New telemedicine approach to the dynamic ECG and other biological signals ambulatory monitoring

Telemedicine is an emerging field that can potentially affect health management, according to the present technological progress, combining medical expertise and communication technology. In this field, three main trials have been up to now experimented; teleconference, tele-intervention, telemonitoring. Teleconference applications are today a true reality, even in the medical field (i.e. consulting), while tele-intervention (i.e. tele-surgery) and telemonitoring remain at the level of pilot projects or limited experiences, mainly for emergency, even dealing with limited band signals as the ECG. The present work concerns the ECG monitoring and is aimed to overcome the main obstacles to its extensive use in medicine: the instrumentation high cost and the managing difficulties of setting up and technical maintaining of a telemedicine control centre. About the patient terminal, an ad hoc modular approach for both hardware and software has been followed in designing the new class of instrumentation, allowing the authors to develop a complete family of ECG monitoring devices, spreading on more products the design and the potential product costs. By means of a modular analog front-end, a modular communication interface and a common digital processing and storing unit, the whole set of monitoring needs has been covered, ranging from a simple ECG instrument capable "to play" the signal by telephone to a multi-functional digital data logger and ECG computerized analyser, radio and/or IR coupled to the telephone line (cellular type included). For what concerns the control central unit again a modular approach has been followed; in fact the system design follows a "web server" phylosophy, mainly oriented to limit the physician engagement to type use of his/her own PC, a standard network browser (i.e. Netscape) and a low cost modem to access remote telemonitored users. The system architecture foresees that all the gateway services to the remote patients, the managing programme maintenance as well as the data safety and security are "provided" by the new figure of network "Medical Provider". The complete system is presented as an application of Tele Holter.