 100 Million ECGs are recorded every year within the European community. Computer-assisted analysis of electrocardiograms started almost 40 years ago. While during the past decades the development was focused on analysis algorithms to perform measurements and interpretation of ECGs, major efforts need now to be put on information integration for long-term storage, retrieval and interchange of ECG-data and on integration of this highly important health information into an electronic health record. Regional health care networks and the Internet are expected to revolutionize health care by promoting personal health management and enabling continuity of care. The mission of the OpenECG Thematic Network is to encourage and to promote the use of computerized electrocardiography standards.
Specific objectives of the OpenECG project are:
  1. Consolidate expertise and interoperability efforts providing best practice guidelines,
  2. Raise community awareness regarding computerized ECG standards and interoperability efforts,
  3. Assist manufacturers and system integrators in the correct implementation of the SCP-ECG standard,
  4. Provide feedback to standardization bodies regarding pitfalls in the existing standards,
  5. Prepare the ground for emerging standards for stress ECG, Holter and real time ECG monitoring.
"Bridging the interoperability gap" is the title of this workshop. From point of view of the OSI seven layer reference communications model the project will deal mainly with the application layer data representation and interchange format. However, because of the significant technological changes since the development of the first version of the SCP-ECG standard also the second part of SCP-ECG, which is the communication specification (proposing an enhanced X-modem protocol for interconnection between an ECG cart and a host or between ECG carts), will require the attention of this workshop and of the OpenECG project. New hardware interfaces, new tools and procedures are now available and should be taken into consideration for interchange of ECGs as well. Interoperability in a technical sense requires that data formats as well as data contents (the semantics of the messages) are "harmonized between sender and receiver". Interoperability in a practical sense, however, includes sometimes workflow aspects as well. For instance, a physician will not consider a device or a system "interoperable" if the system response to any query or action takes minutes or hours. This conference deals essentially with the technical aspects of interoperability.

The program is structured as follows.
Within the opening session the basic contributions introduce the attendees into the workshop objectives and two invited talks address the current status of digital electrocardiography and standardization of health informatics as a key to health-online in European and international collaboration.
The second session gives a more detailed description on the OpenECG project, on the Current Standards in digital electrocardiography and on how industry will be involved in the project via the Industry Advisory Board.
The third session is again a plenary session and addresses standardization for interoperability in medical devices with an introduction to the Universe of Medical Devices, with a report on Specific Experiences and Future Directions using the SCP standard and with an overview on the Present Standardization Activities in Medical Device Communication and Interoperability particularly within CEN. The fourth contribution of this session addresses the Role of Standardization for Interoperability in the Context of Interregional Health Care Networks.
After the three plenary sessions a first breakout session with three round tables on the Adoption of ECG standards provides a discussion forum for users, manufacturers and health care professionals. The discussions address the three following topics:
  1. Visions and expectations for health care: Standards for ECG devices.
  2. Current implementations and use of ECG standards.
  3. Driving forces and barriers for plug-compatibility in the market.
These three round tables are followed by a plenary Wrap up Report of this breakout session I.
The next plenary session is on "Interoperability in Practice" with four contributions: The Health Care network of Crete (a success story and a continuous effort); Interoperability in Home Care Applications; Interoperability: The manufacturers' View and finally Experience with the Electronic Patient Record and the Impact of using digital Electrocardiograms.
This plenary session is followed by a second breakout session on Bridging the Interoperability Gap. Again three sub-groups are formed for discussion on:
  1. Manufacturers' viewpoint: when, where and how?
  2. Health care professional view of interoperability.
  3. Integrators/engineering view of interoperability.
The session is again followed by a plenary Wrap up report of this breakout session II.
Attention is also paid to related R&D initiatives in Europe in the next plenary session. Its introduction addresses Intelligent Personal Health Monitoring: R&D Achievements and future Challenges. This contribution gives an overview of the various projects within the IST program. After the introduction six projects are described in more detail. This session intends to promote the interaction and communication between a specific project cluster of the IST program.
The third breakout session addresses the OpenECG Thematic Network. This session does return concretely to the OpenECG project itself and the discussion within the three groups is focused on:
  1. Layout of the OpenECG Internet Portal.
  2. Certification and Validation Services (for SCP-ECG implementations).
  3. Open source and Shareware tools.
The session is again followed by a plenary Wrap up report of this breakout session III.

The conference was attended by altogether fifty-two participants; among them there were representatives from the development laboratories of approx. ten companies.
Major conclusions of this workshop are:
  1. Almost all manufacturers do have knowledge about the SCP-ECG standard.
  2. The manufacturers are willing to reduce implementation options and to harmonize existing solutions.
  3. There is a strong need to rise public knowledge and awareness of the SCP-ECG standard.
  4. Further standardization activities are necessary to support the harmonization of standards for different application domains, e.g.:
From the responses of the participants the organizers have got the feeling that this conference was very successful because it established a better and closer communication between manufacturers, users and health care professionals, which is mandatory to reach the objectives of the OpenECG project.

Dipl. Ing. Chr. Zywietz
BIOSIGNA
Hannover, March 13, 2003

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