Fundamentals of Telemedicine and the aspects of Transtelephonic ECG Transmission (TET) and Telematic Heart Disease Support (THDS)

The impact of telemedicine on health care management is growing since several years and will grow in the future in an unbelievable way. Therefore we introduce the CARDIAX 12-lead digital Tele Cardio Module telemedicine system (TCM). Some words about the company behind it all: MESA GmbH was founded in 1987 and started with marketing and distribution of digital holter systems and conservative ECG systems. In November 1990 we presented at the international MEDICA exhibition at Düsseldorf, Germany, our CARDIAX PC—ECG to the national and international market. The first feedback has been outstanding, but it was the time of MSDOS driven PC`s and this fact tightened down the benefits of such a kind of system. During the next years up to MEDICA 1997 we succeeded in turning to WINDOWS Software with all additional features and benefits. In 1993 we received FDA approval and since 1995 the system is CE approved. In 1999 we finished the CARDIAX 32-bit Software. MESA is ISO certified. Meanwhile a lot of CARDIAX PC ECG system are under use world wide. The customers are general practicians, cardiologists, hospitals, university clinics and additionally the departments for labour medicine of companies like AKZO NOBEL Inc., UNILEVER INTERNATIONAL and DEUTSCHE LUFTHANSA
Let us explain now the basic system of a fully computerised ECG with all the features of a conservative stand alone ECG and the additional benefits of the today standard computer technology. CARDIAX is a computerised add-on ECG system for PC or Notebook. The signal processor unit and the advanced software turn the computer into a high capacity 12-channel ECG with manual or automatic measurement. The dedicated software provides interpretation of the ECG for adults and children. By connecting an ergometer or treadmill, the system becomes a complete stress test workstation. 12-channel ST-Online observation, median processing and a continous rhythms strip during stress test are available. Documentation of heart rate, blood pressure, Physical Working Capacity and workload is provided alphanumeric and as histograms. By using the XYZ leads, the ECG vector can be shown in two or three dimensional way. All reports may be printed out on normal paper. The patient management is done by an integrated database with storage of patient data on Hard Disk Drive or CD. The result is a fast and effective method of treatment and diagnosis. Of course, interfaces for data transfer to hospital administration software are integrated as well as outputs to standard software packages like f.e. EXCEL which then will use these data for scientific purposes. Based on these fundamentals we developed the CARDIAX Tele Cardio Module (TCM). Telemedicine, or Healthcare Telematics involves the use of telecommunications technology to provide abilities that extend the reach of the doctor or healthcare professional. Using remote health care technology the physician is able to investigate, diagnose and intervene clinically without direct ”hands on contact” with the patient. Defined broadly, telemedicine uses electronic signals to transfer medical data involved in the investigation, monitoring and management of patients, using systems which allow ready access to expert advice and to patient information, no matter where the patient or relevant information is located. Despite the initial outlay costs of investing in the computer hardware, it is anticipated that there are considerable savings to be made in the long terms, by decentralising patient care and moving from the hospital to the patient in the field. The global medical village will be greatly completed during the next decade, when advanced telecommunications, the Internet, digital imaging, robotics, and other / automation/computer technologies will have changed with the very nature of medical care. This emerging infrastructure will be characterised by extensive use of electronically accessed medical information and remote expertise and a greater reliance on nonphysician caregivers to apply this knowledge at the point-of-care. Although telemedicine , the major medium to communicate knowledge in the global medical village, is no substitute for personal medical care, it will refocus the role of the physician from caregiver to coach, and assign greater responsibility to patients and their families. Ongoing reforms in the telecommunications sector are facilitating the rapid uptake of new valued services, like telemedicine , while lowering the costs of the associated equipment. Global standardisation , an important step in allowing equipment from different vendors to work together and thus achieving a wider dissemination of telemedicine, is significant strides. Recently legislated international agreements to remove tarif and trade barriers in tele-communications and information technology equipment are further stimulation for the market for equipment and services. However, before telemedicine enters mainstream medicine, it must be formally adopted and reimbursed by payers, providers , and healthcare organisations, and integrated into practice guidelines and clinical pathways. Privacy issues must be resolved, telemedicine equipment will need to become more user-friendly ( for example suitable for the office enviroment) and it will need to come down further in price, says Rickey Richardson, chairmen of WorldCare (UK), a global telemedicine company, in a 1998 article in The Lancet., ”the commercial world is interested in telemedicine because of its lucrative potential. We need to harness the skills – and greed – of our commercial partners to implement cost-effective, practical applications with added medical value for our patients. Now, what are the features of the new CARDIAX TCM telemedicine module ? There is a sophisticated hardware available. The device is a transportable, small sized ECG-box with LCD-control of correct hook up of the patient menu leads the patient safely from hook up to ECG transmission. This module was designed for use in home care for to assure that the ECG signal quality will be reproducible when sent to a central station (CORLAB). The LCD display shows additionally the ECG as alphanumeric mV information. The system could be used if a physician intends to do a first visual diagnosis of the patients ECG before sending it to a central station for more differential diagnosis or recommendation of a prompt medication. For this application, a printer is adaptable for documentation of the ECG curves. The system is based on the 32-bit CARDIAX 12 channel ECG software. The telemedicine module (TCM) transmits the complete ECG directly via modem to a central station. A central station could be a hospital or a physicians office with a conventional CARDIAX PC-ECG defined as CORLAB Analysis Center. For to guarantee an optimal ECG signal it is recommended to use the 12-lead APRON ECG belt, a moulded, pliable silicon apron, which has been designed anatomically and which contains the electrodes and conductors within it. It is easily applied to the patients chest wall and held in place simply by pressing the arms against the sides of the chest. The APRON is connected to the CARDIAX TCM telemedicine module. There is no more need to coat the patient with a special jelly or to shave the chest in order to obtain close contact between electrode and skin. The APRON is well accepted by patients and physicians because its simple way of application. Once the ECG is detected, it will be stored on the telemedicine module and Transtelephonic ECG (TET) Transmission is started by only pressing a bottom. This means, that an ECG can be applied and transmitted for example during first aid even from non medically trained persons. This technology opens new perspectives for fast diagnosis within emergency medicine and patient monitoring in any fields. The Telematic Heart Disease Support (THDS) will save incredible costs by shortening the time for diagnosis and decisions. Transtelephonic Transmision ECG (TET) and receipt of ECG data with the CARDIAX PC-ECG is possible too. The CARDIAX Software is running under WINDOWS 95, 98 and NT. Optional parumeters which are integrated into an extension version of the CARDIAX Tele Cardio Module (TCM) are: Sp02 (Pulsoximetry), blood pressure, temperature, glucose, peptides, cholesterol, urine status. As mentioned before, advanced telecommunication technology will increase the use of these kind of systems, especially in isolated areas. The CARDIAX-TCM telemedicine specification will include the range of urgent response activities that are necessary for 24 hour On call Services = CORLAB Analysis center like f.e. local general practicians, hospital On call, Passenger Airline. This equipment is expected to have a major impact on the uptake of services, and the market potential includes carers of all types as well as patients and the relatives of patients. Once the initial backbone structures are in place, other quality assured services could be added and made interoperable throughout the world for all citizens. Here are some concrete examples for usage of the CARDIAX TCM system in telemedicine based disease management with Telematic Heart Disease Support (THDS). For pacemaker control after implantation ECG telemedicine could be used for to make sure that the calibration of the pacemaker was done correctly. After surgery a reference ECG will be detected. The patient at home will be equipped like described before and will be able to send an ECG to the CORLAB hospital, where the cardiologist compares this transmitted ECG with the reference ECG. The result is a fast analysis whether the cardiac problem is based on calibration of the pacemaker or other physiological parameters. Professional patient transport services like ambulance cars or ambulance helicopters will use the CARDIAX system for to guarantee the utmost possible health service for patients by being able to react in the sense in of first aid when cardiac problems at patients during transport occur. Of course airlines, ocean liners, trains and all other passenger services will have an optimal health service for their clients, too. Drug companies are able to do drug monitoring for clinical studies to detect side effects and compliance in a very cost effective way. There are special software packages improve like f.e. CARDIAX TCM QT-Dispersion-Software, available. Generally the system is indicated to be used for monitoring of all kind of cardiac risk patients. These are only some examples for the wide range of ECG telemedicine. Indeed, from a technologic point of view, telemedicine is ready to assimilate the worlds different, often separated, healthcare systems into a single, global medical village. Author: Günther C. Glatte, General Manager & CEO MESA Medizintechnik  GmbH, Schärflmühlweg 4, D-83671 Benediktbeuern Germany Keywords: TCM = Tele Cardio Module TET = Transtelephonic ECG Transmission THDS = Telematic Heart Disease Support CORLAB = Telemedicine ECG analysis Center WINDOWS is an registered trademark of MICROSOFT Corp.

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