A Review on Digital ECG Formats and the Relationships Between Them

A plethora of digital ECG formats have been proposed and implemented. This heterogeneity hinders the design and development of interoperable systems and entails critical integration issues for the healthcare information systems. This paper aims at performing a comprehensive overview on the current state of affairs of the interoperable exchange of digital ECG signals. This includes 1) a review on existing digital ECG formats, 2) a collection of applications and cardiology settings using such formats, 3) a compilation of the relationships between such formats, and 4) a reflection on the current situation and foreseeable future of the interoperable exchange of digital ECG signals. The objectives have been approached by completing and updating previous reviews on the topic through appropriate database mining. 39 digital ECG formats, 56 applications, tools or implantation experiences, 47 mappings/converters, and 6 relationships between such formats have been found in the literature. The creation and generalization of a single standardized ECG format is a desirable goal. However, this unification requires political commitment and international cooperation among different standardization bodies. Ongoing ontology-based approaches covering ECG domain have recently emerged as a promising alternative for reaching fully fledged ECG interoperability in the near future.

[1]  C. Zywietz,et al.  Digital ECG transmission from ambulance cars with application of the European Standard Communications Protocol SCP-ECG , 1994, Computers in Cardiology 1994.

[2]  S.P. Nelwan,et al.  Integration of multiple ECG databases into a unified framework , 2005, Computers in Cardiology, 2005.

[3]  Ioanna Chouvarda,et al.  Multimedia cardiologic data browsing and processing modules with the ORCA computer patient record , 1999, Computers in Cardiology 1999. Vol.26 (Cat. No.99CH37004).

[4]  Zhan-Jian Li,et al.  A multimedia system for assessment of attachment organizations and heart rate , 1998, Proceedings of the 20th Annual International Conference of the IEEE Engineering in Medicine and Biology Society. Vol.20 Biomedical Engineering Towards the Year 2000 and Beyond (Cat. No.98CH36286).

[5]  Karl F. Best Convergence and harmonization of standards organizations , 2007, 2007 5th International Conference on Standardization and Innovation in Information Technology.

[6]  D M Rector,et al.  Continuous image and electrophysiological recording with real-time processing and control. , 2001, Methods.

[7]  G. Ferrari,et al.  User interface database for digital SCP-ECG and epidemiological information , 1994, Computers in Cardiology 1994.

[8]  Bob Kemp SignalML from an EDF+ perspective , 2004, Comput. Methods Programs Biomed..

[9]  Ioanna Chouvarda,et al.  An ontology-based approach facilitating unified querying of biosignals and patient records , 2008, 2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[10]  G. Mandellos,et al.  e-SCP-ECG+ Protocol: An Expansion on SCP-ECG Protocol for Health Telemonitoring—Pilot Implementation , 2010, International journal of telemedicine and applications.

[11]  Giandomenico Nollo,et al.  Toward personal eHealth in cardiology. Results from the EPI-MEDICS telemedicine project. , 2005, Journal of electrocardiology.

[12]  Jianchu Yao,et al.  A wearable point-of-care system for home use that incorporates plug-and-play and wireless standards , 2005, IEEE Transactions on Information Technology in Biomedicine.

[13]  Y.C. Yang,et al.  An SCP compatible 12-lead electrocardiogram database for signal transmission, storage, and analysis , 2004, Computers in Cardiology, 2004.

[14]  E.D. Helfenbein,et al.  Philips medical systems support for open ECG and standardization efforts , 2004, Computers in Cardiology, 2004.

[15]  I. Cosic,et al.  A Mobile Device Based ECG Analysis System , 2008 .

[16]  J.P. Cunha,et al.  SIGIF: a digiw signal interchange format for biological signals , 1993, Proceedings of the 15th Annual International Conference of the IEEE Engineering in Medicine and Biology Societ.

[17]  Manolis Tsiknakis,et al.  A gateway between the SCP-ECG and the DICOM supplement 30 waveform standard , 2003, Computers in Cardiology, 2003.

[18]  J. L. Willems,et al.  A universal set of statement codes for the exchange and storage of diagnostic ECG interpretation results , 1991, [1991] Proceedings Computers in Cardiology.

[19]  P.W. Macfarlane,et al.  Development Of A Standard Communications Protocol For The Exchange And The Storage Of Digital ECGs , 1991, Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society Volume 13: 1991.

[20]  Barry D. Brown The FDA’s Digital ECG Initiative and Its Impact on Clinical Trials , 2005 .

[21]  P. Rubel,et al.  XML based mediation for automating the storage of SCP-ECG data into relational databases , 2008, 2008 Computers in Cardiology.

[22]  Chris D Nugent,et al.  A Web-based tool for processing and visualizing body surface potential maps. , 2010, Journal of electrocardiology.

[23]  R. Lux,et al.  Innovation and advantage of the DICOM ECG standard for viewing, interchange and permanent archiving of the diagnostic electrocardiogram , 2007, 2007 Computers in Cardiology.

[24]  Alois Schlögl An overview on data formats for biomedical signals , 2009 .

[25]  P. Marcheschi,et al.  ECG standards for the interoperability in patient electronic health records in Italy , 2006, 2006 Computers in Cardiology.

[26]  Neal Long,et al.  Open ECG data standard: Philips medical systems perspective , 2003 .

[27]  J.T. Cain,et al.  A high resolution ECG tool for detection of atrial and ventricular late potentials , 1996, Computers in Cardiology 1996.

[28]  N. Sarapa Quality assessment of digital annotated ECG data from clinical trials by the FDA ECG warehouse , 2007, Expert opinion on drug safety.

[29]  Haiying Wang,et al.  A markup language for electrocardiogram data acquisition and analysis (ecgML) , 2003, BMC Medical Informatics Decis. Mak..

[30]  Hans Jurgen Hoffmann,et al.  Practical telematics: electrocardiography applications in health care by using the Standard Communications Protocol , 1999, Computers in Cardiology 1999. Vol.26 (Cat. No.99CH37004).

[31]  S.P. Nelwan,et al.  An open source ECG toolkit with DICOM , 2008, 2008 Computers in Cardiology.

[32]  Chr. Zywietz,et al.  Compression and encoding of ECG data within the European standard communications protocol , 1991, [1991] Proceedings Computers in Cardiology.

[33]  M.B. Cunha,et al.  SIGIF: a digital signal interchange format with application in neurophysiology , 1997, IEEE Transactions on Biomedical Engineering.

[34]  C Zywietz SCP-ECG and Vital Signs Information Representation--two examples of successful transcontinental cooperation in medical informatics standardization. , 1998, International journal of medical informatics.

[35]  Haiying,et al.  ecgML : Tools and Technologies for Multimedia ECG Presentation , 2003 .

[36]  A Värri,et al.  A simple format for exchange of digitized polygraphic recordings. , 1992, Electroencephalography and clinical neurophysiology.

[37]  M.G.J.M. Gerritsen,et al.  The development of an application profile for DICOM waveforms in the cathlab , 1999, Computers in Cardiology 1999. Vol.26 (Cat. No.99CH37004).

[38]  Eizen Kimura,et al.  Development MFER(Medical waveform Format Encoding Rules) Parser , 2006, AMIA.

[39]  Jesús Daniel Trigo Vilaseca,et al.  Telemedicine frameworks in cardiology environments: contributions to follow-up services in specific scenarios and the integration and harmonization of interoperability and cardiology standards , 2011 .

[40]  Paul Rubel,et al.  Macro-data: a new approach for the development of tele-expertise applications , 1999, Computers in Cardiology 1999. Vol.26 (Cat. No.99CH37004).

[41]  Álvaro Alesanco Iglesias,et al.  Interoperability in Digital Electrocardiography: Harmonization of ISO/IEEE x73-PHD and SCP-ECG , 2010, IEEE Transactions on Information Technology in Biomedicine.

[42]  W. Zareba,et al.  The ISHNE Holter Standard Output File Format: A Step Toward Compatibility of Holter Systems , 1998 .

[43]  Huajun Chen,et al.  The Semantic Web , 2011, Lecture Notes in Computer Science.

[44]  Hsiu-Chiung Lo,et al.  The Clinical Application of a PACS-Dependent 12-Lead ECG and Image Information System in E-Medicine and Telemedicine , 2010, Journal of Digital Imaging.

[45]  Piotr J. Durka,et al.  SignalML: metaformat for description of biomedical time series , 2004, Comput. Methods Programs Biomed..

[46]  Chris D. Nugent,et al.  An XML Format for storing Body Surface Potential Map recordings , 2009, 2009 36th Annual Computers in Cardiology Conference (CinC).

[47]  Ioanna Chouvarda,et al.  Integrating SCP-ECG files and patient records: an ontology based approach , 2006 .

[48]  Oleg S. Pianykh,et al.  Digital Imaging and Communications in Medicine (DICOM) , 2017, Radiopaedia.org.

[49]  Sooyoung Yoo,et al.  A central repository for biosignal data , 2008, 2008 International Conference on Information Technology and Applications in Biomedicine.

[50]  F. Chiarugi,et al.  Enhanced integrated format and content checking for processing of SCP ECG records , 2006, 2006 Computers in Cardiology.

[51]  DongBack Seo,et al.  Theoretical perspective to analyze organizational strategy for information and communications technology standards , 2007, 2007 5th International Conference on Standardization and Innovation in Information Technology.

[53]  P W Macfarlane,et al.  Establishment of a reference library for evaluating computer ECG measurement programs. , 1985, Computers and biomedical research, an international journal.

[54]  C Zywietz,et al.  Common Standards for Quantitative Electrocardiography: Goals and Main Results , 1990, Methods of Information in Medicine.

[55]  Steve Warren,et al.  Applying the ISO/IEEE 11073 Standards to Wearable Home Health Monitoring Systems , 2005, Journal of Clinical Monitoring and Computing.

[56]  Bob Kemp,et al.  European data format ‘plus’ (EDF+), an EDF alike standard format for the exchange of physiological data , 2003, Clinical Neurophysiology.

[57]  T Penzel,et al.  Standards for biomedical signal databases. , 2001, IEEE engineering in medicine and biology magazine : the quarterly magazine of the Engineering in Medicine & Biology Society.

[58]  George Joseph,et al.  Implementation of the SCP-ECG protocol into stand-alone electrocardiographs , 1992, Proceedings Computers in Cardiology.

[59]  Thomas F. Collura,et al.  A standard for transfer of digital neurophysiological data , 1992, 1992 14th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[60]  R. Fischer,et al.  Integrated content and format checking for processing of SCP ECG records , 2004, Computers in Cardiology, 2004.

[61]  A. Kleijhorst,et al.  A testbed project for DICOM images and waveforms integration , 1998, Computers in Cardiology 1998. Vol. 25 (Cat. No.98CH36292).

[62]  Jocelyne Fayn,et al.  CAVIAR, a serial ECG processing and management system for pharmacological drug trials , 1991, [1991] Proceedings Computers in Cardiology.

[63]  J. Cimino Desiderata for Controlled Medical Vocabularies in the Twenty-First Century , 1998, Methods of Information in Medicine.

[64]  Sheng-Fu Liang,et al.  Construction and Application of an Electronic ECG Management System , 2007 .

[65]  Bernardo Gonçalves,et al.  An Ontological Theory of the Electrocardiogram with Applications , 2009 .

[66]  B. Fortner,et al.  HDF : THE HIERARCHICAL DATA FORMAT , 1998 .

[67]  C.E. Chronaki,et al.  Two-way converter between the HL7 aECG and SCP-ECG data formats using BioSig , 2007, 2007 Computers in Cardiology.

[68]  B. Widiger,et al.  Integrating the ECG enterprise-HES-EKG with the built-in vital signs information nomenclature , 2004, Computers in Cardiology, 2004.

[69]  Anthoula P. Anagnostaki,et al.  A novel codification scheme based on the "VITAL" and "DICOM" standards for telemedicine applications , 2002, IEEE Transactions on Biomedical Engineering.

[70]  W. Tzeng,et al.  Predicting hyperkalemia by the use of a 12-lead temporal-spatial electrocardiograph: clinical evaluations and model simulations , 2005, Computers in Cardiology, 2005.

[71]  Wang Gang,et al.  Developing a DICOM Middleware to Implement ECG Conversion and Viewing. , 2005, Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference.

[72]  Alpo Värri,et al.  Object oriented design of a new, standard file exchange format for vital signs , 1996 .

[73]  Nenad Sarapa,et al.  Quantitative Performance of E‐Scribe Warehouse in Detecting Quality Issues With Digital Annotated ECG Data From Healthy Subjects , 2008, Journal of clinical pharmacology.

[74]  G Hellmann,et al.  Extensible biosignal (EBS) file format: simple method for EEG data exchange. , 1996, Electroencephalography and clinical neurophysiology.

[75]  J R Daube,et al.  Standard specification for transferring digital neurophysiological data between independent computer systems (ASTM E1467-92) , 1993, Journal of clinical neurophysiology.

[76]  J. Lebak,et al.  Reconfigurable Point-of-Care Systems Designed with Interoperability Standards , 2004, The 26th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[77]  Chr. Zywietz,et al.  Communication and storage of compressed resting and exercise ECGs using the revised SCP-ECG standard , 2001, Computers in Cardiology 2001. Vol.28 (Cat. No.01CH37287).

[78]  C. Zywietz Standardized representation of vital signs for continuous care in cardiology , 1998, Computers in Cardiology 1998. Vol. 25 (Cat. No.98CH36292).

[79]  D. Hayn,et al.  A framework for the integration and homogeneous management of electrocardiography formats , 2010 .

[80]  C. Zywietz,et al.  Open ECG: A European project to promote the SCP-ECG standard, a further step towards interoperability in electrocardiography , 2002, Computers in Cardiology.

[81]  C Zywietz,et al.  Standard interchange for computerized electrocardiography. , 1993, Studies in health technology and informatics.

[82]  D. Wei,et al.  Web-based sharing of electrocardiogram: A framework for information publishing , 2009, 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[83]  Recommendations for measurement standards in quantitative electrocardiography. The CSE Working Party. , 1985, European heart journal.

[84]  H. Wang,et al.  Methods and tools for generating and managing ecgML-based information , 2004, Computers in Cardiology, 2004.

[85]  Huilong Duan,et al.  XML-ECG: An XML-Based ECG Presentation for Data Exchanging , 2007, 2007 1st International Conference on Bioinformatics and Biomedical Engineering.

[86]  Giancarlo Guizzardi,et al.  Using an ECG reference ontology for semantic interoperability of ECG data , 2011, J. Biomed. Informatics.

[87]  Bernardo Gonçalves,et al.  ECGAWARE: AN ECG MARKUP LANGUAGE FOR AMBULATORY TELEMONITORING AND DECISION MAKING SUPPORT , 2008, HEALTHINF 2008.

[88]  W.C. Tzeng,et al.  Detecting ECG characteristic points by novel hybrid wavelet transforms: an evaluation of clinical SCP-ECG database , 2005, Computers in Cardiology, 2005.

[89]  Wang Ling-ling,et al.  Developing a DICOM Middleware to Implement ECG Conversion and Viewing , 2005, 2005 IEEE Engineering in Medicine and Biology 27th Annual Conference.

[90]  G.J. Mandellos,et al.  Structuring the e-SCP-ECG+ protocol for multi vital-sign handling , 2008, 2008 8th IEEE International Conference on BioInformatics and BioEngineering.

[91]  Qiang Fang,et al.  An XML based middleware for ECG format conversion , 2009, 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[92]  良治 祐延,et al.  DICOM Digital Imaging and Communications in Medicine, ダイコム , 2003 .

[93]  Manolis Tsiknakis,et al.  ECG in your hands: a multi-vendor ECG viewer for personal digital assistants , 2003, Computers in Cardiology, 2003.

[94]  P. Rubel,et al.  ECG data interchange within the framework of the SCP-ECG and the OEDIPE projects , 1994, Computers in Cardiology 1994.

[95]  C. Weigand,et al.  Method and system for standardized and platform independent medical data information persistence in telemedicine , 2008, 2008 Computers in Cardiology.

[96]  Giancarlo Guizzardi,et al.  An ontological analysis of the electrocardiogram , 2009 .

[97]  Jos de Bruijn,et al.  Semantic Information Integration Inside and Across Organizational Boundaries , 2003 .

[98]  Towards open data interchange and processing of serial ECGs , 1992, Proceedings Computers in Cardiology.

[99]  Fabio Badilini,et al.  The ISHNE Holter Standard Output File Format , 1998 .

[100]  C. Zywietz,et al.  A web service for conformance testing of ECG records to the SPC-ECG standard , 2005, Computers in Cardiology, 2005.