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

Breakout Session II: Bridging the Interoperability Gap

Chairman: JJ Schmidt, CH

WG Table 3: Integrator / Engineering View of Interoperability

Reporters: Alberto Macerata, I & Rod Cooper, UK

Topics for discussion

• Are there any problems in exchanging data? If yes, how could they be solved.
• What experience do you have in exchanging data?

Participants

Prof. P. Rubel, INSERM, Lyon, F
F. Chiarugi, FORTH, GR
M. Tsiknakis, FORTH, GR
M. Breus, Tapuz Medical Technology, A
Prof. N. Maglaveras, Aristotle University Thessaloniki, GR
P. Lees, FORTH, GR
J. Wagner, Meditech Ltd, H
Prof. D. Fotiadis, University of Ioanina, GR
Prof. A. Sargentini, Istituto Superiore di Sanita, I
E. Leisch, FORTH, GR
R. Fischer, Medicin Hochschule Hanover, DE
R. Ruiz Fernandez, RGB Medical Devices, E
R. Cooper, Tunstall Telemedicina, UK
Prof. A. Macerata, IFC-CNR, I

Body of Meeting

The main issue in exchanging data is the improper interpretation of SCP-ECG. Bi-directional exchange of data is missing, and the download of ECG Worklist is not described. However, several of the manufacturers in the workshop had implemented the standard and did not consider that there were great problems in doing so.

So why are so few manufacturers attempting to implement the standard? 80% of manufacturers were involved in developing SCP-ECG but have not taken it up.

Comparative tests have only been performed once by Italian Notified Body.

Is there a clinical requirement or a technical requirement for cart to cart communication?

It was initially considered that the clinical requirement was to be able to disconnect one manufacturers product and replace it with another and the system will still operate. However, when the idea of equipment 'drivers' was mooted it was considered acceptable to be able to select the equipment from a list and a software driver is loaded allowing the unit to communicate with the system. Manufacturers considered that this might give a large software overhead on Hospital Information Systems, similar to that caused by the hundreds of different drivers on Windows 2000. It was also recognised that the vast majority of ECG equipment is held in practices rather than in hospitals. Redundant data entry is to be avoided, preferably by integration at user interface level.

It was considered that making a proprietary driver public is only partially sufficient, the manufacturer also needs to provide a viewer in open source.

Concerns that having interoperability would lose competitive advantage were considered invalid. Competition is achieved by equipment functionality rather than communication protocol.

OEM concerns were that there was too high an overhead associated with implementing SCP-ECG when transmitting telemedicine data over GSM modem (9600 Baud) in real time. In this instance transmission is in a proprietary protocol and converted to SCP-ECG at integration.

Small companies are interested in interoperability so that product can be brought to market quicker.

End users tend to have their favourite equipment, this is not driven by standards.

Doctors practice equipment requirements are cost dependent.

Buyers need interoperability to allow easy Hospital Information System integration.

RGB have no experience with SCP but with VITAL and have exchanged a great deal of information between GP's and hospitals in this format.

Summary

How can manufacturers be convinced to implement interoperability?

• It will not come from physicians as they are only interested in the raw data and do not mind how it is arrived at.
• It will not come from within the industry as it costs money to provide it with no obvious return on investment.
• The fund holders are the only area where pressure can be brought to bear on the manufacturers. Hospital Managers need a fully integrated system, and look to regional government and fundholders influenced by their IT departments to give a decision.
• Medium and Large Enterprise' marketing departments need to evaluate the potential benefits and apply pressure to these fundholders to insist on interoperable equipment.
• Pressure is needed from the low end of the market to produce interoperable and flexible products.