TRANSMISSION OF DIGITAL ELECTROCARDIOGRAM TRANSMISSION OF DIGITAL ELECTROCARDIOGRAM

BY MODEM CONNECTION IN RURAL BRAZILBY MODEM CONNECTION IN RURAL BRAZIL

A L F Sparenberg, T Russomano, M A dos Santos, D F G de Azevedo

Microgravity Laboratory/IPCT-PUCRS, Porto Alegre, RS, Brazil.

Sociedade de Medicina de Sao Lourenco do Sul, RS, Brazil

adolfosparenberg@hotmail.com

Digital ECG System (D.E.S.)Digital ECG System (D.E.S.)BackgroundBackground

The lack of cardiologists to analyze electrocardiograms (ECG) in small cities around The lack of cardiologists to analyze electrocardiograms (ECG) in small cities around the world, especially in developing countries, frequently delays the correct diagnosis the world, especially in developing countries, frequently delays the correct diagnosis of cardiovascular emergencies. Thus the delay in the provision of an analysis of an of cardiovascular emergencies. Thus the delay in the provision of an analysis of an emergency ECG in Sao Lourenco do Sul (SLS) Brazil, a city with a population of emergency ECG in Sao Lourenco do Sul (SLS) Brazil, a city with a population of 44,000, averaged 24 h before the introduction of a digital ECG system (DES) which 44,000, averaged 24 h before the introduction of a digital ECG system (DES) which allowed electronic data transmission to, and interpretation by, a remote cardiologist.allowed electronic data transmission to, and interpretation by, a remote cardiologist.

Total Area: 8.547,404 km2 - Length of coast line: 7491 km

Population: 176.000.000 - Language: Portuguese

Source: Brazilian Institute of Geography and Statistics

RSRS

Rio Grande do Sul (RS)Rio Grande do Sul (RS)

# Population: 10.398,133 inhabitants -Urban : 8.601.491 inhabitants -Rural : 1.796.642 inhabitants

# European Immigration: Late 19th century

# Climate: Temperate

Source: State Government 2002

                                                                         

Sao Lourenco do SulSao Lourenco do Sul

Porto Alegre - capitalPorto Alegre - capital

• 497 cities497 cities

Porto Alegre - CapitalPorto Alegre - Capital

City - Sao Lourenco do Sul, RS, Brazil

PopulationPopulation

Total: 43.691 inhabitantsTotal: 43.691 inhabitants - Urban 23.463 inhabitants- Urban 23.463 inhabitants

- Rural 20.228 inhabitants- Rural 20.228 inhabitants

Economic activity - Agriculture / CattleEconomic activity - Agriculture / Cattle

Source: State Government 2000

Hospital Santa Casa / Urban HospitalHospital Santa Casa / Urban Hospital Walter Thophern Hospital /Rural HospitalWalter Thophern Hospital /Rural Hospital

Sao Lourenco do Sul, RS, BrazilSao Lourenco do Sul, RS, Brazil

# 2 Hospitals (1 Urban / 1 Rural)# 2 Hospitals (1 Urban / 1 Rural)

# 43 Physicians# 43 Physicians

# 2 Cardiologists# 2 Cardiologists

Mean time for ECG Analyses – 24 h, unsuitable for cardiovascular emergenciesMean time for ECG Analyses – 24 h, unsuitable for cardiovascular emergencies

D.E.S.D.E.S. METHODS AND MATERIAL METHODS AND MATERIAL

# Wincardio - Digital ECG Machine

# Computers - 1 Desktop/modem/host/patient 1 Laptop/modem/cardiologist # Telecommunication Software - PC Anywhere/Symantec # Phone Lines - Fixed/Conventional Cell phone line (9.600 bits/s)

D.E.S.D.E.S. METHODS AND MATERIAL METHODS AND MATERIAL

# WINCARDIO - Digital ECG machine - 12 channel - Serial interface to PC/57.600 bps - Response frequency: 0.05 – 128 Hz - A/D conversion 12 bits/sample

300 samples/s/channel - >100 MHz Pentium PC

1 PC (Desktop / Host)

Pentium > 100 MHz

Modem 56 K

Serial interface

Windows 95, 98, 2000 or XP

1 Laptop (Remote/Cardiol)

Pentium > 100 MHz

Modem 56 K

Serial interface for cell phone

Windows 95, 98, 2000 or XP

# COMPUTERS

D.E.S.D.E.S.METHODS AND MATERIALMETHODS AND MATERIAL

# TELECOMMUNICATION SOFTWARE

PC Anywhere 32, 7.5 version – Symantec - HOST / Hospital - REMOTE / Cardiologist (Modem connection)

# PHONE LINES

-Remote Cardiologist

Cell Phone Nokia model 6120i cable DLR-3P

- Urban Hospital

Fixed/Conventional Phone line

- Rural Hospital

Cell Phone Nokia model 7160i cable DLR-3P

D.E.S.D.E.S.REQUIREMENTSREQUIREMENTS

# Time Effective: Early Diagnosis (on-line)

# Cost Effective: Developing Country

# Collaborative Technology: “User Friendly Systems”

# Enrolment of a Cardiologist

D.E.S.D.E.S. ANSWERS TO REQUIREMENTS ANSWERS TO REQUIREMENTS

# Time effective – ECG transmission and analyses in approximately 10 min

# Cost effective - Wincardio: U$ 1.100 Computers: U$ 2.000 PC anywhere: U$ 150 Cell / Fixed phones: U$ 200 TOTAL U$ 3.450

# Collaborative Technology - Windows 95, 98, XP - Easy to teach and to learn ( User Friendly System.) - High level of team motivation

# Ensure the participation of local or regional Cardiologist.

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D.E.S.D.E.S.

RESULTSRESULTS

1. A total of 1,100 digital ECGs have been made in the two hospitals since the implementation of D.E.S.

2. The time between data transmission and analyses with D.E.S. was around 10 min, which markedly decreased the previous estimated period of 24 h.

3. The utilization of a cell phone line has allowed the data transmission from a hospital located in a rural area where conventional phone lines are not

available.

D.E.S.D.E.S.

CONCLUSIONCONCLUSION

1. D.E.S. allows an immediate interpretation of an ECG by a remote cardiologist.

2. The low cost of this system makes it useful and appropriate for small cities and remote areas of developing countries where cardiologists are not available for on-site consultation.

3. D.E.S. has proven to be of great benefit to patients by decreasing the time for diagnosis of cardiovascular diseases with a possible reduction in morbidity and mortality rates.