Post on 23-Jul-2022
University of Calgary
PRISM: University of Calgary's Digital Repository
Research Centres, Institutes, Projects and Units E-Health Resource Repository
2005-04-08
Telecardiological System CARDIO.NET: Promises and
Pitfalls
Rudowski, R.; Sierdzinski, J.; Grabowski, M.; Szymanski, F.
Presented at Med-e-tel 2005 Conference in Luxembourg.
http://hdl.handle.net/123456789/3559
Presentation
Downloaded from PRISM: https://prism.ucalgary.ca
TelecardiologicalTelecardiological System CARDIO.NET. System CARDIO.NET. PromisesPromises andand PitfallsPitfalls
R. R. RudowskiRudowski (1), J. (1), J. SierdzinskiSierdzinski (1), M. (1), M. GrabowskiGrabowski (1,2),(1,2),
F. F. SzymańskiSzymański (1,2)(1,2)
1 1 -- DeptDept. . ofof MedicalMedical InformaticsInformatics andand TelemedicineTelemedicine, , TheThe MedicalMedical UniversityUniversity ofofWarsawWarsaw
22-- CardiologyCardiology ClinicClinic, , II--stst FacultyFaculty ofof MedicineMedicine,,
TheThe MedicalMedical UniversityUniversity ofof WarsawWarsaw
OutlineOutline
BackgroundBackgroundAimAimElementsElements ofof thethe system: system:
-- EHR, EHR, -- DatabaseDatabase, , -- ExpertExpert system for system for riskrisk stratificationstratification
ResultsResultsRiskRisk stratificationstratification andand ethicsethicsPromisesPromises andand PitfallsPitfalls
Mortality rateMortality rate inin PolandPoland per 100 000 per 100 000 inhabitantsinhabitants
0
200
400
600
800
1000
1200
Mortality
Mortality caused by cardiovascular diseases
319
474557 537 530 513 505 503 469
813
9931056 1029 1020 1002 1001 998 987
1970 80 90 91 92 93 94 95 9996
Data from the Institute of Cardiology -2001
HemodynamicHemodynamic procedures procedures iin Poland 1999n Poland 1999--20022002
0
10000
20000
30000
40000
50000
60000
70000
80000
1999 2000 2001 2002
Coronarography
Coronary Angioplasty
46379
15453
65760
24326
76000
30000
58600
19580
From The Institute of Cardiology - 2001
MazoviaMazovia DistrictDistrict
HemodynamicHemodynamiclaboratorieslaboratories
Data from the Institute of Cardiology -2004
AcuteAcute CoronaryCoronary SyndromesSyndromes
The acute coronary syndromes (ACS) contain all three The acute coronary syndromes (ACS) contain all three clinical types of events (heart attack, unstable coronary clinical types of events (heart attack, unstable coronary heart disease, some cases of cardiac death) heart disease, some cases of cardiac death) andand are are one of the most frequent diagnoses of ischemic heart one of the most frequent diagnoses of ischemic heart disease. disease.
Credible epidemiological data on the incidence of ACS Credible epidemiological data on the incidence of ACS of all types in Poland is unavailable, but the estimate of all types in Poland is unavailable, but the estimate isis 250 000 cases per year. 250 000 cases per year.
AimsAims
TheThe designdesign andand implementationimplementation ofof prototypeprototypetelecardiologicaltelecardiological system system inin MazoviaMazovia DistrictDistrict..
ImporovementImporovement ofof cooperationcooperation amongamongcardiologicalcardiological centerscenters..
RationalizationRationalization ofof thethe specializedspecialized clinicalclinical resourcesresourcesandand accessaccess to to unifiedunified digitaldigital archivesarchives..
ReductionReduction ofof time time fromfrom symptomessymptomes to to interventionintervention((possiblepossible reductionreduction ofof mortalitymortality).).
The structure of The structure of Cardio.netCardio.net
Reference CenterLayer 1
Layer 2
Layer 3
Regional hospital 1
Regional hospital 2
Regional hospital n
AmbulanceAmbulance 11 AmbulanceAmbulance nnAmbulanceAmbulance 22
ToolsTools
ElectronicElectronic HealthHealth RecordRecord ((accesibleaccesible via Internet)via Internet)
RelationalRelational data data basebase MySQLMySQL
ExpertExpert System for System for riskrisk assessmentassessment
ElectronicElectronic HealthHealth RecordRecord ((accesibleaccesible via Internet)via Internet)
Pacjent -Elektroniczna
HistoriaChoroby
TerapiaD
iagn
osty
kaFa
rmak
oterap
ia
Lecz
enie
niefar
makolo
giczn
e
Rozpoznanie
wstępneBadanie
przedmiotowe
Badaniepodmiotowe
BadaniaEKG
Badania
biochemiczne
(Biomarkery)
Bada
niaob
razo
we
Roz
pozn
anie
osta
tecz
ne
- choroba wieńcow
a
- niewydolność serca
- zaburzenia rytmu
serca
- inne choroby
-szmery serca
-zastój w krążeniu
małym (Kilip)
-BMI
-RR (sk./rozk.)
- inne
-Bóle wieńcowe typowe
-Klasa CCS-Nietypowe bóle w klatce
piersiowej-Klasa NYHA
- inne czynniki
- EKG przy przyjęciu- EKG w trakcie leczania
- EKG przy wypisie
- Troponina
-CK
-CK-MB
- CK-MB
masa
- Kreatynina
- CRP-
ECHO
- cho
roba
wieńc
owa
- nie
wyd
olność
ser
ca- z
abur
zeni
a ry
tmu
serc
a- w
ady
serc
a-c
horo
by m
ięśn
ia s
erco
weg
ow
sier
dzia
i os
ierd
zia
- inn
e ch
orob
y
-Angioplastyka
-STEMI
-NSTEMI
- Zabieg kardiochirurgiczny - CABG
- Respirator
- Przeskórna ablacja
- inne
- t-PA
- Aspiryna
- Klopidogrel/Tiklopidyna
- Inhibitor ACE
- Statyna
- Antagonista GP IIb/IIIa
- inne
EElectroniclectronic formform 11
EElectroniclectronic formform 22
DatabaseDatabase
ClientClient--seversever architecturearchitecture withwith 3 3 layerslayers::
1. 1. ClientClient –– Internet Explorer min. Internet Explorer min. verver. 5.5.x. 5.5.x
2. 2. MiddlewareMiddleware –– PHPPHP3. 3. DatabaseDatabase serverserver -- MySQLMySQL
WWW ServerWWW Server
((ApacheApache))
ExpertExpert system (ES) for system (ES) for riskrisk stratificationstratification
InputInput datadata
BNPBNP
SIMPLESIMPLEOutputOutputVotingVoting
SystemSystemhighhigh riskriskoror lowlow risk
TIMITIMIrisk
GRACEGRACE
ZWOLLEZWOLLE
ES ES consultationconsultation –– finalfinal stepstep
BNP levels add additional prognostic BNP levels add additional prognostic information to risk scores in STEMI patients information to risk scores in STEMI patients
treated with PCItreated with PCI
MortalityMortality %%
ROC ROC curvescurves for for riskrisk scoresscores andand BNP BNP ininpredictionprediction ofof 3030--day day mortalitymortality
0,832
0,869
0,819
0,9
0,892
ES ES –– data data inputinput
ES ES –– resultsresults andand explanation moduleexplanation module
InterInter--rater agreement between rater agreement between realreal physician and physician and developed ESdeveloped ES Indication for pharmacotherapyIndication for pharmacotherapy
AspirinAspirin ACE inhibitorACE inhibitor BetaBeta--adrenoliticsadrenolitics
PhysicianPhysician PhysicianPhysician PhysicianPhysician
ESES YesYes NoNo SumSum YesYes NoNo SumSum YesYes NoNo SumSum
YesYes 5757 22 5959 123123 88 131131 102102 22 104104
NoNo 66 8484 9090 33 1515 1818 1515 3030 4545
SumSum 6363 8686 126126 2323 117117 3232
κκ 0,889 0,889 0,690 0,690 0,705 0,705
κκ < < 0,2 0,2 poorpoor
0,21 0,21 –– 0,4 fair0,4 fair
0,41 0,41 –– 0,6 0,6 moderatemoderate
0,61 0,61 –– 0,8 0,8 goodgood
0,81 0,81 –– 1,0 1,0 veryvery goodgood
Risk stratification in STEMI by different Risk stratification in STEMI by different strategiesstrategies
CClassificationlassification errorserrors
0,00%
2,00%
4,00%
6,00%
8,00%
10,00%
12,00%
BNP SIMPLE TIMI GRACE ZWOLLE Voting system
Cardio.netCardio.net -- resultsresults
EHR EHR hashas beenbeen createdcreated for for overover 100 100 patientspatients fromfrom SP SP CSK AM CSK AM HospitalHospital ((referencereference centercenter) ) andand for a for a fewfewpatientspatients fromfrom regionalregional centerscenters remotelyremotely. . ThisThis confirmedconfirmedfunctioningfunctioning ofof thethe system system andand verifiedverified appliedappliedsolutionssolutions..
PromisesPromises
2 2 mainmain elementselements ofof thethe system: EHR system: EHR andand databasedatabaseareare functioningfunctioning properlyproperly..
TheThe projectproject ofof presentedpresented telecardiologicaltelecardiological system system supportssupports ee--healthhealth strategystrategy for for PolandPoland for 2004for 2004--2006 2006 andand thethe NationalNational Program Program ofof HealthHealth. .
BothBoth initiativesinitiatives mentionmention thethe fightfight againstagainst coronarycoronarydiseasesdiseases as one as one ofof theirtheir strategicstrategic aimsaims..
PitfallsPitfalls
AmbulanceAmbulance networknetwork isis a a crucialcrucial factorfactor inin improvementimprovementofof healthhealth carecare ofof thethe ACS ACS patientspatients andand alsoalso itsitsintegrationintegration withwith regionalregional andand referencereference centerscenters
BetterBetter cooperationcooperation ofof ambulancesambulances withwith thethe regionalregionalandand refrencerefrence centerscenters isis requiredrequired ((organizationalorganizationalpitfallpitfall))
TheThe ambulancesambulances requirerequire newnew equipmentequipment for ECG data for ECG data transmissiontransmission overover mobile mobile phonesphones
Internet Internet connectionconnection inin regionalregional centerscenters isis a problem. a problem. TheThe staffstaff needsneeds trainingtraining inin EHR EHR andand databasedatabaseoperationoperation