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 3: Driving forces and barriers for plug-compatibility in the market.

Reporters: A. de Guili, I & Ricardo Ruiz-Fernandez, E

Objectives of the breakout sessions

Identify the driving forces and barriers to the adoption of interoperability standards for ECG from the viewpoint of Manufacturers, Cardiologists, Pharmaceuticals, Insurance IT specialists

Participants

Aldo De Giuli, I
Magda Costi, I
Aurelia Sargentini, I
Sophia Zhou, US
Dimitris Fotiadis, GR
Nikos Maglaveras, GR
Michael Breuss, A
Thomas Norgall, DE
Catherine Chronaki, GR
Paul Rubel, F
Franco Chiarugi, GR
Rod Cooper, UK

Overview

First a presentation by the moderator, with the following ideas for later brainstorming

Presentation by the moderator

Summary of SCP-ECG

• Addresses cardiovascular diseases (35%morbidity and mortality)
• More than 100 M ECGs are recorded annually in the EC
• SCP standard is being transferred to ISO for worldwide standardisation

Point of view of:

1. Manufacturers, System Integrators, IT specialists?
   • Is there an economical benefit?
   • Is there an increase of market penetration?
   • Does it bring about a clear benefit in user satisfaction?
   • What is the concurrence doing?
   • What are the expectations for the future?
   • What norms are there? What is the status?
   • What requirements are stated in the latest tenders?
   • What makes a company make a move in the direction of using a norm such as SCP?
   • How can I be sure that an implementation is really in accordance to the norm?
   
   
2. Cardiologists

   ...Daily Practice: Can it be improved?

   • ECG record, associated to a patient session
   • Identification of patient to session data
   • 100 millions ECG annually captured (how many recorded)?
   • Security and privacy issues, are they fulfilled?
   • How can the SCP standard help on this?
   • What is the cost of equipment?
   
   
3. Pharmaceuticals
   • Are there any benefits from a greater recording of ECG data?
   • Better evaluation of care plans defined?
   • Achieve same medical results with optimised therapy?
   • Higher customer satisfaction?
   • None of the above?
   
   
4. Health Care Insurance Companies
   • Better surveillance of insured patients?
   • Can new services be offered to clients?
   • Improved patient satisfaction?
   
   
5. System Integrators

   Consolidated standards, security in medical data transmission, storage?

   • The end user (cardiologist & patient): Information distribution.
   • Manufacturers: Standard versus Proprietary solutions
   • Health Care and Insurance Managers:
   • Standards for setting up large solutions
   • Cost of adopting standards
   • Regional strategy
   
   

Perspective on Barriers

• More concurrence, lower margins
• There is no demand for it now
• There is a cost to adapt devices to the norm
• H/S development costs
• Modifications in H/S require new certification for CE mark

Are there any driving forces in the use of the norm?

• More demand and flexibility as a result of data interoperability?
• As MD manufacturer, more 'integrators' can be clients
• As Integrator, more MDs from which to choose
• If we will do it anyway, better start now?:
• OpenECG can provide support to make implementation easier and with lower investment?

Brainstorming

The discussion started with a Roll-Call for introduction, followed by comments made by the following attendants (from manufacturers, health institutions, and research (med-tech dpt.)

De Giuli:

Do we accept the norm? Market will accept less and less the proprietary solutions. Trend is to ask for interoperability; technology solutions have changed the emphasis, and now we find real value on semantic and data models.

Nicolas:

Sophia:

Thomas:

Paul:

Depending on scenarios, we can find cart to cart, cart to host, and the manufacturers must be compliant to avoid implementation differences. Doctors are used to interpreting ECG through image at a rate between 50 mm/sec or 25 mm/sec; SCP format is not easy to understand by cardiologist, who may not be aware (or interested) in the potential to perform serial analysis. Patients now get the ECG record in paper. What will they receive now? ... an electronic record?

[Driving Forces] SCP was not initially pushed to GPs and Cardiologists.

Franco

Multimedia EHCR is important. Cart to Host is mandatory to have MD plug & play. There may be problems related to particular scenarios with faulty interpretation of data.

Thomas

Plug and Play solves every problem from a user perspective.

Dimitris

Think of users. Why companies have not invested? If they do not use a standard, there is no need for it. He can get a holter instead (traditional cassette). A standard for ECG only is not enough. Also new communication platforms should be considered such as blue-tooth.

Nicolas

SCP can become a big player for interoperability.

Aurelia

It is a matter of culture. User will ask the manufacturer to have the standard it in place in the MD. We need to push the user to do it.

Thomas

Users must have the information. Then manufacturers will offer the product if the norm is demand it.

Sophia

Every year between 100 and 200 mm ECGs are collected. How many of those are stored? Very few (10%). So we need to cover the whole circle, not only the MD. How can a manufacturer make a product a success? How can it make attractive to the user? For companies, this is all about the big unknowns, business management is a science, how to link demand with supply ... . So if there is no SCP awareness, there is no demand.

Conclusions

There were no arguments against SCP -driving force-, but proper norm implementation is a barrier. Further barriers are the gap between supply and demand, and the cultural issue. Profiles for each application should consider the differences on ECG requirements between cardiology and telemedicine, e.g. doctors still interpret through images.