6 CONCLUSION AND FUTURE WORK
The design of this EMS system focuses on the needs of clinical physicians and academic researchers. Many criteria have been considered, such as stability, compatibility, accessibility, flexibility, user-friendly and maintenance cost. Under this design, the EMS system can offer good performance and efficiency. The aims of this study are: (1) to provide a repository for collecting ECG files, (2) to decode SCP-ECG files and store the results in a database for data management and further analysis, (3) to exchange ECG files in XML, SVG, DICOM, PNG and/or other formats, (4) to develop an ECG data representation system for users to view ECG data in various formats, (5) to develop tools for ECG signal analysis and (6) to support clinical applications of ECG.
In conclusion, the established EMS system can provide effective ECG informatics services such as online ECG pattern recognition to aid diagnosis for clinical physicians and ECG signal processing and analysis for researchers. The design and development of this web-based database is an important component in providing better and more efficient online ECG data management and query. This database may work along with other analyzing modules to enhance the physician’s diagnosis and researcher’s analysis. The format transforming programs developed by this study can foster the interoperability and exchange of ECG data. In the future, our work may include other medical signals such as holter ECG, exercise ECG, patient monitor, and phenocardiogram. Intra-hospital integration of the system is another task, such as communication with HIS, interaction with PACS and integration with the EPR.
In addition, more efforts should be extended to establish a country-wide inter-hospital medical signal database.
7 REFERENCES
[1] Health_Informatics, "Standard communication protocol for computer-assisted electrocardiography, European Committee for Standardization (CEN/TC 251/Secretariat: prEN 1064:2002), Stockholm, Sweden," 2002.
[2] C. E. Chronaki, F. Chiarugi, P. J. Lees, M. Bruun-Rasmussen, F. Conforti, R.
Ruiz Fernandez, and C. Zywietz, "OpenECG: a European Project to Promote the SCP-ECG Standard, a Further Step Towards Interoperability in Electrocardiography," Computers in Cardiology, vol. 29, pp. 285-288, 2002.
[3] Open ECG Project, website: http://www.openecg.net
[4] J. T. Willis, "Biomedical Digital Signal Processing, Chapter 1, University of Wisconsin-Madison," 1993.
[5] A. L. Goldberger, L. A. Amaral, L. Glass, J. M. Hausdorff, P. C. Ivanov, R. G.
Mark, J. E. Mietus, G. B. Moody, C. K. Peng, and H. E. Stanley, "PhysioBank, PhysioToolkit, and PhysioNet: components of a new research resource for complex physiologic signals," Circulation, vol. 101, pp. e215-e220, 2000.
[6] C. Zywietz, "A Brief History of Electrocardiography - Progress through Technology," available at: http://www.openecg.net
[7] "A brief history of electrocardiography," available at:
http://inet.uni2.dk/home/sykulski/ECGTIME.HTM
[8] E. J. Berbari, "Principles of Electrocardiography, Chapter 13: Principles of Electrocardiography, The Biomedical Engineering Handbook: Second Edition.
Ed. Joseph D. Bronzino Boca Raton: CRC Press LLC, 2000," available at:
http://dei-s1.dei.uminho.pt/outraslic/lebiom/cardio/
[9] S. Meek and F. Morris, "ABC of clinical electrocardiography.Introduction.
I-Leads, rate, rhythm, and cardiac axis," Bmj, vol. 324, pp. 415-418, 2002.
[10] J. Malmivuo and R. Plonsey, "BIOELECTROMAGNETISM, Principles and Applications of Bioelectric and Biomagnetic Fields, Chapter 19: The Basis of ECG Diagnosis, Oxford University Press, New York, 1995," available at:
http://butler.cc.tut.fi/~malmivuo/bem/bembook/19/19.htm
[11] R. Fischer, F. Chiarugi, J. J. Schmid, T. Norgall, and C. Zywietz,
"Communication and Retrieval of ECG Data: How many Standards Do We Need?," Computers in Cardiology, vol. 30, pp. 21-24, 2003.
[12] M. R. McGuire, "Automation of the Patient Medical Record: Steps Toward a Universal Patient Record, 2001," available at: http://www.uprforum.com/
[13] M. Li, Design and Implementation of a Database-Driven Web-Based Student Evaluation and Tracking System for the Emergency Medicine: Department of University of North Carolina at Chapel Hill. A Master's Paper for the M.S. in I.S.
degree. Advisor: Gary Marchionini, April 2003.
[14] M. Hedberg and Institutionen för datavetenskap (Göteborg), Biomedical signal storage in a distributed system. Göteborg: Chalmers tekniska högsk., 2004.
[15] Y. H. Cho, M. J. Jeon, H. S. Choi, I. Y. Kim, and S. I. Kim, "Development of ECG Management System conformable to DICOM Waveform using XML,"
SCAR, Boston, USA, 2003, May.
[16] M. A. Paracha, S. N. Mohammad, P. W. Macfarlane, and J. M. Jenkins,
"Implementation of Web Database for ECG," Computers in Cardiology, vol. 30, pp. 271-274, 2003.
[17] S. Zhou, G. Guillemette, R. Antinoro, and F. Fulton, "New Approaches in Philips ECG Database Management System Design," Computers in Cardiology, vol. 30, pp. 267-270, 2003.
[18] G. Guillemette, R. Antinoro, F. Fulton, and S. Zhou, "Design of an ECG Database Management System," International Journal of Bioelectromagnetism, vol. 5(1), pp. 120-121, 2003.
[19] The BIOSIG Project, website: http://biosig.sourceforge.net/
[20] Health Level Seven, website: http://www.hl7.org/
[21] Medical Connections' Home Page, website:
http://www.medicalconnections.co.uk/
[22] "HL7 Version 3 Data Types - Abstract Specification," available at:
http://www.hl7.org/V3AnnECG/foundationdocuments/helpfiles/datatypes.htm [23] A. Varri, B. Kemp, T. Penzel, and A. Schlogl, "Standards for biomedical signal
databases," IEEE Eng Med Biol Mag, vol. 20(3), pp. 33-37, 2001.
[24] "How to Implement SCP - Part II, July 2003," available at:
http://www.openecg.net/tutorial2/
[25] "ASCII Character Code Reference," available at:
http://nemesis.lonestar.org/reference/telecom/codes/ascii.html [26] "FDA Docket No. 03N-0158," available at:
http://www.fda.gov/OHRMS/DOCKETS/98fr/03-10475.htm [27] "HL7 Version 3 Standard Ballot Package," available at:
http://www.hl7.org/V3AnnECG/index.htm
[28] "HL7 Version 3 Standard, Document: Health and Clinical Management Domains," available at:
http://www.hl7.org/V3AnnECG/foundationdocuments/welcome/index.htm [29] F. Badilini and L. Isola, "Freeware ECG Viewer for the XML FDA Format,
S5.5_PA.pdf, AMPS LLC, Montichiari. New York, USA, Italy.," 2nd OpenECG Workshop, Berlin, Germany, 2004.
[30] B. Brown, M. Kohls, and N. Stockbridge, "FDA XML Data Format Design
Specification, Draft C," April 18, 2002.
[31] H. Wang, F. Azuaje, B. Jung, and N. Black, "A markup language for electrocardiogram data acquisition and analysis (ecgML)," BMC Medical Informatics and Decision Support, vol. 3 (4), 2003.
[32] H. Wang, F. Azuaje, G. Clifford, B. Jung, and N. Black, "Methods and tools for generating and managing ecgML-based information," Proc. of 2004 Computers in Cardiology, IEEE Press, Chicago, September 2004.
[33] H. Wang, B. Jung, F. Azuaje, and N. Black, "ecgML: "Tools and technologies for multimedia ECG presentation," Proc. of XML Europe Conference, London, United Kingdom, May 2003.
[34] The DICOM Standard, website: http://medical.nema.org/dicom/2003.html [35] H. Y. Lin and T. Kao, Development of a Standard DICOM ECG Storage and
Diagnosis Environment, Institute of Biomedical Engineering, National Yang-Ming University, Master Thesis, July 2003.
[36] Graphics on the Web, website: http://www.w3.org/Graphics/
[37] B. Jung, J. Brohan, R. Maher, L. J. O'Shea, and V. Wade, "Stirring XML:
Visualisations in SVG," Proceedings SVG Open 2003, Vancouver, Canada, July 2003.
[38] SVG Home Page, website: http://www.w3.org/Graphics/SVG/
[39] W3C PNG, website: http://www.w3.org/Graphics/PNG/
[40] PNG Home Page, website: http://www.libpng.org/pub/png/
[41] MySQL, website: http://www.mysql.com/
[42] phpMyAdmin, website: http://www.phpmyadmin.net/home_page/
[43] Apache Home Page, website: http://www.apache.org/
[44] PHP, website: http://www.php.net/
[45] "Java SDK," available at: http://java.sun.com/
[46] CSIRO, website: http://www.cmis.csiro.au/
[47] CEN/TC304, "Guide to the use of character sets in Europe, 8-Bit Character Sets - Historical background," available at:
http://ra.dkuug.dk/CEN/TC304/guide/GHIST.HTM
[48] W3 Schools Home Page, website: http://www.w3schools.com/svg/default.asp [49] Adobe SVG Viewer, website:
http://www.adobe.com/svg/viewer/install/main.html
[50] W3C Consortium, "Scalable Vector Graphics (SVG) 1.1 Specification,"
available at: http://www.w3.org/TR/2003/REC-SVG11-20030114/
[51] C. Li, C. Zheng, and C. Tai, "Detection of ECG characteristic points using wavelet transforms," Biomedical Engineering, IEEE Transactions on biomedical engineering, vol. 42(1), pp. 22-28, 1995.