You can access now the recording of our November online joint webinar of the Tele-Cardiology Working Group of the International Society for Tele-Medicine and eHealth (ISfTeH) and the European Commission representatives, held on 7 november 2019.
You can download the sildes of the presentation below.
Top speakers discussed about the future directions of the European Union digital health sector and also update us on general data protection regulations (GDPR):
Mme. Ioana-Maria GLIGOR (European Commission-Head of European Reference Networks and Digital Health Unit)
M. Dalibor VOJTA (European Commission)
Also visit our NEW website (www.telecardiologywg.isfteh.org), and share information on our Facebook group, on Twitter and on our LinkedIn group. The Tele-Cardiology Working Group of the International Society for Telemedicine & eHealth is a working group dedicated to all advances in cardiology that involve artificial intelligence, computers, cardiac devices and IT. Thank you for sharing this post to your friends interested in eHealth and eCardiology.
The ESC Digital congress was a bold and
successful initiative of the European Society of Cardiology, and took place in
Tallin, a few days ago. The location was not chosen by hazard, as Estonia has
99% of health data digitized and 99% of prescriptions are digital. Prof.
Viigimaa exposed the architecture of the Estonian Electronic helth system in a
at the beginning of the congress.
of digital healthcare
was reviewed by Prof. Martin Cowie in an excellent presentation,
where he highlighted that we need to identify barriers and find appropriate
solutions on this emerging sector. We will always find at the center of our
care the patient and his family, and this aspect should not be overlooked or
forgotten, especially in this rapid-digitalized era.
Patient care, patient empowerment
and nursing issues
were also addressed by Prof. Donna
Fitzimons and ACNAP President-Elect
Lis Neubeck, with accent on developing the short and longer path to
action which have in center the patient and the nurse (as midlevel team
member). Digital nursing sessions drawed a lot of constructive comments, with Donna Fitzimons opinioned that
if the patient is art ease at using online interaction with a “digital” nurse
(avatar talking and guiding the patient by means of AI), then we should use
this technology mainly to prevent, and not to treat. Find below the interesting
slides from the presentations and their link
to full presentations.
A very interesting session addressed the issue
of preparing the healthcare force for
the digital future chaired by ACCA President
Susanna Price. Even though some solutions have been highlighted in a
paper, like as the need for a culture of learning (develop extensive
learning environment, encourage innovation and dare to fail), building a strong
learning infrastructure and developing a multi-professional and collaborative
approach to learning, these approaches are unachievably in the current state of
the medical system in Europe, where most of the current medical personnel are
disengaged or over-fatigued, doctors and nurses are burned-out.
Does technology make things worse for the
medical workers? Can artificial intelligence and automation ease things? See
all the debate here.
The same issue was addressed in another session.
While trying to find solutions for the future, present issues of healthcare
professionals and the digital boom relate to lack of trust and poor experience
with new technologies, difficulty to interact with technology, fear of change. This
is maybe where artificial intelligence could make the difference, as it can
improve healthcare efficiency and delivery and could replace human involvement
in some tasks of the medical industry, as suggested Dr. Casado Arroyo. However,
for the moment, present algorithms are not completely in their mature stage.
Cybersecurity was a hot topic. Dr. Avi Fischer
resumed some of the important cautions to take in reducing cybersecurity risks,
sharing responsibility between
stakeholders-healthcare facilities, patients, providers, and manufacturers of
cybersecurity should be a priority
during the design and development phase of the medical device and the issue
should be addressed in a “Bolt-On to Integrated” fashion;
if a vulnerability is found,
communication and coordinated actions between stakeholders and healthcare
facilities are vital. Development and involvement of government structures to
assure security is very important.
The participants also expressed the
urgent need for developing secured protocols to transmit data.
A special session to electronic medical record (EMR) can be accessed here.
The consensus was that even though EMR are an efficient data base that can help
health professionals in decision making, it is also time consuming. A new concept
that consists on “less keyboard, more patient contact” should be adopted,
because according to one study, for every hour
physicians provide direct clinical face time to patients, nearly 2 additional
hours is spent on EHR and desk work within the clinic day, and outside
office hours, physicians spend another one
to two hours of
personal time each night
doing additional computer
and other clerical
work. Dr. Nico
highlighted an important limitation of EMR used in Europe (vs. US), notably in
Europe we use more than 30 languages that makes data collection difficult, and
that should probably be aimed by a future Horizon 2020 project.
Augmented, mixed and virtual reality discussions were
divided into cardiologist-related and patient-related. The 3 terms are
intercorrelated and should not be confused one with another, here is their
meaning and a schematic representation:
Virtual reality (VR) immerses users in a fully artificial digital
Augmented reality (AR) overlays virtual objects on the real-world
Mixed reality (MR) not just overlays but anchors virtual objects to
the real world.
The 2 main applications
in medicine targets the patients and of course the doctors.
For patients, one
of the presenters suggested that VR will do for patient education what
Google Maps has done for navigation, thus it “will transform learning
experiences by better retention and recall, it will improve patient journey and
will determine behavioral change by challenging health beliefs through
For doctors, Dr. Dariusz Dudek
explained how a pioneer programe of mixed reality that is currently used in
Poland helps cardiologists choose a better punction site for TAVI, with
expectancy in the very near future to have VR mask that will allow
cardiologists to have echo, CT and eventually other 3D reconstructions in the
corner of their eyes, while a cardiac intervention is taking place. Other
important applications are stroke recovery and cardiac rehabilitation.
One of the worries highlighted was that this
new technology could cause anxiety in healthy fit subjects, translating into
unnecessary consultations either by their general practitioner either by their
cardiologist, as presented by Prof.
Martin Cowie. 57% of subjects from the “Apple heart” study thought
to seek medical attention after having an alarm from a smart device.
Even though wearables and connected devices
impact sometimes positively our daily lives (sleep apnea analysis app, selfie
to quantify oedema app, accelerometers incorporated into devices that quantify
daily effort, smartphone-based blood pressure measurement by transdermal
optimal imaging, etc), Dr.
Klaus Witte highlighted that there is increased concern that
wearables and connected devices impact negatively the society by increased (but
unnecessary) cost to the consumer and increases (but unnecessary) cost to the
medical system (by over-investigating a healthy person thus launching a battery
of tests like holter ECG, echocardiography, stress test). With this in mind,
there was a unanimous consensus that medical wearables and connected devices
should target special groups of populations if we want to avoid death, strokes
or hospitalizations and the clinical benefit of these kind of devices should be
carefully thought and evaluated.
Digital technology can help healthcare by
providing new tools for diagnosis and therapy delivery, redesigning clinical
pathways, individualized risk stratification and individualized care, patient
empowerment, support to precision medicine (thus fewer medical errors), and
telemonitoring. Digital technology and connected devices (tablets, wearables,
apps) will enhance decision making of health professionals only if there is a
direct link towards a clinical benefit, and maybe they would have a huge impact
if they could be directly linked also to EMR. In real life, adoption of digital
technology in healthcare depends on validation, easy integration of workflow
& prescription pathways and ability to reduce work.
Consumers could think that by using digital
technology and connected devices, they take control over their health; this is
partially false because alarms issued by devices could translate into
unnecessary consultations and increased cost to overall health system by doing
unnecessary tests in otherwise healthy subjects. Narrowing the indications and
the target population for the use of this devices should be a priority.
And finally, some punctual issues need rapid
and clear solutions: stricter security protocols should be incorporated in data
transmission, regulations should be adopted for all digital technology (there
are too many devices and few regulations), the huge amount of data (that is
collected from all digital technology) needs to be transformed into
#Sensium is a wireless system that monitors vital signs (temperature, respiration and ECG) in the low-risk post-surgery patients. It costs 20€/patient. The nurse is alerted if any of the parameters is abnormal and takes action.
#Sensordot is a device that can measure ECG, motion, blood pulse flow and respiration with autonomy of 24h.
#LabPad is a smart device that tests INR in 5 seconds… costs around 700€. Very useful for our patients under VKA.
#mawi wrist band is an ingenious device similar to the FitBit, however, it is able to provide a 1channel ECG.
Even though I found all the devices and software very interesting, I would say that the @mawi wrist band has by far the biggest potential, due to its capability to provide a 1 channel ECG and due to its low price (around 30€).
#Cardiologs is a cloud-based start-up that uploads 7 days holter ECG and interprets it faster and more accurate.
#Carnalife is a portable telemedical system combining artificial intelligence and augmented reality simulations of CT and MRI scans
#implicity gathers all pacemaker and defibrillator brands under one platform, interprets data and sends it quickly to cardiologists for appropriate response. @escardio
#Cardiomatics is a cloud-driven tool for ECG analysis
#PhysioMem from GETEMED is a 2-channel ECG equipped with 3G that can send instantaneous ECG of your patient directly to your inbox. It is the size of an Iphone, with 4 contact points to the skin and costs 450€ with a monthly fee of 20€ for the 3g.
#CardioSecur also presented their successful solution for 12 and 15 channel ECG acquisition, using a mobile device.
#Cardiocity is a 1 or 6 lead home-ECG monitoring device, which costs around 1000€.
#Comarch ECG monitoring vest allows 30 days one-lead ECG via 3g connection with a cardiologist. Ideal for primary and secondary prevention.
- Head of Interventional Cardiology, Centre Hospitalier Montluçon, France - Editor in chief CCRJ (Cardiology Case Reports Journal) - Editor in chief secondary JFCC (Journal Francophone de Cas Cliniques)
- FESC : Fellow of the European Society of Cardiology
- ESC Research Grant winner