Broadening the Exchange of Electrocardiogram Data from Intra-Hospital to Inter-Hospital

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An electrocardiogram (ECG) is a commonly used clinical tool to diagnose cardiac diseases. In most clinical practice, to improve ECG diagnosis accuracy, cardiologists not only determine the abnormal conditions of the current ECG, but also examine the serial changes in reference to the previous ECGs. Expert cardiologists strongly believe that ECG diagnosis is incomplete without a comparison to previous ECGs (Ariet et al., 2005). Obviously, a prerequisite for the clinical practice using serial ECG comparison is the availability of previous ECGs. For the reason above, it has been a growing interest in medical informatics to improve ease of access to ECG data using information technology. Initially, the computer systems, now referred to as ECG management systems (EMSs), were invented to serve a valuable function for ECG data management (Crevasse & Ariet, 1987). They consisted of a central minicomputer that collected the ECG signals from peripheral electrocardiographs over serial cables, telephone lines or local area network, and provided the power to store and retrieve the collected ECG data. Storage and retrieval of ECG data were organized in the perspective of their future use, particularly for serial comparison, but also for different managerial and research purposes, such as over-reading by physicians, re-analysis by different ECG programs, and statistics for management (Fayn & Rubel, 1991). The EMS solution allows a patient’s ECG data accessible throughout the hospital and anywhere outside the hospital through a Web interface. A major issue in the employment of EMS is the interoperability between electrocardiographs and EMSs, and the interoperability among EMSs. In a major hospital, there are usually a number of electrocardiographs that are from different vendors. These electrocardiographs may use different vendor-proprietary standards for ECG data storage and transmission, but an EMS is developed conformably to only a few vendor-proprietary standards. In order to facilitate the use of electrocardiographs from different vendor, several EMSs that are conformable to different vendor-proprietary standards may coexist in a hospital. As for the issue of the interoperability among the EMSs, some possible solutions have been reported.