A report on Telecardiology systems available in Ontario, Canada.

1. Telemedicine and Telecardiology Report
Author: Jose Pablo Pinilla Gomez
Delivering expert healthcare services to patients located in rural areas and improving hospital
visits services are the objectives behind the development of different telemedicine
applications. Telephone consultations to reduce hospital and emergency room visits along
with the transmission of Electrocardiograms (ECG) in the early 1900's evolved to the
development of portable telemedicine equipment and web-based services. From an
engineering point of view the signals generated by the bio-potentials found in the muscles of
the heart can be processed and transmitted through any network meant for voice or digital
data communication. Therefore, the development of telecardiology has been in constant
growth coupled with the evolution of electronics and telecommunications.
Cardiovascular disease is the leading cause of death in Canada for both men (28%) and
women (29.7%)1 putting together deaths due to ischemic heart disease(54%), heart
attack(23%) and stroke(20%). These statistics arise a great concern among cardiology
specialists to deploy a broad system for remote initial and follow-up consultations, chronic
illness self-managing and services/organizations interconnection, relying on the available
technologies related to telemedicine. A resulting scheme is the one achieved by the Ontario
Telemedicine Network (OTN) founded in 2005. It represents the integration of organizations
and technology to eliminate geographic barriers, reduce unnecessary transfers and improve
diagnosis in general.
One of OTN's projects is “Telehomecare”, a quality service for patients with Congestive Heart
Failure (CHF) or Chronic Obstructive Pulmonary Disorder (COPD) to keep them connected
with health care professionals through a diagnosing device connected to their home
telephone. This service changes the patient's awareness of their disease by involving them in
the diagnostic procedures and improving their willingness to take care of their health, which is
a noticeable improvement compared to direct patient-physician interaction. Additionally,
patients inside the TeleHomercare system benefit from supplementary physical activity and
were pleased by their family's involvement in their treatment. The results from this project are
so satisfactory that the model is meant to be expanded to other therapeutic areas. 2
Furthermore, medical devices and physicians with high levels of expertise can be seen as
limited resources, unavailable to isolated and rural healthcare providers. Decreasing the
number of hospital admissions would improve the service and availability of these resources.
Accordingly, stroke specialists for emergency situations can take advantage of TeleStroke
systems, making themselves spatially available faster through remote presence, drastically
changing the outcome for patients with this kind of condition. Also, the avoidance of routine
visits, specially for those located in rural areas or with severe levels of heart conditions, is a
helping factor for their treatment.
For Telehomecare and other telemedicine services, the patients need access to medical
1 Heart & Stroke Foundation.”Statistics”. 2012. 22 Feb. 2012.
<http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483991/k.34A8/Statistics.htm>
2 Ontario Telemedicine Network. “Telehomecare”. 22 Feb. 2012. <http://otn.ca/en/services/telehomecare/>

2. stations available in health-care centers or at the commodity of their homes through portable
devices. Existing telemedicine stations include, but are not limited to ECG, ultrasound, blood
pressure and oxygen meters, and the way physicians read this information is classified into
two modes of operation.
The first one relates to store-and-forward operation which, as its name suggests, acquires the
patient's information and stores the data in a server where the information is accessible to
doctors and medical staff. A direct connection between patient and physician is not necessary,
as a result, the diagnosis can take place whenever the physician is available.The
technological resources for this kind of assistance is low, the connection to the server can be
made separate to the data acquisition and with low bandwidths.
The availability of high bandwidth connections in rural locations due to the deployment of
wireless technologies boosted the creation of telemedicine stations in an interactive mode of
operation. This involves real-time data transmission and videoconferencing for different
applications. Videoconferencing on its own applies to different telecardiology practices
besides the ones involving patients and apart from long distant meetings. The use of
multimedia transmission for education can be found inside operating rooms for “live surgery”
broadcasting helping the promotion of procedure techniques and better practices between
different physician and different institutions. Intouch health 3 represents a working example of
videoconferencing systems with both applications, remote presence for patient-physician
consultations as well as surgical telementoring and collaboration. The service can also be
used with software installed in common personal computers serving as “Control Stations”.
These two modes of operation are now being put together to create more functional
telemedicine stations. InstaCath4 is an Image Distribution System focused on cardiology
imaging and offering both modes of operation. It provides access from any location to medical
images taken in catheterization laboratories, echocardiograms and cardiac nuclear medicine
in real time or serving as a data base. This kind of image collection is a valuable asset for any
medical institution as it provides easier access to information from local experience or
external background in case of an integration between different institutions. The real-time time
functionality is similar to the one provided by OTN's “Telehomecare” but the data transmitted
from the host is acquired from specialized machines which are only available in certain
medical facilities. Physicians can use InstaCath to view medical images from their home or
office.
Nowadays, consumer electronics are still evolving rapidly, making high performance wireless
devices available to anybody almost anywhere. The common feature on these personal
computers for telemedicine to delve into is their access to the web. The development of a
reliable web-service facilitates the distribution of clients 5 to any location with low cost, this
way, a physician can read a patients sheet and analyze any additional information from a
laptop and give a diagnosis with the same accuracy as if he/she would have done within the
patient's room. However, when it comes to the technology implemented in servers and
telemedicine stations with data acquisition capabilities, a higher design criteria has to be
3 InTouch Health. “Applications”.22 Feb. 2012. <http://www.intouchhealth.com/applications.html >
4 Meddiff. “InstaCath”. 2011. 22 Feb. 2012. <http://www.meddiff.com/instacath.php >
5 Clients: Programs or workstations requesting data from a server.

3. taken into account. The quality, security and reliability of the service has to comply with the
standards of clinical practice, ensure the confidentiallity of the information and afford enough
quality to enable uninterrupted and clear communication.
After ensuring these characteristics of the system, the disposition of internet connection and
health-care centers will determine the mode of operation and architecture in which the
services will be provided. Regions with rural population and a limited number of specialists,
like Prince Edward Island (PEI), require stations in the main health-care centers
interconnected to provide Islanders with nearby remote access to specialists in Charlottetown
and off-island health providers. An external physician (outside PEI) can only provide care to
Islander patients by adhering to licensing requirements between the institutions with
jurisdiction over each implied part. The reduced size of PEI and the existence of broad band
connections in all schools permited this interconnection 6. The situation for vast regions like
British Columbia wouldn't be very different. Although, half of B.C population is in metro
Vancouver where patients can find quality service providers, rural population is widely spread,
this requires the utilization of more portable telemedicine stations and the installation of
stations in small health-centers with proper personnel to assist its operation.
These days telecardiology takes part in every telemedicine technology, not only because of
the high rates of mortality it generates, but also because heart conditions can be monitored
and found prior to critical states, consequently improving pre-hospital attention and
prevention.
6 Committee on Knowledge Assessment, National Research Council. Lighting the Way: Knowledge Assessment in Prince
Edward Island. The National Academies Press. 1999. p102-111. <http://www.nap.edu/openbook.php?
record_id=6413&page=102>