A Flexible 12-Lead/Holter Device with Compression Capabilities for Low-Bandwidth Mobile-ECG Telemedicine Applications

Abstract

In recent years, a number of proposals for electrocardiogram (ECG) monitoring based on mobile systems have been delivered. We propose here an STM32F-microcontroller-based ECG mobile system providing both long-term (several weeks) Holter monitoring and 12-lead ECG recording, according to the clinical standard requirements for these kinds of recordings, which in addition can yield further digital compression at stages close to the acquisition. The system can be especially useful in rural areas of developing countries, where the lack of specialized medical personnel justifies the introduction of telecardiology services, and the limitations of coverage and bandwidth of cellular networks require the use of efficient signal compression systems. The prototype was implemented using a small architecture, with a 16-bits-per-sample resolution. We also used a low-noise instrumentation amplifier TI ADS1198, which has a multiplexer and an analog-to-digital converter (16 bits and 8 channels) connected to the STM32F processor, the architecture of which incorporates a digital signal processing unit and a floating-point unit. On the one hand, the system portability allows the user to take the prototype in her/his pocket and to perform an ECG examination, either in 12-lead controlled conditions or in Holter monitoring, according to the required clinical scenario. An app in the smartphone is responsible for giving the users a friendly interface to set up the system. On the other hand, electronic health recording of the patients are registered in a web application, which in turn allows them to connect to the Internet from their cellphones, and the ECG signals are then sent though a web server for subsequent and ubiquitous analysis by doctors at any convenient terminal device. In order to determine the quality of the received signals, system testing was performed in the three following scenarios: (1) The prototype was connected to the patient and the signals were subsequently stored; (2) the prototype was connected to the patient and the data were subsequently transferred to the cellphone; (3) the prototype was connected to the patient, and the data were transferred to the cellphone and to the web via the Internet. An additional benchmarking test with expert clinicians showed the clinical quality provided by the system. The proposed ECG system is the first step and paves the way toward mobile cardiac monitors in terms of compatibility with the electrocardiographic practice, including the long-term monitoring, the usability with 12 leads, and the possibility of incorporating signal compression at the early stages of the ECG acquisition.

Arm-ECG Wireless Sensor System for Wearable Long-Term Surveillance of Heart Arrhythmias

“…Compared with similar devices presented in the literature, our prototype has a lower power consumption than other Wi-Fi based systems [34,35] which is similar to results achieved by other systems using Bluetooth [13,[31][32][33] and ISM wireless communication [19,29].…”

Benefits of and barriers to telehealth for the informal caregivers of elderly individuals in rural areas: A scoping review

“…Without adequate attention to the barriers, there is a significant risk that telehealth will exacerbate health inequities 47 . A serious problem lies in the inadequate telehealth infrastructure 48 . According to Morgan et al, 23 the success of the telemedicine component of the clinic is due in large part to the excellent infrastructure support provided by the Telehealth Saskatchewan Network.…”

“…47 A serious problem lies in the inadequate telehealth infrastructure. 48 According to Morgan et al, 23 the success of the telemedicine component of the clinic is due in large part to the excellent infrastructure support provided by the Telehealth Saskatchewan Network. A person who had to travel more than 100 km for a telehealth appointment was almost 9 times more likely to interrupt an appointment than the person who had to travel <50 km, and the risk of interrupting an appointment tended to increase as the distance saved by using telehealth decreased.…”

Telecardiology in Rural Practice: Global Trends

“…The other three papers in this classification presented clinical cases of remote monitoring using mobile devices. Pineda-Lopz et al [ 32 ] reported on a long-term Holter monitoring and 12-lead ECG recording system using mobile phones in Spain. They concluded that a 32-bit mobile microcontroller ECG system can be especially useful in rural areas of developing countries, where the lack of specialized medical personnel justifies the introduction of telecardiology services.…”