Title: An Intelligent Platform for Personalized Remote Monitoring of the Cardiac Patients with Electronic Implant Devices http://www.srdc.com.tr/icardea/
1An Intelligent Platform for Personalized Remote
Monitoring of the Cardiac Patients with
Electronic Implant Devices http//www.srdc.com.tr
/icardea/
- Catherine Chronaki
- On behalf of SRDC and the iCardea Consortium
Credit J. Brugada
2Causes of death in heart failure
3Cardiac Implantable Electronic Devices
- Pacemaker (PM)
- Implantable Cardioverter-Defibrillator (ICD)
- Cardiac Resynchronization Therapy (CRT)
- Implantable Loop recorder (ILR)
- Implantable Hemodynamic Monitoring (IHM()
4Cardiac Implantable Electronic Devices
- Pacemaker (PM)
- Implantable Cardioverter-Defibrillator (ICD)
- Cardiac Resynchronization Therapy (CRT)
- Implantable Loop recorder (ILR)
- Implantable Hemodynamic Monitoring (IHM()
5The number of cardiac implants in increasing..
- Expected exponential increase over the next years
- 2 million patients worldwide
- 2007
Pacemakers ICDs CRTs
North America 564.074 234780 148092
Europe 683472 87747 61010
6Telemonitoring technology in the EU
7Device Telemonitoring opportunities
8Device Telemonitoring opportunities
9Management from home-ICD opportunities
10Device-Centric Diagnostics
11Status of Affairs in interoperability
12iCardea Objectives
- There has been an exponential growth in the
number of cardiac implantable devices 800.000
CIED patients in EU with 5.8 million follow-up
visits - CIED electronic and software complexity have
widen their function and application - However, due to their limited processing
capabilities restricted by their size, CIEDs need
to be supported with software running on the data
centers - Currently, the data center processing is
standalone with their custom software and
proprietary interfaces - Patient and device data is stored in data centres
operated by the vendors - Presented via secure Web-sites to the access of
responsible healthcare professionals - Access to follow-up information often requires
clinicians to use multiple vendor specific
systems and interfaces, reducing efficiency
13CIED Data Exposure Module
- iCARDEA aims to expose CIED data through standard
interfaces based - International standards such as HL7, ISO/IEEE
11073 (Point of Care Medical Device Communication
Standards) - Standard profiles such as Integrating the
Healthcare Enterprise (IHE) Implantable Device
Cardiac Observations (IDCO) Profile - Standard transport protocols such as Web Services
- iCARDEA will provide the necessary
authentication, authorization and secure transfer
of data mechanisms based on solid standards and
profiles - As a result...
- CIED data will be ready to be integrated into the
automated clinical follow-up workflows - By exposing CIED data through standard
interfaces, interoperability of data coming from
CIEDs from different vendors will be made
achievable
14Personalized Adaptive Care Planner for CIED
Recipients
- Personalized follow-up of CIED patients will be
coordinated through a care plan - An executable definition of a care pathway that
consists of computer interpretable clinical
guideline models - Control flow of the care plan will be dynamically
adapted based on the patients context - Personalized Adaptive Care Planner Engine
- Care plan will be constructed through re-usable
building blocks to be personalized for each
patient - Subscribe to necessary context variables provided
by the data source services - Interact with the existing healthcare
institutions for operations like scheduling
in-clinic follow-up with the responsible
physician - Check the existing healthcare records from EHR
systems - Provide reminder and personalized guidance
services to the patient to enable improved
compliance with the follow-up
14
15Interoperability Infrastructure for EHRs, PHRs
and Code Systems
- Follow-up of CIED patients requires access to
medical history and other clinical information of
the patients that are stored in EHR and PHR
systems - iCARDEA will develop Interoperability
Infrastructure for EHRs - Enable the legacy EHR systems of the end-users
(in whatever format they are) to expose EHR using
HL7 CDA as the EHR content standard and HL7 Web
Services Profile as the transport protocol
standard - Interoperability Infrastructure for Personal
Health Records - IHE Exchange of Personal Health Record Content
(XPHR) Profile will be implemented in iCARDEA - Code Mapping API
- Handle automatic mapping of coded terms from
different code systems by implementing HL7 Common
Terminology Services (CTS) interfaces - Unified Medical Language System Knowledge Source
Server (UMLSKS) - The implementation will be exposed as Web
Services as defined by the CTS
16Data Analysis and Correlation Tool
- For detection of further complications such as
contraindications and co-morbidities - Analogical reasoning will be used
- Analyze patients various physiological
parameters such as blood pressure, pulse and
electrocardiogram (ECG) gathered via CIED Data
Exposure Module together with the patient data
extracted from electronic healthcare records or
patient health records - Correlate the data with the data stored in
established biomedical knowledge bases, such as
PhysioNET, to extract hidden patterns and trends
in data which leverages the quality and
effectiveness of decision making and to alert
doctors in an unusual situation or unexpected
profile deviations
17Patient Empowerment Framework
- iCARDEA will provide a Web based Personal Health
Record (PHR) system - Patients will be able to view their medical
history, CIED data, and manage their medication
summaries, daily nutrition information - iCARDEA targets high acceptance of patients and
gain the maximum clinical and social benefit - Tools for patient education and feedback will be
provided - Static and dynamic educative materials such as
written guidelines and interactive demos - Facilitate connection with the responsible
healthcare professional for enabling patients to
send and retrieve feedback about their health
status - Patient controlled and configurable privacy
mechanisms and enhanced security mechanisms will
be provided - Privacy will be managed by the patient himself
through the Patient Consent Editor
17
18iCARDEA Architecture
18
19iCARDEA Pilot Application
- Deployment will be in Salzburg Clinics in Austria
with two groups of patients - First group of ICD patients with ordinary
post-surgical control (twice per year), - Second group of ICD patients with
iCARDEA-enhanced remote monitoring, each group
between 20-50 persons - The aspects of evaluation and validation will
include - Possible medical risks which could be detected
earlier - Management of symptoms
- Time and pathway from patient symptoms to
clinical decision in response to the symptom - Indicators on how remote iCARDEA monitoring can
reduce risks for the patients (concerning the
device and medical risks) - Usability and acceptance (patients, medical
experts) - Patient well-being
- Current barriers and limits perspectives for
future developments - Adequacy of the iCARDEA security and privacy
measures
20iCardea Data Sources
- Cardiovascular Implantable Electronic Devices
- Pace Maker
- Implantable cardioverter defibrillators (ICD)
- Cardiac Resynchronization Therapy (CRT) device
- EHR
- Previous or ongoing healthcare problems
- Medications
- Family History
- PHR
- Dietary
- Daily usage of medications
- Allergies
- Physical Activities
21Example Data to be used in Decision Support
- History of non-cardiac conditions
- Detailed information about severity of each
condition (e.g., specifics of therapy for the
condition) - The medications
- The non-cardiac conditions denoting
contraindications to the proposed therapies
22An Example the Prognosis of Heart Failure
- Predictors come from different sources
- From EHR and PHR
- Demographics
- Body Weight, Physical Activity
- The medications (including angiotensin-converting
enzyme inhibitors and beta-blockers) - Problems Hypotension, Diabetes, Anaemia, Chronic
obstructive pulmonary disease, Depression, Sleep
related breathing disorders - From CIED
- Electrophysiological Tachycardia, Complex
Ventricular Arrhythmias, Atrial Fibrillation,
Heart Rate Variability - The onset of atrial fibrillation has also shown
to be a predictor sudden cardiac death - An increase in mean heart rate has been shown to
predict an increase in cardiac mortality - Accumulation of consecutive day-to-day
differences between the daily and reference
impedance can predict heart failure
23Foreseen Decision Making Processes
- An Example
- A patient with ischemic cardiomyopathy is
discharged with a ICD implantation - Data followed diagnostic data on heart rhythm,
atrial, and ventricular arrhythmias accompanied
by IECG (VT, VF, SVF Detection, Ventricular
Episodes, Mode Switch episode duration,
Ventricular Rhythm, Mean Ventricular Rate, Mean
Ventricular Extrasistole, CRT Pacing ) - From this data, atrial and ventricular arrhythmia
development is detected (Early detection of
Asymptomatic clinical event) - Combining this data with data coming from the
patients EHR and PHR, the following becomes
possible - Change in drug therapy by considering
- Comorbidities
- Intolerances to certain drugs
- Current medications
24iCARDEA consortium
Partner no Partner name Partner org. short name
EHR-profiles Software Research and Development and Consultancy Ltd. SRDC, Turkey
Research OFFIS e.V. (OFFIS) OFFIS, Germany
Research Salzburg Research Forschungsgesellschaft m.b.H SRFG, Austria
interoperability Foundation for Research and Technology Hellas Institute of Computer Science FORTH, Greece
Hospital Salzburger Landeskliniken BetriebsgesmbH SALK, Austria
ICD manufacturer St. Jude Medical Medizintechnik Ges.m.b.H SJM, Austria
ICD manufacturer Medtronic Österreich GmbH Medtronic, Austria
hospital Hospital Clinic I Provincial de Barcelona HCPB, Spain
25iCARDEA Architecture
25
26Thank very much you for your attention
- http//www.srdc.com.tr/icardea/