1st Workshop: Bridging the Interoperability Gap in ECG Devices 10-12 October 2002, KNOSSOS Royal Village, Hersonissos, Greece

Breakout Session I: Adoption of ECG Standards

Chairmen: G. van Herpen, Erasmus University & Prof. P.W. Macfarlane, UK

WG Table 1: Visions and Expectations for healthcare: standards for ECG devices

Reporters: P.J. Lees, GR & J. Fayn, F

Participants

A. Strataki (Quality Engineer, ICS-FORTH)
N. Stathiakis (Computer Engineer, ICS-FORTH)
A. Lymberis (Scientific Officer, IST Program, European Commission)
V. Rizzo (industry representative)
M. Bruun-Rasmussen (OpenECG consortium)
Dr. G. van Herpen (cardiologist)
Dr. T. Pinborg (cardiologist)
Dr. P. Giovas (cardiologist)
H. Oelmaier (industry representative)
A. Macerata (OpenECG consortium)

Purpose

The purpose of this session was to identify user needs now and in the future.

Topics

1. What advantages does a digital ECG offer compared with a paper print out?
   • Under what circumstances might it be necessary to send an ECG recording from one place to another?
   • You are an experienced cardiologist. Another physician wants to send you some ECG information from a patient to get advice. What relevant information do you need before you can advise? In other words, what are your requirements (means, quality assurance, data content) in order to be able to interpret the ECG tracing as if it was recorded in your own department, enabling you to access the same facilities (information content and tools) as those which you normally use for decision making in clinical practice?
   • Are digital ECGs really more accessible than traditional paper prints? - where, when and how?
   • Any other advantages (ease of use, durability, reliability).
   
   
2. Is there a real need for storage of all acquired ECGs?
   • In what clinical circumstances is it useful to have access to previous ECG recordings?
   • Is there such a thing as an ECG recording that contains no useful information?
   • Does the context make a difference - e.g. primary health care centre, hospital, emergency point of call?
   
   
3. Which is the right standard for the exchange of ECGs among healthcare organizations (e.g. PDF, JPEG, XML, SCP, DICOM)?
   • What do you know about existing standards for digital ECG recordings?
   • Should ECGs be treated in the same way as medical images (e.g. ultrasound, coronary angiograms, X-rays)? If not, why not? What is the difference?
   • What should be included in a 'standard' digital ECG (raw ECG data, demographic data, computer diagnosis)?
   • Who should be allowed to edit these data? How, when and where
   
   
4. You are a manufacturer. What is your most important concern for the future?
   • to produce large series of the same device compliant with international standards, depending on new technologies for the product's evolution
   • to produce frequently updated versions in a closed market with a limited distribution at high cost?
   
   
5. What is the best working practice for electrocardiography you are aware of?
   • How consistent should the recording and archiving of ECGs be?
   • What are the most important security aspects (risks vs. benefits)?
   
   
6. What is the role of computerized ECGs in epidemiological studies and health monitoring of the population?
   • You are a user of ECG services with no particular interest in the field of electrocardiology. What kind of ECG services facilities are you expecting (health/medical benefit, cost, efficiency, technology)?
   • In the near future, the initiator of the ECG expertise request could be the patient/citizen himself. In that case, do the user requirements expressed above remain the same? What are the possible changes?
   
   
7. What can we learn from the results of standardisation in other areas (e.g. computers and peripherals)?
   • PC compatible computers
   • printers

Conclusions

Owing to changes in the Workshop programme, the time allotted was insufficient to cover all the planned topics.

After each participant had introduced him/herself, a guided discussion commenced, starting with the point of view of the cardiologist and covering ECG settings ranging from first point of care, through general practice to hospital clinical and research applications. The following conclusions emerged:

1. First point of care. Digital ECGs have an increasingly important role to play in prompt diagnosis and instigation of pre-hospital patient management, via remote consultation with transmission of ECG data.
2. Remote consultation is also of value at the level of general practice for the screening of possible cardiac patients.
3. For the cardiologist, digital ECGs comprise a valuable part of a clinical medical archive. They also facilitate measurements on the ECG tracing and the classification of data for research purposes.
4. At the hospital level, receipt of ECG data while the patient is still on route, allows early preparation for patient admission, thus contributing to efficient resource management.
5. There is a need for bidirectional communication between ECG devices and Hospital Information Systems and for an easy-to-use and powerful ECG viewer for a quick display of ECGs to interpret.
6. Most, if not all, of the above factors require the standardisation of digital ECG recording and transmission, in order to achieve data homogeneity and to facilitate the exchange of information between different sites.