Remote ECG monitoring systems will soon be commonplace medical devices for remote and long-term physiological monitoring, especially for that of the elderly and frail patients.

Remote ECG monitoring systems are long past their infancy. They have advanced past most issues of security and reliability and their use is steadily on the rise. They will soon be commonplace medical devices for remote and long-term physiological monitoring, especially for that of the elderly and frail patients. The systems will consist of three major components: a mobile gateway, deployed on the patient's mobile device, that receives 12-lead ECG signals from any ECG sensor; a remote server component that hosts algorithms for accurate annotation and analysis of the ECG signal; and a point-of-care device for the doctor to receive a diagnostic report from the server based on the analysis of the ECG signals. The wireless physiological information collection nodes of the wearable network will be connected to the patient's portable terminal, such as a personal digital assistant (PDA), smart phone, or other communication device, to send data. At the same time, it will also be capable of uploads, backup, analysis, and feedback of data to a remote medical service center through the Internet or mobile communications network.

Technology Update

Wearable systems. The wearable health monitoring system can be based on a microprocessor and customization platform, smart textiles, body area network, commercial Bluetooth sensor, mobile phone, etc. However, the variables involved in the performance of these systems are usually antagonistic, and therefore the design of usable wearable systems in real clinical applications entails a number of challenges that have yet to be addressed including sensor contact, location, rotation, signal correlation, and patient comfort, and two objective functions including functionality and wearability. These variables were optimized using linear and nonlinear models to simultaneously maximize the objective functions. The methodology and results demonstrated that it is possible to overcome most of the design barriers that have thus far prevented wearable sensor systems from being used in everyday clinical practice. Additionally, future wearable devices should rely on the body's own energy to operate. How to improve durability without reducing performance or increasing the size of the device is the challenge of designing a wearable device.

WBSN. The use of wireless body sensor network (WBSN) in the medical field aims at providing continuous monitoring of patients' physiological data. There are many reasons for innovating the mobile and ehealthcare systems, e.g., a daily monitoring of vital physiological parameters to the detection of an abnormal event accomplished by ambulatory monitoring. In a recent study a tele-home healthcare system, for example, has been proposed for remote patient monitoring. The system utilizes wearable devices, wireless communication technologies, and multisensory (cuffless blood pressure meter, ECG, and PPG sensors) data fusion methods. In another study, researchers have proposed a body sensor network (BSN), which allocates extra resources for important parameters like ECG, maintaining the security of data over the network. The integrated network of IEEE 802.11/WLAN and IEEE 802.16/WiMAX can bring a synergetic improvement to the telemedicine services on coverage, data rates, and quality of service (QoS) provisioning to mobile users. This integrated network will be able to provide services like emergency telemedicine, mobile medical data, mobile robotic system, and pre-hospital care.

System on Chip (SoC). A portable system on chip for ECG monitoring has been developed, which is capable of implementing configurable functionality with low power consumption. The SoC is implemented in 0.18 m CMOS process and consumes 32 W from a 1.2 V while heart beat detection application is running, and integrated in a wireless ECG monitoring system with Bluetooth protocol.

Hardware. The portable ECG monitor is developing toward a multi-channel, new record, digital, intelligent, network-sharing device that will use digital technology to improve work efficiency and accelerate timeliness. This will significantly improve the accuracy of clinical diagnoses. The research and development trends of ECG detection and analysis systems mainly include the following aspects: a compact instrument, and an acquisition synchronization of 12 channels. The portable ECG HOLTER system and the heart beeper are products of this developmental trend. Eventually, the multi-guide synchronous ECG detection system and the twelve-guide synchronous ECG detection system will replace the current application of a wide range of single-guide ECG detection systems.

Abnormalities detection. With the increased processing power of mobile devices, it has been possible to detect the abnormalities such as arrhythmia or cardiovascular diseases (CVD) from the acquired physiological data/signals. An early and, in some cases, real-time detection of such abnormalities will be able to provide quick treatment to the patient. There are systems that consist of wearable ECG recording system along with a server-based arrhythmia calculating and monitoring mechanism, which will let the physician know about the arrhythmic condition, if any. The patient will get the follow up from the physician through an Internet-enabled personal digital assistant (PDA). Scientists have also developed cellphone-based ambulatory and continuous ECG signal-processing systems. The Mobicare cardio monitoring system consists of a cellular phone embedded with real-time ECG processing algorithms (MobiECG), a wireless ECG sensor, a web based server, a patients' database, and a user interface. The system is capable of detecting the condition of atrial fibrillation (AF) and display the maximum heart rate (MH) and intensity of patient's body movements on GUI.

Future wearable equipment will pay more attention to the wearer's psychology and emotional state. These devices will not only collect information, but also regulate information. Wearable medical devices will not only detect the wearer's psychological and physiological parameters, but also make regulations to the body according to the collected information. They will have more implantable and separated equipment. The terminal will also be able to collect data to be processed and send an alert of sudden illness to the patient's family via the transmission of data.

Outlook

A number of technological breakthroughs and advancements have made possible cardiac telemetry to be evaluated remotely by a physician or other trained personnel. However, there are still several questions regarding their cost-effectiveness, the patient populations that could benefit from them, as well as how the transmitted data should be interpreted and acted upon by the patient's physician. Inherent problems in designing blind and bias-free trials for implantable devices, together with heterogeneity in study protocols, pose extra difficulties in their assessment.

Dr Sharat D Hegde,Consultant Physician, Bangalore Hospital and Excel Care Hospital, Bengaluru
Second Opinion
Still Holds Ground in Modern Clinical Practice

ECG has been one of the earliest investigations discovered in the modern medical practice. Though now with advent of advanced cardiac care facilities ECG is losing its relevance as a diagnostic tool, but still has relevance in the screening tool especially in the peripheral setup. It continues to be the screening tool for the heart related illnesses. ECG has come a long way in modern practice. From large machine that fills the room to tiny hand held devices. A miniature version where 3 leads can be recorded by connecting to the finger tips is also available in the market. But conventional portable device which can record 12 leads is still the preferred machine for ECG recording.

The print is usually taken on a carbonated paper with square boxes printed on the paper, which helps for the various calculations to be made for the interpretation of ECG. Although with well-trained eyes ECG serves a very useful tool for screening still it needs to be confirmed with advanced tests to ascertain the suspected abnormality.

Few limitations of ECG are that it can be normal in certain conditions where further testing may warrant based on the symptoms, difficult to record in uncooperative patients and does not give much information on patients with permanent pacemakers.

With good history, careful examination of patient and an ECG interpretation with corroborative clinical findings still holds ground in modern clinical practice.

Dr Sharat D Hegde,
Consultant Physician,
Bangalore Hospital and Excel Care Hospital,
Bengaluru


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