Resumen de Telemedicine frameworks in cardiology environments: contributions to follow-up services in specific scenarios and the integration and harmonization of interoperability and cardiology standards
Telemedicine (or eHealth) can be defined as the use of new Information and Communication Technologies (ICT) as tools for enhancing health care delivery. These eHealth services can be applied in several different areas of daily medical practice. As cardiovascular diseases (CVDs) are the leading cause of death in industrialized countries, there is a clear need to undertake projects to improve the quality of life in chronic cardiac patients. Monitoring of cardiovascular-related signs - such as blood pressure, pulse rate, temperature, weight, blood glucose, oxygen saturation, or electrocardiogram (ECG) - is the most common procedure for evaluating and stratifying patients at risk of CVD. Traditionally, the follow-up of the aforementioned signs was provided at the clinic. However, the innovative, patient-centered healthcare paradigm has led to novel remote follow-up services.
Such follow-up services to telemonitor the vital signs of cardiac patients can be developed for different scenarios. Two such scenarios include the study of Heart Rate Variability (HRV) during hemodialysis and PaceMaker (PM) therapies. Regarding the former, previous works point out the relationship between hemodialysis and HRV, which may have prognostic value in hemodialysis patients identifying an increased risk of sudden death. Lengthy duration of dialysis sessions - on average four hours - makes it very suitable for remote follow-up by means of remote processing servers. Regarding the latter, existing PM follow-up procedures for pacemakers - in-clinic, trans-telephonic monitoring or emerging remote monitoring - do not completely satisfy the needs of PM patients. Application of ICT to such cardiology scenarios could enhance follow-up procedures. This Thesis therefore proposes ICT-driven solutions that improve the existing medical routine care in such scenarios. The first proposed framework comprises three main subsystems: the general practitioner acquiring the ECG signal in the dialysis unit, the remote information server receiving and processing ECGs, and the cardiology specialist who analyzes the results in the follow-up procedure. This system enables the physician to remotely screen and follow-up the HRV indices of patients at risk of CVD. The second comprises a telemedicine framework for remote and manufacturer-independent pacemaker follow-up. The architecture, technical features and evaluation of this collaborative system are presented, focusing primarily on the mobile ECG acquisition system.
The two frameworks presented in this PhD dissertation reveal many similarities, proving that such generic architecture for remote following-up of cardiac patients can be applied to a range of different cardiology scenarios. Nonetheless, cardiovascular condition follow-up has undergone a paradigm shift in recent years, due mainly to the increasing need for interoperability and standardization. There are many standards and protocols in this area, specifically in the digital ECG standardization arena. However, the current situation of all such standards and norms is not only complex but also part of a widening and ever-changing context. This hinders the design and development of end-to-end standard-based systems for the follow-up of cardiac patients. The integration and harmonization of interoperability and cardiology standards in a generic follow-up cardiology solution is the approach proposed in this Thesis to attain fully-fledged, interoperable cardiology ecosystems. In order to do so, a standard-based ontology-driven end-to-end telecardiology framework for the standardized exchange and homogeneous management of digital ECG formats is presented. It integrates ISO/IEEE11073 for the interoperability of PHDs in the patient environment and a group of digital ECG formats in the cardiology server of the healthcare information system. This cardiology server follows an ontology-based approach for homogeneous handling of the different digital ECG formats. The end-to-end solution draws on a specific standard for ECGs (SCP-ECG) as exchange format. Therefore, harmonization between ISO/IEEE11073 and SCP-ECG is required. The required mapping is described in detail. As a result, an entire prototype has been designed, developed and tested as a proof-of-concept cardiology follow-up solution.
As a general conclusion, evidence is provided of the added value of ICT-driven frameworks for following-up cardiovascular conditions. This is made possible since ICT enhances the capabilities of such systems as early-detection and screening services and it improves the decision-making process. In addition, it is proved that an appropriate and consistent application of the existing and emerging standards to the communication process in these new frameworks for cardiovascular follow-up vastly improves interoperability as well as the reutilization of the resources, thereby avoiding the proliferation of non-reusable prototypes.
