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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.", "publicationTitle": "IEEE Transactions on Information Technology in Biomedicine", "publisher": "", "place": "", "date": "2012", "volume": "16", "issue": "3", "section": "", "partNumber": "", "partTitle": "", "pages": "432-444", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "", "DOI": "10.1109/TITB.2011.2176955", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1089-7771", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "IEEE Xplore", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Converter", "type": 1 }, { "tag": "DICOM", "type": 1 }, { "tag": "Electronic Health Records", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Information Systems", "type": 1 }, { "tag": "Ontology", "type": 1 }, { "tag": "Signal Processing, Computer-Assisted", "type": 1 }, { "tag": "Standards", "type": 1 }, { "tag": "Telemedicine", "type": 1 }, { "tag": "XML", "type": 1 }, { "tag": "appropriate database mining", "type": 1 }, { "tag": "cardiology settings", "type": 1 }, { "tag": "critical integration", "type": 1 }, { "tag": "data mining", "type": 1 }, { "tag": "digital ECG formats", "type": 1 }, { "tag": "digital ECG signals", "type": 1 }, { "tag": "diseases", "type": 1 }, { "tag": "electrocardiogram (ECG)", "type": 1 }, { "tag": "electrocardiography", "type": 1 }, { "tag": "format", "type": 1 }, { "tag": "fully fledged ECG interoperability", "type": 1 }, { "tag": "health care", "type": 1 }, { "tag": "healthcare information systems", "type": 1 }, { "tag": "interoperability", "type": 1 }, { "tag": "interoperable exchange", "type": 1 }, { "tag": "interoperable systems", "type": 1 }, { "tag": "mapping", "type": 1 }, { "tag": "medical computing", "type": 1 }, { "tag": "medical information systems", "type": 1 }, { "tag": "ontology-based approaches", "type": 1 }, { "tag": "open systems", "type": 1 }, { "tag": "plethora", "type": 1 }, { "tag": "relationship", "type": 1 }, { "tag": "review", "type": 1 }, { "tag": "standard", "type": 1 } ], "collections": [ "ARK2BPUS" ], "relations": {}, "dateAdded": "2013-07-19T18:08:36Z", "dateModified": "2013-07-19T18:08:36Z" } }, { "key": "ICIB8VBN", "version": 844, "library": { "type": "group", "id": 131279, "name": "OntologySummit2013", "links": { "alternate": { "href": "https://www.zotero.org/groups/ontologysummit2013", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/131279/items/ICIB8VBN", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ontologysummit2013/items/ICIB8VBN", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/131279/items/6I2MSZWM", "type": "application/json" } }, "meta": { "createdByUser": { "id": 995370, "username": "bebray", "name": "Bruce Bray", "links": { "alternate": { "href": "https://www.zotero.org/bebray", "type": "text/html" } } } }, "data": { "key": "ICIB8VBN", "version": 844, "parentItem": "6I2MSZWM", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2013-07-19T18:08:16Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/21775198", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2013-07-19T18:08:16Z", "dateModified": "2013-07-19T18:08:16Z" } }, { "key": "6I2MSZWM", "version": 844, "library": { "type": "group", "id": 131279, "name": "OntologySummit2013", "links": { "alternate": { "href": "https://www.zotero.org/groups/ontologysummit2013", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/131279/items/6I2MSZWM", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ontologysummit2013/items/6I2MSZWM", "type": "text/html" } }, "meta": { "createdByUser": { "id": 995370, "username": "bebray", "name": "Bruce Bray", "links": { "alternate": { "href": "https://www.zotero.org/bebray", "type": "text/html" } } }, "creatorSummary": "Bond et al.", "parsedDate": "2011-10", "numChildren": 1 }, "data": { "key": "6I2MSZWM", "version": 844, "itemType": "journalArticle", "title": "A review of ECG storage formats", "creators": [ { "creatorType": "author", "firstName": "Raymond R", "lastName": "Bond" }, { "creatorType": "author", "firstName": "Dewar D", "lastName": "Finlay" }, { "creatorType": "author", "firstName": "Chris D", "lastName": "Nugent" }, { "creatorType": "author", "firstName": "George", "lastName": "Moore" } ], "abstractNote": "INTRODUCTION: The interoperability of the Electrocardiogram (ECG) between heterogeneous systems has been facilitated by not one, but a number of predefined open storage formats. To improve the techniques currently used, it is important to define the similarities and the differences between these ECG storage formats.\nMETHODS: This paper presents a review of 9 formats used to store the ECG. Three of the predominant formats, namely, SCP-ECG, DICOM-ECG, and HL7 aECG are reviewed in detail along with the undertaking of a SWOT analysis. The remaining formats have been examined to a lesser extent as they are not as predominant in the literature.\nDISCUSSION: This study suggests that a plethora of open ECG formats, all aiming to promote interoperability has the opposite effect of adding more complexity. This paper discusses whether a format supporting a variety of diagnostic modalities is more advantageous than a format that only supports the ECG. It is conclusive that a general purpose format such as DICOM solves more interoperability issues, however, no general purpose format currently exists that fulfils the requirements of all users. As a result, the healthcare industry has been bombarded with custom storage formats, i.e., a format for storing the resting ECG, a format for storing the ambulatory ECG, a format for storing the ECG in clinical trials, a format for storing ECG data on mobile devices etc. This study then examines which implementation method is more suited to encode ECG data, i.e. binary or XML. Binary encoding has been used in the past to store the ECG, however, unlike binary, XML files are human readable, searchable and provide a better form of semantics. Based on analysis within this work it is speculated that XML may overtake binary as the preferred implementation method for encoding ECG data since it has already made a huge impact in the healthcare industry.\nCONCLUSION: It can be concluded that there is a wide range of vastly different techniques used to store the ECG. Although the specifications of these formats are openly available, neither has been internationally adopted to be used with all ECG machines. Therefore, there remains a lack of global interoperability of ECG information.", "publicationTitle": "International journal of medical informatics", "publisher": "", "place": "", "date": "Oct 2011", "volume": "80", "issue": "10", "section": "", "partNumber": "", "partTitle": "", "pages": "681-697", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Int J Med Inform", "DOI": "10.1016/j.ijmedinf.2011.06.008", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1872-8243", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 21775198", "tags": [ { "tag": "Humans", "type": 1 }, { "tag": "Information Storage and Retrieval", "type": 1 }, { "tag": "Programming Languages", "type": 1 }, { "tag": "electrocardiography", "type": 1 } ], "collections": [ "ARK2BPUS" ], "relations": {}, "dateAdded": "2013-07-19T18:08:16Z", "dateModified": "2013-07-19T18:08:16Z" } }, { "key": "R4Z8F6D3", "version": 843, "library": { "type": "group", "id": 131279, "name": "OntologySummit2013", "links": { "alternate": { "href": "https://www.zotero.org/groups/ontologysummit2013", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/131279/items/R4Z8F6D3", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ontologysummit2013/items/R4Z8F6D3", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/131279/items/VIGZFEWG", "type": "application/json" } }, "meta": { "createdByUser": { "id": 995370, "username": "bebray", "name": "Bruce Bray", "links": { "alternate": { "href": "https://www.zotero.org/bebray", "type": "text/html" } } } }, "data": { "key": "R4Z8F6D3", "version": 843, "parentItem": "VIGZFEWG", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2013-07-19T17:58:47Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/22128009", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2013-07-19T17:58:47Z", "dateModified": "2013-07-19T17:58:47Z" } }, { "key": "VIGZFEWG", "version": 843, "library": { "type": "group", "id": 131279, "name": "OntologySummit2013", "links": { "alternate": { "href": "https://www.zotero.org/groups/ontologysummit2013", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/131279/items/VIGZFEWG", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/ontologysummit2013/items/VIGZFEWG", "type": "text/html" } }, "meta": { "createdByUser": { "id": 995370, "username": "bebray", "name": "Bruce Bray", "links": { "alternate": { "href": "https://www.zotero.org/bebray", "type": "text/html" } } }, "creatorSummary": "Trigo et al.", "parsedDate": "2012-05", "numChildren": 1 }, "data": { "key": "VIGZFEWG", "version": 843, "itemType": "journalArticle", "title": "A review on digital ECG formats and the relationships between them", "creators": [ { "creatorType": "author", "firstName": "Jesús Daniel", "lastName": "Trigo" }, { "creatorType": "author", "firstName": "Alvaro", "lastName": "Alesanco" }, { "creatorType": "author", "firstName": "Ignacio", "lastName": "Martínez" }, { "creatorType": "author", "firstName": "José", "lastName": "García" } ], "abstractNote": "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. 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J B", "lastName": "Van Ettinger" }, { "creatorType": "author", "firstName": "J. A.", "lastName": "Lipton" }, { "creatorType": "author", "firstName": "M.C.J.", "lastName": "de Wijs" }, { "creatorType": "author", "firstName": "N.", "lastName": "Van der Putten" }, { "creatorType": "author", "firstName": "S. P.", "lastName": "Nelwan" } ], "abstractNote": "Unlike the ubiquitous use of DICOM for sharing various medical image modalities, the storage and retrieval of digital 12-lead electrocardiograms across different ECG management systems is often limited to manual file-based export and import using vendor-specific solutions. In addition to SCP-ECG, a number of open standard initiatives have been introduced, such as DICOM-ECG and HL7 aECG. By extending and improving a previously developed ECG toolkit we have explored the capabilities of these open standards in terms of interoperability, filesize and transmission times. 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concussion in sports Report of the Guideline Development Subcommittee of the American Academy of Neurology", "creators": [ { "creatorType": "author", "firstName": "Christopher C.", "lastName": "Giza" }, { "creatorType": "author", "firstName": "Jeffrey S.", "lastName": "Kutcher" }, { "creatorType": "author", "firstName": "Stephen", "lastName": "Ashwal" }, { "creatorType": "author", "firstName": "Jeffrey", "lastName": "Barth" }, { "creatorType": "author", "firstName": "Thomas S. D.", "lastName": "Getchius" }, { "creatorType": "author", "firstName": "Gerard A.", "lastName": "Gioia" }, { "creatorType": "author", "firstName": "Gary S.", "lastName": "Gronseth" }, { "creatorType": "author", "firstName": "Kevin", "lastName": "Guskiewicz" }, { "creatorType": "author", "firstName": "Steven", "lastName": "Mandel" }, { "creatorType": "author", "firstName": "Geoffrey", "lastName": "Manley" }, { "creatorType": "author", "firstName": "Douglas B.", "lastName": "McKeag" }, { "creatorType": "author", "firstName": "David J.", "lastName": "Thurman" }, { "creatorType": "author", "firstName": "Ross", "lastName": "Zafonte" } ], "abstractNote": "Objective: To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article.\nMethods: We systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations.\nResults: Specific risk factors can increase or decrease concussion risk. Diagnostic tools to help identify individuals with concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, concussion history, and younger age identify those at risk for postconcussion impairments. Risk factors for recurrent concussion include history of multiple concussions, particularly within 10 days after initial concussion. Risk factors for chronic neurobehavioral impairment include concussion exposure and APOE ε4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion. 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