Updated: Feb 1, 97
ESTEEM

Project Code:   A2010 Project value:   2527 KECU EC contribution:   1318 KECU No of partners:   4 No of countries:   4 Duration:   36 months

Contact: Dr. Mario Veloso Hospital Egas Moniz Dept. Neurology Rua da Jungueira 126 P-1300 Lisboa, Portugal Tel.: +351-1-362.00.50 / 362.23.10 Fax: +351-1-363.34.09

Overview

ESTEEM has approached the problem from a very pragmatic angle. In order to ensure success within a reasonable time, it concentrated on a well circumscribed domain of medicine: electromyography. Still, it built a general tool for developing and testing knowledge based systems but applied it, as a pilot, only to electromyography. Such a restriction is essential for a critical assessment of the expert systems technique and it is the first step to a generalisation in other medical domains.

Purpose and objectives

Results

• Successful development of an integration environment (version 3 prototype), entitled the EMG-Platform, on which several different kinds of application modules can be plugged into. Major components of this EMG-Platform are:
  • the EASE kernel providing a general solution for how to integrate other systems into the platform;
  • the ECP (ESTEEM Communication Protocol) providing the means for exchange of EMG data;
  • the EMG data entry tool, now entitled the Electronic EMG Patient Record (EEPR), for the acquisition and analysis of the EMG data sets from the different EMG centres in the work of building up the ESTEEM multicentre consensus database;
  • the ESTEEM database containing consensus cases;

• Illustrating its open architecture several distinct application prototypes have been already interfaced into the EMG-Platform:
  • the KANDID KBS module for the planning and diagnosis support of EMG studies;
  • the HINT system (High-level Inferencing Tool), an expert system for the interpretation of neurophysiological studies;
  • the DEMONSTRATOR prototype, a second generation of a EMG knowledge-based system based on a causal functional approach;
  • the NeuroMyosis system; and
  • the ET (Evaluation Tool) prototype including an automatic EMG case generation from the ESTEEM database for testing knowledge-based systems credibility.

• Established a growing, committed, European network of clinical users promoting the incorporation and utilisation of these new technologies into disseminated clinical utilisation and which delivered important clinical achievements:
  • A complete and update specification of the structure of a common general usable EMG data set covering all used EMG examination techniques and including higher level interpretations.
  • Developed terminology for the representation of EMG data in a coherent and consistent way.
  • Collected and analysed 700 EMG cases retrospectively for documenting the factual differences among the involved EMG laboratories.
  • Performed an extensive collection of EMG data cases providing information about the use of examination techniques, diagnostic criteria, planning strategies, etc.
  • Developed a procedure for seeking consensus on diagnoses and pathophysiologic states of anatomical structures, representing a truly medical audit of EMG cases, on a European basis.
  • Implemented a multicentre EMG database containing EMG patient cases with attached consensus diagnoses.

Benefits for users:

In addition, in the near future, with the EMG-Platform applied and used in the daily routine in the eight different ESTEEM EMG centres, a truly telematic environment for clinical EMG in

Europe will be then established where:

• data acquisition from local EMG machines to the EMG-Platform will become automated
• EMG cases can easily be circulated and discussed between experts from different sites
• applications of different kinds (e.g. Electronic EMG patient record systems, databases and EMG KBSs) can communicate and collaborate.

Plans for exploitation:

The planned incorporation of ESTEEM prototypes onto the integrating Hospital Information System environment being implemented in ISAR project enables on site external clinical user validation of ESTEEM achievements. This together with the several presentations in scientific meetings of ESTEEM contribute both to the dissemination of ESTEEM results and to the impact at the neurophysiology medical community and standardisation bodies (i.e. CEN 25 l ) as to the emergent standards in the field.

Many requests from other EMG centres to join the international audit and consensus process of ESTEEM have been received. The Clinical user group of ESTEEM is currently considering to establish an organisation which can handle a world-wide network for this activity incorporating several national sub-nets which can continue and extend this important process leading to new effective methods and guidelines for quality assurance.

List of Deliverables

• Specification of the kernel of the EMG-Platform
• Specification of a common EMG dataset
• Specification and design of the EMG -Platform
• Clinical considerations for the standardisation and evaluation in the context of EMG
• EMG-Platform
• EMG Multi-centre database
• Evaluation methods for knowledge-based EMG systems

List of Participants

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