Thanks to CSC’s technology, the results of the ECG from several manufacturers have been converted into a standard interoperable format standard.

El Hospital Clínic in Barcelona, reference center in both teaching and health care, has carried our a technology integration in order to ensure that all its digital electrocardiograms share a common format. In this manner, the electrocardiograms generated by devices from multiple manufacturers (GE, Philips, Gem-Med, Welch Allyn and Mortara), are converted into DICOM Waveform, independently from their previous format and the original device’s technology.

The use of this unified format facilitates storing all the digital electrocardiography of the Hospital Clinic in a central repository, accessible by other applications, without having to resort to departmental solutions which are difficult to integrate with the rest of the systems.

The chosen format (DICOM Waveform) is a standard on which the electrocardiogram’s waveforms are stored numerically in the file within a clinical context and correctly linked to the patient’s data, furthermore these waveforms can be recovered and represented without any loss of quality by any clinical visor that supports the standard.

Example of DICOM Waveform ECGs checking with MEDViewer

Addition advantages

The chosen solution has the following additional advantages:

• Better use of the hospital’s image storing infrastructure: electrocardiograms can be stored in the PACS, the centralized medical image file system.
• Quick learning curve: users do not require a specific training, given the fact that the tools used for storing and accessing the information are the same as the ones used in other health care workflows with which they are already familiar.
• Scalability: Because this solution is based on an integration server and electrocardiographs with network connection, it allows for the incorporation of additional electrocardiographs without having to carry out further software installations.
• Integration: the interoperability promotes the disappearance of information “islands”, so that electrocardiography studies can be looked up by an authorized user at any time from any location.

Additional information

The described technical solution is based on MIO ECG, C2C’s multi-manufacturer digital electrocardiography integration software. Within the framework of this project, C2C has also provided software development and system integration services.

The Mediterranean Ophthalmological trust (FOM) initiated on the 10th of February the first ocular checkup of the approximately 20.000 that will carry out within the framework of the program in 2011. C2C’s technology has been key to guaranteeing the processing of the huge amount of medical images associated to the studies.

The project which the “No sightless diabetics” program starts up with is framed within the Valencian Community’s 2006-2010 diabetes plan, and envisages 6.200 check-ups of diabetics in Vinaroz’s Department of Health; 4.100 in Requena’s Department of Health; and 9.200 in Alcoy’s Department of Health during 2011.

Retinography study. (c) 2010 FOM

For the project’s implantation, FOM has provided 4 retinographs that will go over the different Healthcare Centers of the aforementioned departments. All patients will be called from their Healthcare Centers seven days in advance.

In total, around 20 diabetics per retinograph and day will be examined. This will result in 400 diabetics monthly per retinograph or 4.800 diabetics yearly per retinograph. The program’s goal is the early detection of diabetic retinopathy among the community’s diabetic population who isn’t currently being treated by an ophthalmologist.

FOM’s nurse assistants will collect every patient’s data and history, evaluate their visual acuity and carry out a retinography for each eye.

Technological solution

With C2C’s MIO™ technology, the images obtained by the retinographs are sent in a secure way to a centralized repository based on MEDTING, where an automatic screening algorithm evaluates them and detects the presence or absence of lesions in the retina. Thanks to the integration carried out by C2C, the results of the screening process, stored in MEDTING, can be consulted directly by FOM ophthalmologists, allowing them to filter those patients with lesions for a later additional checkup and issuing of a new diagnostic.

Management of Diabetic Retinopathy images in MEDTING.

The automatic screening solution integrated by C2C aims to reduce the workload of the doctors assigned to the Healthcare Centers by half, as well as optimizing the dedication of the ophthalmologists, who will be able to allot their working hours to visit patients with lesions instead of reviewing negative retinographies (without pathologies) and issuing reports.

Review of Diabetic Retinopathy images in MEDTING.

Furthermore, the use of this automatic platform will allow to establish the necessary exam periodicity to these patients for an early diagnostic, thus improving resource management and minimizing the personal and social costs of this illness.

Management of Diabetic Retinopathy cases in MEDTING.

Predominance of Diabetic Retinopathy

The prevalence of diabetes among the general population of the community is of the 14%, according to the study “Valencia de Diabetes”, which was carried out by Dr. M. Catalá, director of the Community’s diabetes plan.

Diabetic Retinopathy is one of the most common complications among patients with type 1 and type 2 diabetes. It is estimated that between 15% and 30% of the diabetics suffer it.
This pathology is the second cause of blindness in Spain and the first cause of total sight lose in working age. This illness consists in a progressive damage to the retina’s blood vessels (the part of the eye sensible to the light), that can end up causing a total blindness.

The best protection against the progression of the diabetic retinopathy, apart from controlling the diabetes, is a complete eye exam. For the early detection of this illness, the diabetic patients have to be aware of the risk of ocular disorders and have to carry out periodic check-ups.

(Source: Mediterranean Ophthalmological trust and in-house contributions)