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. 2018 Mar 1;15(3):428.
doi: 10.3390/ijerph15030428.

An Interoperable System toward Cardiac Risk Stratification from ECG Monitoring

Cristina Soguero-Ruiz  1 , Inmaculada Mora-Jiménez  2 , Javier Ramos-López  3 , Teresa Quintanilla Fernández  4 , Antonio García-García  5 , Daniel Díez-Mazuela  6 , Arcadi García-Alberola  7 , José Luis Rojo-Álvarez  8   9
Affiliations

An Interoperable System toward Cardiac Risk Stratification from ECG Monitoring

Cristina Soguero-Ruiz et al. Int J Environ Res Public Health. .

Abstract

Many indices have been proposed for cardiovascular risk stratification from electrocardiogram signal processing, still with limited use in clinical practice. We created a system integrating the clinical definition of cardiac risk subdomains from ECGs and the use of diverse signal processing techniques. Three subdomains were defined from the joint analysis of the technical and clinical viewpoints. One subdomain was devoted to demographic and clinical data. The other two subdomains were intended to obtain widely defined risk indices from ECG monitoring: a simple-domain (heart rate turbulence (HRT)), and a complex-domain (heart rate variability (HRV)). Data provided by the three subdomains allowed for the generation of alerts with different intensity and nature, as well as for the grouping and scrutinization of patients according to the established processing and risk-thresholding criteria. The implemented system was tested by connecting data from real-world in-hospital electronic health records and ECG monitoring by considering standards for syntactic (HL7 messages) and semantic interoperability (archetypes based on CEN/ISO EN13606 and SNOMED-CT). The system was able to provide risk indices and to generate alerts in the health records to support decision-making. Overall, the system allows for the agile interaction of research and clinical practice in the Holter-ECG-based cardiac risk domain.

Keywords: archetypes; cardiovascular risk stratification; electronic health records; heart rate turbulence; heart rate variability; semantic interoperability; web system.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Functional schema of the proposed sudden cardiac death (SCD) risk stratification system.
Figure 2
Figure 2
Archetypes used for defining the cardiac risk stratification (CRS) domain (a), the patient data subdomain (b), and the heart rate turbulence (HRT) (c) and heart rate variability (HRV) (d) subdomains. Archetypes selected from the Clinical Knowledge Manager (CKM) and used with no modifications are in white, specialized archetypes from the CKM are in green, and archetypes proposed in this work are in blue.
Figure 3
Figure 3
Interoperability schema of the data collection and transmission, as well as the elements and standards involved in the proposed system.
Figure 4
Figure 4
Screenshots to illustrate the workflow between EHR and RSEM: (a) demographic and clinical data from a patient recorded in the EHR; (b) OMG HL7 message; (c) risk stratification request generated in RSEM; (d) screenshot of the alert created in the EHR.
See this image and copyright information in PMC

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