ANMCO position paper E-health integration in cardiology clinical care framework.

Figures

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  Figure 1. Teleconsultation. Overview of teleconsultation, showing asynchronous (store-and-forward) and synchronous (real-time) modes for remote physician collaboration and clinical decision support.

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  Figure 2. Multidimensional framework for the generation, validation, and clinical use of synthetic health data. The figure depicts an operational workflow that begins with a multidisciplinary team defining clinical and methodological constraints and continues through ongoing interaction between clinical expertise and computational development. Subsequent stages involve creating and assessing synthetic datasets, including analysis of internal consistency, practical usability, and alignment with clinical standards. This approach embeds medical reasoning within generative algorithms, ensuring that synthetic data are not only statistically reliable but also clinically credible.

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  Figure 3. Televisit. Key indications and essential requirements for conducting a televisit in routine clinical practice.

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  Figure 4. Clinical governance framework, organisational structure, and decision processes in cardiovascular telemedicine. Clinical responsibility for telemedicine services remains with the cardiology specialist, in continuity with in-person care. Telemonitoring, televisits, and teleconsultations are fully recognized clinical acts and must meet the same standards of appropriateness, traceability, reporting, and medico-legal accountability. Technology functions as an enabling tool within the care process but does not replace clinical judgment or medical decision-making. The organisational model includes a reference cardiology centre (HUB or equivalent) responsible for clinical oversight, protocol definition, and activity supervision, supported by structured multiprofessional teams with clearly defined roles and shared protocols for patient enrollment, alert management and prioritisation, and escalation to in-person reassessment or higher levels of care when needed. Alerts generated by telemonitoring systems are filtered according to predefined clinical criteria and integrated into a structured decision pathway distinguishing nursing assessment, specialist evaluation, and therapeutic…

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  Figure 5. Hospital–community telemedicine network and HUB & SPOKE model with specialist cardiology governance. Clinical governance in telemedicine should promote effective integration between hospital and community care while maintaining a clear allocation of responsibilities: the cardiology specialist remains the primary clinical reference, whereas community care providers (general practitioners and community nursing services) operate within a functionally integrated, protocol-driven framework. Information flows must be bidirectional, secure, and interoperable. Within this context, structured clinical governance models are essential for the appropriate implementation of telemedicine in cardiovascular care pathways. The HUB & SPOKE model with specialist cardiology governance represents a recommended organisational approach, in which effectiveness depends not only on technological availability but also on alignment with established diagnostic–therapeutic care pathways and clearly defined governance structures. This model is particularly applicable to chronic heart failure, atrial fibrillation, remote monitoring of implantable cardiac devices, and high-risk post-discharge follow-up. Its main…