Updated: Feb 1, 97
OEDIPE

Project Code:   A2026 Project value:   2492 KECU EC contribution:   1246 KECU No of partners:   6 No of countries:   5 Duration:   36 months

Contact: Prof. Paul Rubel Inserm U 121 Hôp. Cardiologique 28, Av. du Doyen Lepine PO Box Lyon-Montchat F-69394 Lyon Cedex 03, France Tel.: +33-72-35.73.72 Fax. +33-72-34.18.76 E-mail: rubel@insa.insa-lyon.fr

Overview

Purpose and objectives

Recent advances in clinical research indicate that the human and financial cost-effectiveness could be improved in this domain, provided that means will be developed in order to allow a more reliable follow-up of cardiac diseased patients, and the early detection of the occurrence of life threatening cardiac events.

Early detection of life threatening changes in coronary heart diseased patients is probably one of the most challenging issues of the nineties. Detecting and analysing serial electrocardiographic (ECG) changes is up to now the only practical investigation which will assist the physician in early diagnosing acute myocardial infarction and in advising administration of thrombolytics and/or admission in a coronary care unit. This implies that a reference ECG and any relevant clinical information have already been stored, with the perspective of their future use, either on central databases, or on individual data cards, and that the data will be accessible even in emergency situations from home or during the transport in an ambulance.

The first objective of the OEDIPE project was thus to implement and experiment electronic data interchange of digital ECGs following the lines of the SCP-ECG standard communications protocol developed during the exploratory phase of AIM, setting-up demonstrators for cart-to-host and host-to-host communications and exchanging ECG and other related data between several test sites.

Another objective was to implement and to test the Conceptual ECG data storage Reference Model which has been developed during the exploratory phase of AIM and to set-up a European demonstration database for the follow-up of heart transplant patients. Operational testing would include the follow-up of patients suffering from acute myocardial infarction during their transportation in the emergency car or after their admission in a coronary care unit and the follow-up of patients during experimental drug studies.

The third objective was to develop and to test methods of serial ECG analysis for the early detection of acute myocardial infarction, the diagnosis of acute and chronic heart transplant rejection and the follow-up of patients suffering from chronic coronary disease.

The final objective was to promote open European data interchange and processing for Electrocardiography by setting-up demonstrator systems for the follow-up of selected heart diseased populations which would prefigure large-scale monitoring of ambulatory or critical ill patients at home, during their transportation in an emergency car or during their stay in a hospital.

Results

Demonstrators

The OEDIPE project has designed several demonstration systems for the follow-up of cardiac diseased patients, integrating serial analysis, decision support, open databases and communication protocols. It has also developed several building blocks bringing generic solutions to the more general problem of distributed, co-operative processing of patient signals and other relevant data, some of which are stored in distant distributed co-operative databases.

The project has successfully implemented the European SCP-ECG Standard Communications Protocol for Electrocardiography, which became European pre-standard "prENV:1064" (developed in the SCP-ECG project during the AIM Exploratory phase practically by the same partners) and the related compression algorithms on stand-alone, industry standard microprocessor based ECG carts from three different makes and on Personal Computer based ECG data acquisition systems. Tools and databases for open data interchange in Electrocardiography have been designed. The project has developed and implemented a Conceptual core data model, and solved all of the problems raised by its physical implementation. The scope of the OEDIPE project has been further extended by designing a Cardiology Clinical Workstation demonstrator providing shared access to distributed, co-operative non-ECG databases and predictive data display of both ECG and other clinical information and by developing a portable diagnostic station for the decisional risk assessment of patients during their transportation in the emergency car.

Exploitation of Results

The industrial partners have developed and are now commercialising end products consisting in ECG interpreting carts that incorporate the SCP-ECG communications protocol.

The partner Elettronica Trentina is now commercialising an ECG cart with the following features:

• Digital acquisition and transmission of 12 leads ECGs
• Automatic quantitative analysis
• Computerised interpretation with textual report.

A portable ECG cart to be put in an emergency car, will be commercialised soon.

The partner Hewlett-Packard is also implementing the SCP-ECG protocol for their own products, manufactured in Böblingen in Germany. Other manufacturers are going to follow this movement. IEC is going to adopt the SCP-ECG protocol at the international level. In life-threatening acute myocardial infarction, ECGs are being used in ambulances by paramedical personnel to assess the necessity for administering thrombolytic agents, with long-distance monitoring whenever possible. Future prospects indicate that home care will be a major application field.

The project has also developed a powerful construction set composed of various building blocks to be easily reused and integrated in different telemedical architectures. Domain information models have been developed for medical decision and telematic services support in a multi-actors environment. That yielded in user-friendly interfaces for the reviewing and the graphical display of serial, dynamic data and trends, integrating different information sources in a relevant synthesis that fits the requirements of emergency departments as well as of general practitioners or University hospitals. Communication interfaces for electronic data interchange have been set-up, with the aim of automating the whole data flow process according to the users needs. Data models for the storage and retrieval of serial records have been developed and implemented in open and modular structures that support various scenarios of distributed, co-operative processing tasks. Various experiments and operational testing have already been successfully performed, and will be evaluated at a large scale in a set of Tele-assistance, Tele-expertise and Tele-consultation projects.

Obstacles and difficulties

List of Deliverables

Year 1

• Def. of non ECG data content and format for heart transplant patients (6/R/P)
• Requirements for data collection and transmission of multilead data (8/R/P)
• User requirements and potential benefits of serial ECG analysis (8/R/P)
• Funct. requirements for serial ECG management & control of analysis process (11/S/R)
• Demonstrator for open cart-to-host ECG data exchange (12/P/P)

Year 2

• Graphical interface for presentation of serial dynamic data & trends (6/R/R)
• Demonstrator for open host-to-host ECG data interchange (8/P/P)
• Spec. for home and ambulance recording & transm. of digital ECGs (8/S/P)
• Demo. of the implemented conceptual reference model for ECG storage (12/P/P)

Year 3

• Evaluation report on ECG data transmission from emergency cars (3/R/P)
• Evaluation report on electrocardiographic data interchange (4/R/P)
• Experim. European network of distributed co-operative ECG databases (6/R/P)
• Experim. European serial ECG database for heart transplant patients (8/R/P)
• Specification report on ECG data integrity preservation (8/R/P)
• Serial analysis demo sys for heart transplant & coronary diseased pat (9/P/P)
• Efficiency analysis report on serial ECG measurements (DRAFT) (9/R/P)
• Final efficiency analysis report on serial ECG measurements (12/R/P)
• Consolidated Clinical Specifications for Cardiology Workstations (6/S/R)
• Portable Cardiology Station Prototype (6/P/R)
• Industrial Cardiology Workstation Prototype Demonstrator (12/D/R)
• Portable Cardiology Station Evaluation (12/R/P)

List of Participants

	Copyright 1997 © EHTO All rights reserved This server is the only official EHTO WWW knowledge repository. Mail suggestions to: webmaster@ehto.org