Communication infrastructure in a contact center for home care monitoring of chronic disease patients

The Citizen Health System (CHS) is a European Commission (EC) funded project in the field of IST for Health. Its main goal is to develop a generic contact center which in its pilot stage can be used in the monitoring, treatment and management of chronically ill patients at home in Greece, Spain and Germany. Such contact centers, which can use any type of communication technology, and can provide timely and preventive prompting to the patients are envisaged in the future to evolve into well-being contact centers providing services to all citizens. In this paper, we present the structure of such a generic contact center and in particular the telecommunication infrastructure, the communication protocols and procedures, and finally the educational modules that are integrated into this contact center. We discuss the procedures followed for two target groups of patients where two randomized control clinical trials are under way, namely diabetic patients with obesity problems, and congestive heart failure patients. We present examples of the communication means between the contact center medical personnel and these patients, and elaborate on the educational issues involved.

Agent-based monitoring and alert generation for a home care telemedicine system

In the present paper, a multi-agent system is proposed, which can be integrated in the home care telemedicine system that was developed in the context of the Citizen Health System (CHS) European project, functioning as a contact center for diabetic and congestive heart failure patients. The objective of the multi-agent system is to provide a set of alert/notification mechanisms for the clinicians, helping them to classify the clinical condition of each patient. Therefore, despite the huge amount of data managed by the system, due to the daily use of the contact center's services, these alert mechanisms provide the clinician with an overview of the cases that need further examination and save him/her time from the trivial cases. The multi-agent system consists of different types of agents, each one assigned with specific tasks, which communicate with each other, in order to share knowledge.

Deconvolution and wavelet-based methods for membrane current estimation from simulated fractionated electrograms

In infarcted myocardium, extracellular recordings exhibit multiple deflections due to irregular pathway of the electric impulse. In this work the problem of distinguishing local from distant deflections is tackled. In order to evaluate the proposed methods in a controlled setting, simulated data are used, following both Beeler-Reuter and Luo-Rudy kinetics. The input is an array of electrograms positioned on grid-points of a rectangular grid and the output is an array of estimates of the membrane current. First, deconvolution techniques are used in the form of spatial filtering for membrane current estimation from the extracellular recordings. Second, the extracellular recordings undergo wavelet based transformation, followed by a spatial filter which enhances local activity deflections and suppresses distant activity deflections. It is shown that wavelet filtering of the extracellular recordings acts as an evaluator of the efficiency of the deconvolution techniques for the membrane current estimation. Subsequently, activation times based on the results from the two methods are used for the reconstruction of the propagation pattern in a zig-zag case in two-dimensional grids. It is shown that the wavelet-based method is more robust, and can work well even in cases where the grid interval in the y direction is four times larger than the single cell size.

Spatial filtering methods for local activation determination in fractionated electrograms from simulated infarcted hearts

The purpose of this work is the enhancement of local activation in multiphasic extracellular recordings coming from infarcted myocardial tissue and, consequently, the distinction of local from distal activation. Deconvolution procedures are applied, in the form of spatial filtering, in order to estimate transmembrane currents from the extracellular recordings. Simulated data are used in order to test the methods. The current source estimates are compared to the actual transmembrane currents and to Laplacian estimates.

Spatial Filtering Methods for Local Activation Determination in Fractionated Electrograms from Simulated Infarcted Hearts

The purpose of this work is the enhancement of local activation in multiphasic extracellular recordings coming from infarcted myocardial tissue and, consequently, the distinction of local from distal activation. Deconvolution procedures are applied, in the form of spatial filtering, in order to estimate transmembrane currents from the extracellular recordings. Simulated data are used in order to test the methods. The current source estimates are compared to the actual transmembrane currents and to Laplacian estimates.

An integrated environment for ECG processing

The huge amount of information involved in clinical cardiological examination raises the need for efficient patient data management and for the fusion of modern information processing techniques in the everyday clinical workstation. An integrated medical information system has been developed in order to organize the local cardiological legacy system in the AHEPA hospital. An ODBC based database (like Ms SqlServer or MSAccess) holds patient and ECG data. The system incorporates data management (storing and retrieval) and data processing modules. The processing module is added as an independent DLL. The visualization component results in a better view of the information. The components are integrated in a friendly window interface that lets the doctor browse patient information, apply modern signal processing techniques, make special measurements and store them in the database for research reasons.