Future Perspective

This chapter first presents the description of a common approach to ECG interpretation triggering, assuming that the parameters are updated each time the input data is available. The heartbeat detector runs for each acquired sample, and all heartbeat-based diagnostic parameters (e.g., arrhythmias) are calculated immediately after a positive detection of a heartbeat. This approach keeps the diagnostic parameters up to date with the frequency of the physical variability limit of their source at the cost of unnecessary computation. Slowly changing parameters are significantly over-sampled and consecutive values show high redundancy. At the end of the chapter, we present a concept of a packet-content manager. This procedure collects all requests concerning diagnostic parameter update and computation, supervises the propagation of the validity attribute backwards through the processing chain, and provides an exceptional pathway for all abnormality alerts emerging in the processing chain. As a result, all parameters are reported as rarely as possible without breaking the Shannon rule.

Optimization and Prioritization of Cardiac Messages

This chapter presents a proposal of medically justified modulations of the frequency of cardiac reporting, implemented in a client-server distant cooperation model. The supervising center analyzes incoming messages and other conditions, and issues the desired reporting interval back to the remote device. As a result of the authors’ tests and simulations, this method may reduce wireless channel usage and increase remote autonomy up to three times.

Interpretation of the ECG as a Web-Based Subscriber Service

This chapter is about the idea of medical information interchange networks providing signal and possibly image interpretation services. Technically, the issue is similar to Web-accessible services: document conversion, searching the Web, photo development, video on demand, electronic booking of hotels or airline ticketing. Various services use state-of-the-art Internet technology for commerce and entertainment purposes. Unfortunately, medical applications are rarely represented in that form.

Social Impact of Network-Based Ubiquitous Cardiac Surveillance

This chapter is a summary of the book and attempts to evaluate the social impact of the general idea of ubiquitous cardiology. The project discussed in the book is in fact oriented toward designing wireless bidirectional cooperation of two programmable ECG interpreting devices used for permanent heart monitoring and semi-automatic medical diagnosis. As shown above, the main idea of the project under consideration is to replace the traditional patient-doctor interaction model with a semi-automatic system, which was invented, designed, and developed by the staff of the Biocybernetic Laboratory at AGH University of Science and Technology, Krakow, Poland. The system under consideration offers ubiquitous surveillance without time and distance constraints. In this book we presented and discussed the technological aspects of the ubiquitous cardiology system. Conversely, this chapter is about its social aspects. This is also an important issue because every human-dedicated system must take into account human preferences and human limitations. The ubiquitous cardiology system will be used by patients and accepted by doctors when and only when its properties and parameters will be properly related to patient expectations and doctors demands. These aspects of the project are discussed in this chapter.

Introduction

This chapter summarizes new needs, new opportunities, new challenges, and new fields for development of innovative IT methods for permanent and ubiquitous cardiological monitoring. The main idea for new generation of telecardiological devices goes as follows: Bad heart always under permanent qualified observation, and every ill patient never without help—irrespective of moment of time and place on Earth.

Dynamic Task Distribution in Mobile Client-Server Cooperation

This chapter discusses the technical limitations of remote wearable recorders. These are caused mainly by high expectations of mobility and manifest themselves through short autonomy time, low computational power, limited resources, and unacceptable physical size.

Investigations about the Distributions of Important Information in ECG Signals

This chapter presents an investigation of the distribution of medically relevant information in ECG signal timelines. ECG records clearly represent a cycle of heart evolution; its components, although partly superimposed, follow the time-related dependencies of heart function. During the initial inspection of the ECG, the cardiologist focuses his or her attention on several points of the trace, seeking signs of disease. It seems obvious, but is not often considered, that some segments of the signal are more important for a doctor than the remaining parts. Depending on a doctor’s habits and experience, the interpretation starts from the most severe or most suspected abnormality or from the most unusual signal component. The order of the ECG inspection is based on the investigation strategy and is determined by irregular distribution of medical information in the ECG. These assumptions have already been explored with regard to speech or audio signals, resulting in numerous successful applications, such as the MP3 compression algorithm.

General Idea of the Proposed System

After an introduction and three chapters highlighting the present state of the art in computerized electrocardiography (Chapter 2), methodological issues of medical and technical nature (Chapter 3), and electronic management of medical data storage and exchange (Chapter 4), this chapter is a midway summary. This book might end here if it were a review of present achievements of tele-medical solutions in cardiology. Fortunately, we are not only witness to the progress, but are also involved in the development of ubiquitous cardiology, so we want to share our ideas, realizations, and results of the research.

Background 3

This chapter defines the set of standard diagnostic parameters and metadata expected from cardiac examinations. Rest ECG, exercise ECG, and long-term recording techniques are compared with regard to method-appropriate hierarchies of diagnostic results. This summary is approaching the idea of high redundancy in the dataset influencing data transmission and database operations. As far as the paper record was concerned, these spare data were useful in the validation and correction of human errors. Nowadays, automatic error detection and correction codes are widely applied in systems for storage and transmission of digital data. Basic issues about DICOM and HL7, two widespread medical information interchange systems, are presented thereafter. These general-purpose systems integrate multi-modal medical data and offer specialized tools for the storage, retrieval, and management of data. Both standards originate from the efforts of standardizing the description of possibly wide aspects of patient-oriented digital data in the form of electronic health records. Certain aspects of data security are also considered here.

Background 2

This chapter presents basic facts about the social impact and frequency of cardiovascular diseases in aging societies. Being the primary cause of mortality in developed countries, cardiovascular abnormalities receive the most of the attention in the medical world. The problem is particularly observed in developed countries with a significantly longer life expectancy (Japan, Canada) and leading in healthcare organization and research. Also considering the acuteness of a typical cardiac failure gives proper attention to why cardiology is given so much importance in the treatment of life-threatening situations. Making progress in cardiac diagnosis and treatment, including modern and wide-range surveillance, is potentially beneficial to whole societies and countries. It also influences both life length and comfort, which are today among the most appreciated of human values.