Check Point new 09.2015 full

BODIES ONLINE
Check Point™ Telemonitoring Platform
BODIES ONLINE
Check Point™ Telemonitoring Platform

Telemonitoring today
• Cardiovascular disease causes 47% of all deaths in Europe
• Each year cardiovascular disease causes over 4 million deaths in Europe
• In the same time biometric monitoring in cardiology, surgery, gynecology , etc, is still:
2
big
static
offline

• Multinational medical technology developent project
• With mission to identify and integrate the best practices in world telemonitoring
• Own telemonitoring centre with capacity of 15 000 patients simultaneously monitored
• Proven track record since 2000
• Specialised in innovative telemonitoring applications
• Primarily focussed on telemonitoring of vital-signs
• Key applications are telemonitoring of:
- ECG
- SpO2
- Temperature
- Cardiac Events
- Early Warning Score (Visensia Index)
- Fetal Heart Rate
- Ventilation parameters
- Health and fitness testing (Vital-Vision)
• Distribution network in Europe, Asia and United States of America
• Product solution comprises monitoring equipement, servers, software and Smartphone applications
• Product suite certified by CE, FDA, FCC and PTCRB
What is Check Point Cardio
• Multinational medical technology developent project
• With mission to identify and integrate the best practices in world telemonitoring
• Own telemonitoring centre with capacity of 15 000 patients simultaneously monitored
• Proven track record since 2000
- ECG
- SpO2
- Temperature
- Cardiac Events
- Fetal Heart Rate
- Ventilation parameters
- Health and fitness testing (Vital-Vision)
• Distribution network in Europe, Asia and United States of America
• Product solution comprises monitoring equipement, servers, software and Smartphone applications
• Product suite certified by CE, FDA, FCC and PTCRB

We offer healthcare providers an all-encompassing solution for remote monitoring and diagnostics of
their patients to:
• Improve patient comfort by keeping them in their home environment longer without risk
• Reduce number of complication events in post-operative and post-clinical stage
• Reduce the workload and increase cost efficiency of telemonitoring services by remote monitoring
• Contribute to improving overall health by offering health and fitness testing services
• Increase self-confidence in patients, reduce stress
• Reduce expences for logistics, hospital stay, surgery invasions , of the state or private health systems
Proposition
We offer healthcare providers an all-encompassing solution for remote monitoring and diagnostics of
their patients to:
• Improve patient comfort by keeping them in their home environment longer without risk
• Reduce number of complication events in post-operative and post-clinical stage
• Reduce the workload and increase cost efficiency of telemonitoring services by remote monitoring
• Contribute to improving overall health by offering health and fitness testing services
• Increase self-confidence in patients, reduce stress
• Reduce expences for logistics, hospital stay, surgery invasions , of the state or private health systems

Solutions and application
TelemonitoringVital-Signs Telemonitoring Fetal Heart Rate Telemonitoring 12-lead ECGTelemonitoringVital-Signs Telemonitoring Fetal Heart Rate Telemonitoring 12-lead ECG
Telemonitoring Ventilation Heart attack Index Score Health & Fitness testing

Technical overview PC software
Telemonitoring
Configuration and
data download
Alerts
WEB portal
File Server
Hardware unit
With built-in modem
and SIM card *
Telemonitoring
All data available online
Patient Server
Alerts
own monitoringown monitoring
centrecentre

PLATFORM 1
Check Point universal offer
7

Partnership Check Point – Vital Connect
USA
• One of the most fast developing telemedicine R&D companies in US
• Company is developing basic, but affordable system enabling a remote
transmission of ECG from patients to doctors
• Simple, easy-to wear, working with a Android smartphone
• Extremely long batery life – up to 7 days without a re-charge!
• Company is developing basic, but affordable system enabling a remote
transmission of ECG from patients to doctors
• Simple, easy-to wear, working with a Android smartphone
• Extremely long batery life – up to 7 days without a re-charge!
• Only 85 g. weight
•Together with Check Point, in 2015 is developed a complete system for cardiac
telemonitoring, including
- 1-lead lifestream ECG
- Temperature
- Respiration
- Body posture
- Pulse
- Heart rate and variability
- Cardiac Events
- GPS

Simple, easy to wear, modern
9

Remote ECG diagnosis and consultation
Data transfer Data visualizing Diagnose

 Vital connect is certified as a complete solution, including data transmission, server system, software and
Smartphone applications for real-time monitoring of patient’s vital signs and ECG waveforms.
 Vital connect is a IIb medical device and is allowed for use in the Intensive Care Unit and Operating Theater.
 The products are allowed for sale in Europe, USA, Asia, EMEA and Africa.
 The products are designed and manufactured by ISO standards for medical products (ISO 9001 and ISO 13485).
 Vital Connect comes with the following certificates:
 CE-mark (0344)
 FDA 510(k) approval for the Americas
 CAMDCAS approval for Canada
 FCC approval for the radio transmission for USA and Canada
 PTCRB approval for the cellular transmission
 SAR approval for body worn telecom units
Certifications
 Vital connect is certified as a complete solution, including data transmission, server system, software and
Smartphone applications for real-time monitoring of patient’s vital signs and ECG waveforms.
 Vital connect is a IIb medical device and is allowed for use in the Intensive Care Unit and Operating Theater.
 The products are allowed for sale in Europe, USA, Asia, EMEA and Africa.
 Vital Connect comes with the following certificates:
 CE-mark (0344)

PLATFORM 2
Check Point premium offer
12

Partnership with Techmedic International - Nederlands
• Dutch based medical technology development company
• Operating since 2000-Th
• Carrier of all world standards for telemedicine and a lot of patents
• The only system, ensuring real time data
• Profound automatical analyses of vital signs, when the doctor can program the allert,
individually for each patient
- ECG
- SpO2
- Temperature
- Cardiac Events
- Fetal Heart Rate
• Dutch based medical technology development company
• Operating since 2000-Th
• Carrier of all world standards for telemedicine and a lot of patents
• The only system, ensuring real time data
• Profound automatical analyses of vital signs, when the doctor can program the allert,
individually for each patient
- ECG
- SpO2
- Temperature
- Cardiac Events
- Fetal Heart Rate
13

Dyna-Vision™ Applications
Telemonitoring
System
Resting ECG
Cardiac
Events
SpO2 and
Pulse Rate
Dyna-Vision™ Telemonitoring System is used for a
variety of applications in the medical and
paramedic environment.
The core application is the Dyna-Vision™
Telemonitoring system.
Simple add the plug-in(s) for the application(s)
of choice;
 DV-REST-ECG
 DV-VIS-MON
 DV-RTP-MON
 DV-EVENT-MON
 DV-FHR-MON
 DV-HVM-MON
 DV-SPO2-MON
Telemonitoring
System Real-time
Patient
Monitoring
Continuous
Early
Warning
Score
Fetal Heart
Rate /
Uterine
Contractions
Home
Ventilated
Patients
Dyna-Vision™ Telemonitoring System is used for a
variety of applications in the medical and
paramedic environment.
The core application is the Dyna-Vision™
Telemonitoring system.
Simple add the plug-in(s) for the application(s)
of choice;
 DV-REST-ECG
 DV-VIS-MON
 DV-RTP-MON
 DV-EVENT-MON
 DV-FHR-MON
 DV-HVM-MON
 DV-SPO2-MON

Dyna-Vision™ with Internal Battery = one of most
endurable hardwares, designed for multi-renting!

Resting ECG – Telemedicine System
Dyna-Vision™ unit with
built-in SIM card and
internal modem
connected to the patient
Dyna-Vision™
secured
telemedicine
server
PC with Dyna-Vision™ software
connects to the telemedicine server PDF reports and online
storage in Electronic
Health Record

Vital Signs Tele-monitoring Display

 All data collected by Dyna-Vision™ is used in high-level reports
 Reports are stored in PDF or FDA-XML format
 The reports can be send to others by secured connection via the server
 Dyna-Vision™ applications can output data to EHR
 The reports present high-resolution medical data in superb quality graphs
 Interconnectivity of data with other software / systems (XML/PDF/others)
Reporting
Example of reports

Dyna-Vision™ Connected to Patient
3-Lead 3-Lead patch 12-Lead patch

Dyna-Vision™ with Mobile Patient

 Dyna-Vision™ Telemedicine System is certified as a complete solution, including data transmission, server system,
software and Smartphone applications for real-time monitoring of patient’s vital signs and ECG waveforms.
 Dyna-Vision™ Unit is a IIb medical device and is allowed for use in the Intensive Care Unit and Operating Theater.
 Techmedic International is audited annually by a notified body. The products are allowed for sale in Europe, USA,
Asia, EMEA and Africa.
 Dyna-Vision™ comes with the following certificates:
 CE-mark (0344)
Certifications
 Dyna-Vision™ Telemedicine System is certified as a complete solution, including data transmission, server system,
software and Smartphone applications for real-time monitoring of patient’s vital signs and ECG waveforms.
 Dyna-Vision™ Unit is a IIb medical device and is allowed for use in the Intensive Care Unit and Operating Theater.
 Techmedic International is audited annually by a notified body. The products are allowed for sale in Europe, USA,
Asia, EMEA and Africa.
 Dyna-Vision™ comes with the following certificates:
 CE-mark (0344)

2002: Herman Wijffels Innovation Award for new Heart-Lung Machine design
2004: Patent granted for “Emergency Warning System”
2005: Patent granted for “New Method for Respiration Monitoring”
2006: Patent granted for “New Clamping Method for Mounting Equipment”
2007: Patent granted for “Work-of-Breathing Detection Method”
2009: Patents filed for “Real-time Remote Patient Monitoring using Integrated Cellular Technology”
2010: Nominated for the “Global GSMA m-Health Award – due February 2011
2010: Finalists for the “International Business Award – due April 2011
2011: Received the “Frost & Sullivan Excellence Award for Remote Patient Monitoring”
Awards and Patents
2002: Herman Wijffels Innovation Award for new Heart-Lung Machine design
2004: Patent granted for “Emergency Warning System”
2005: Patent granted for “New Method for Respiration Monitoring”
2006: Patent granted for “New Clamping Method for Mounting Equipment”
2007: Patent granted for “Work-of-Breathing Detection Method”
2009: Patents filed for “Real-time Remote Patient Monitoring using Integrated Cellular Technology”
2010: Nominated for the “Global GSMA m-Health Award – due February 2011
2010: Finalists for the “International Business Award – due April 2011
2011: Received the “Frost & Sullivan Excellence Award for Remote Patient Monitoring”
International Business Award 2010

MONITORING, DIAGNOSTICS,
EMERGENCY REACTION
Check Point Tele medicine center
23

What is Medical center Check Point?
• Created 2010
• Over 9500 patients files with different telemedicine systems
• 24/7 monitoring of cardiac and gynecology data
• 6 doctors, 10 nurses
• With automatic data analyses , up to 15 000 patients capacity for
simultaneously monitoring
• Own ERP for management, first reaction within 2 minutes standard
• Certified by suppliers for 13 485 and ISO 9001 standards
• Know-how for spreading design and structure in other countries
• Created 2010
• Over 9500 patients files with different telemedicine systems
• 24/7 monitoring of cardiac and gynecology data
• 6 doctors, 10 nurses
• With automatic data analyses , up to 15 000 patients capacity for
simultaneously monitoring
• Own ERP for management, first reaction within 2 minutes standard
• Certified by suppliers for 13 485 and ISO 9001 standards
• Know-how for spreading design and structure in other countries
24

CP center
• Telemedical centre has emergency operators,
administration operator and call operator for
registration, observation and contact with the
patient, physicians and emergency centers
• This is the place where heart rate and its
variability, rhythm and conduction disorders are
analyzed, together with physical activity of the
patient, allowing some conclusions about
his/her current cardiovascular condition and
risk.
• In case a predefined critical condition is met,
short messages (SMS) are generated and sent to
the medical specialist, or/and call to the patient,
his physician or emergency centre are initiated.
• Telemedical centre has emergency operators,
administration operator and call operator for
registration, observation and contact with the
patient, physicians and emergency centers
• This is the place where heart rate and its
variability, rhythm and conduction disorders are
analyzed, together with physical activity of the
patient, allowing some conclusions about
his/her current cardiovascular condition and
risk.
• In case a predefined critical condition is met,
short messages (SMS) are generated and sent to
the medical specialist, or/and call to the patient,
his physician or emergency centre are initiated.
www.checkpointcardio.com

General statistics 2010-2014
• Total number of patients telemonitored with diferent checkpoint cardio systems =
9500
• Mean period for telemonitoring – 5.34 days
• Indications:
– Rhythm disorders – 74%
– Ischemia detection – 26%
• Detection of a new condition during telemonitoring (undocumented rhythm disorder,
evidence of ischemia) – 76.7%
• Telemonitoring resulting in therapy modification / change (either because of a new
diagnosis or because telemonitoring revealed that previous therapy was inappropriate
/ ineffective for the present patient condition) – 84.6%
• Urgent hospitalization for a condition detected during telemonitoring – 33.6%; mean
time from detection to hospitalization – 2 hours;
• Patient driven telemonitoring discontinuation due to side effects – 0.6%
• Total number of patients telemonitored with diferent checkpoint cardio systems =
9500
• Mean period for telemonitoring – 5.34 days
• Indications:
– Rhythm disorders – 74%
– Ischemia detection – 26%
• Detection of a new condition during telemonitoring (undocumented rhythm disorder,
evidence of ischemia) – 76.7%
• Telemonitoring resulting in therapy modification / change (either because of a new
diagnosis or because telemonitoring revealed that previous therapy was inappropriate
/ ineffective for the present patient condition) – 84.6%
• Urgent hospitalization for a condition detected during telemonitoring – 33.6%; mean
time from detection to hospitalization – 2 hours;
• Patient driven telemonitoring discontinuation due to side effects – 0.6%

Indications. Atrial fibrillation.
• Patients with suspected but undiagnosed atrial fibrillation:
– Clinical symptoms such as palpitations or dyspnoea should trigger ECG
monitoring to demonstrate AF, or to correlate symptoms with the underlying
rhythm - IIaB.
– Additional ECG monitoring should be considered for detection of ‘silent’ AF in
patients who may have sustained an AF-related complication - IIaB.
– It has been estimated that 7 day Holter ECG recording or daily and symptom-
activated event recordings may document the arrhythmia in around 70% of AF
patients, and that their negative predictive value for the absence of AF is
between 30 and 50%.
• Patients with known atrial fibrillation:
– When arrhythmia or therapy-related symptoms are suspected, ECG monitoring
should be considered - IIaC.
• Patients with suspected but undiagnosed atrial fibrillation:
– Clinical symptoms such as palpitations or dyspnoea should trigger ECG
monitoring to demonstrate AF, or to correlate symptoms with the underlying
rhythm - IIaB.
– Additional ECG monitoring should be considered for detection of ‘silent’ AF in
patients who may have sustained an AF-related complication - IIaB.
– It has been estimated that 7 day Holter ECG recording or daily and symptom-
activated event recordings may document the arrhythmia in around 70% of AF
patients, and that their negative predictive value for the absence of AF is
between 30 and 50%.
• Patients with known atrial fibrillation:
– When arrhythmia or therapy-related symptoms are suspected, ECG monitoring
should be considered - IIaC.
Management of Atrial Fibrillation, ESC, Focused Update from 2012; Guidelines for the
management of atrial fibrillation, 2010

Indications. Sudden cardiac death.
• Patients with primary risk factors of SCD :
– Patients experienced cardiac arrest and/or hemodynamically significant sustained ventricular tachycardia;
– Patients experienced myocardial infarction;
– Patients with syncope episodes ;
– Patients with systolic left ventricular dysfunction (ejection fraction of less than 40%) and/or episodes of unstable
ventricular tachycardia, established by instrumental examinations;
With patients with the above listed high risk factors, there is high possibility of recurrence of fatal ventricular rhythm
disorders with the development of acute heart failure and sudden cardiac death.
Recommended monitoring period : 7-10 days, four times a year.
• Patients with secondary risk factors of SCD :
– Patients with left ventricular hypertrophy;
– Patients with hypertension;
– Patients with hyperlipidemia;
– Patients with diabetes;
– Patients with hyper sympathicotonia;
– Patients with obesity;
– Smokers;
– Patients regularly using alcohol.
Recommended monitoring period : 7-10 days, two times a year.
• Patients with primary risk factors of SCD :
– Patients experienced cardiac arrest and/or hemodynamically significant sustained ventricular tachycardia;
– Patients experienced myocardial infarction;
– Patients with syncope episodes ;
– Patients with systolic left ventricular dysfunction (ejection fraction of less than 40%) and/or episodes of unstable
ventricular tachycardia, established by instrumental examinations;
With patients with the above listed high risk factors, there is high possibility of recurrence of fatal ventricular rhythm
disorders with the development of acute heart failure and sudden cardiac death.
Recommended monitoring period : 7-10 days, four times a year.
• Patients with secondary risk factors of SCD :
– Patients with left ventricular hypertrophy;
– Patients with hypertension;
– Patients with hyperlipidemia;
– Patients with diabetes;
– Patients with hyper sympathicotonia;
– Patients with obesity;
– Smokers;
– Patients regularly using alcohol.
Recommended monitoring period : 7-10 days, two times a year.

Indications. Bradyarrhythmia and syncope.
• When an intermittent bradyarrhythmia is suspected but not proven, the suspicion should be
corroborated by an ECG documentation of bradyarrhythmia or, alternatively, by laboratory
testing.
• Since most patients with syncope have infrequent symptoms, recurring over months or years,
long-term ECG monitoring is often necessary to establish a diagnosis
• When an intermittent bradyarrhythmia is suspected but not proven, the suspicion should be
corroborated by an ECG documentation of bradyarrhythmia or, alternatively, by laboratory
testing.
• Since most patients with syncope have infrequent symptoms, recurring over months or years,
long-term ECG monitoring is often necessary to establish a diagnosis
2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy

Other telemonitoring Indication Recommended
time period
History of undocumented arrhythmia 7-14 days
Suspected but undiagnosed AF 5-7 days
Rhythm disturbances in mitral valve prolapse patients 5-7 days
Rhythm evaluation after antiarrhythmic therapy initiation 5 days
Evaluation of heart rate in patients with permanent AF or bradyarryhtmia 3 days
Heart rate control after cardiac surgery 15 days
Heart rate and rhythm evaluation after ablation therapy 7 -15 days
Detection of “silent” AF in stroke patients or after peripheral embolic event 7 - 14 days
High risk patients for ventricular arrhythmia or sudden cardiac death (long QT syndrome, ARVD,
Brugada syndrome, ventricular preexcitation, MI patients with LV dysfunction etc)
14 - 28 days
First degree relatives of patients with congenital heart diseases associated with high risk for SCD 10-14 days
Syncope / presyncope, dizziness 7 days
Active / elite sport with extreme physical stress 3 days
High risk professional occupation 5 days

Verification
• Validation of the system was performed at National Cardiology institute in WARSAW,
Poland and National cardiological hospital, Sofia Bulgaria.
• We evaluated 60 patients, 22 (37%) of them female, mean age – 58 ± 8 y, applying
simultaneously standard Holter ECG and Checkpoint system.
• Two different comparisons were performed:
– ECG with standard 12-lead ECG
– Checkpoint Holter with standard ECG Holter
• The design of the study included simultaneous Holter ECG and Checkpoint system
monitoring for at least 20 hours.
• The protocol of the study included also 5 simultaneous ECG recordings (Checkpoint
and standard ECG) at baseline, 1st, 2nd, 6th hour and at the end of the monitoring
period.
• Patient compliance during the monitoring period was excellent.
• Validation of the system was performed at National Cardiology institute in WARSAW,
Poland and National cardiological hospital, Sofia Bulgaria.
• We evaluated 60 patients, 22 (37%) of them female, mean age – 58 ± 8 y, applying
simultaneously standard Holter ECG and Checkpoint system.
• Two different comparisons were performed:
– ECG with standard 12-lead ECG
– Checkpoint Holter with standard ECG Holter
• The design of the study included simultaneous Holter ECG and Checkpoint system
monitoring for at least 20 hours.
• The protocol of the study included also 5 simultaneous ECG recordings (Checkpoint
and standard ECG) at baseline, 1st, 2nd, 6th hour and at the end of the monitoring
period.
• Patient compliance during the monitoring period was excellent.
Mateev H, Simova I, Katova T, Dimitrov N. ISRN Cardiology 2012; article ID 192670, 8 pages

Verification – ECG comparison
• We analyzed ECG recordings considering 5 parameters: heart rhythm
(sinus rhythm, atrial fibrillation, atrial flutter), HR, SVEB, VEB and significant
pauses (> 2500 ms).
• For these parameters we have reported the percentage of coincidence
(accordance) between Checkpoint ECG and standard ECG.
• We have performed 297 standard ECG recordings and 297 Checkpoint
ECGs (mean number of ECGs per patient – 4.95 for each mode of
recording).
• We found a very high coincidence rate of 99.3% when Checkpoint derived
ECGs were compared with standard ECGs.
• We analyzed ECG recordings considering 5 parameters: heart rhythm
(sinus rhythm, atrial fibrillation, atrial flutter), HR, SVEB, VEB and significant
pauses (> 2500 ms).
• For these parameters we have reported the percentage of coincidence
(accordance) between Checkpoint ECG and standard ECG.
• We have performed 297 standard ECG recordings and 297 Checkpoint
ECGs (mean number of ECGs per patient – 4.95 for each mode of
recording).
• We found a very high coincidence rate of 99.3% when Checkpoint derived
ECGs were compared with standard ECGs.
Mateev H, Simova I, Katova T, Dimitrov N. ISRN Cardiology 2012; article ID 192670, 8 pages

Verification – automatic analysis comparison with Holter ECG
Parameter ECG Holter Checkpoint
system
Correlation ICC p value
Average HR 75 ± 14 74 ± 16 0.85 0.91 < 0.001
Maximal HR 130 ± 33 121 ± 19 0.42 0.48 0.017
Minimal HR 54 ± 14 48 ± 13 0.77 0.84 < 0.001Minimal HR 54 ± 14 48 ± 13 0.77 0.84 < 0.001
% time in tachycardia 10.2 ± 16.3% 9 ± 15.1% 0.59 0.72 < 0.001
VEB single 456 ± 618 363 ± 722 0.43 0.58 0.02
VEB couplets 109 ± 258 76 ± 195 0.75 0.47 0.01
SVEB single 815 ± 1002 315 ± 678 0.68 0.59 0.001
SVEB couplets 105 ± 218 33 ± 106 0.19 0.24 0.05

Typical case examplesTypical case examples

Supraventricular Ectopic beat

Ventricular ectopic beats - bigeminy

Ventricular ectopic beats - trigeminy

Interpolated venticular ectopic beats

Ventricular ectopic beats followed by ventricular tachycardia

Atrial Flutter

Atrial fibrillation

Registration of reestablishing of sinus rhythm on patient with Atrial
fibrillation

AV block 2 degree; 2nd type with conductivity in AV 2:1

Patient Cases

CASE 1: Patient with AVNRT detected during the telemedical
observation

•
Case 4 : 55 years old patient
• Hospitalized with an ischemic stroke, embolic etiology was sugessted, but an embolic source was
not found during diagnostic work out.
• In order to detect asymptomatic episodes of AF telemedical device was installed
Just on the 4th supervision day an asymptomatic AF episode was detected.
• Telemonitoring was ended – diagnosis secured;
• Anticoagulation therapy was initiated for secondary prophylaxis – prevention of stroke and
systemic embolism.

• Admitted at hospital with inferior STEMI
• SCAG revealed RCA occlusion and pPCI was performed
Case 6: 72-year-old man

• At discharge a Telemedical device was installed.
• Sinus rhythm with supraventricular ectopic beats.

• On the 1st day of observation a long-lasting (3 and a half hours) episode of
tachyarrhythmia – AF was registered.
• That required initiation of antiarrhythmic therapy and triple antithrombotic
therapy (anticoagulation included).

• Admitted at hospital with initial diagnosis Unstable Angina;
• During hospital stay no objective evidence of myocardial necrosis or inducible ischemia
was found
• At discharge Telemedical device was installed; telemonitoring revealed multiple
prolonged episodes of significant ST segment depression in modified V5 lead.
Case 7: 77-year-old man

• A decision was made for SCAG
• Single-vessel CAD with a significant LCx lesion
• PCI with LCx stenting was performed

Check Point new 09.2015 full

More Related Content

What's hot

Viewers also liked

Similar to Check Point new 09.2015 full

Check Point new 09.2015 full