jwb@ecsvax.UUCP (02/24/84)
At least three companies are currently marketing computer ECG analysis
systems. They are Marquette Electronics, IBM, Hewlett-Packard. We use the
Marquette system which works quite well. Marquette and IBM use variants of
the same program (the "Bonner" program below, original development funded by
IBM.) Apparently because of fierce competition, much current information,
particularly with regard to algorithms, is proprietary. Worst in this regard
(a purely personal opinion) is HP who seems to think nobody but HP needs to
know how they do things and physicians are too dumb to understand anyway.
Another way hospitals get computer analysis of ECG's is through "Telenet" who
offers telephone connection to a time sharing system (I think located in the
Chicago area). Signals are digitized and sent via a modem through standard
phone lines. ECG's are analyzed and printed information is sent back.
Turn-around time is a few minutes. They offer an advantage to small hospitals
by offering verification of the analysis by a Cardiologist (for an extra fee).
I understand this service has had some financial problems (rumors).
Following is a bibliography gathered for a lecture to medical students about
computer analysis of ECG's. Because of this it is mainly from more or less
clinical literature and is oriented toward methods of validation (This is
tough, because reading of ECG's by cardiologists, like many clinical
decisions, is partly a subjective process. The major impact of these systems
so far has been to force the medical community to develop objective criteria
for their analysis.)
BIBLIOGRAPHY
Computer Analysis of the Electrocardiogram
August 29, 1983
BOOK
Pordy L (1977) Computer electrocardiography: present status and criteria.
Mt. Kisco, New York, Futura
PAPERS
Bonner RE, Crevasse L, Ferrer MI, Greenfield JC Jr (1972) A new computer
program for analysis of scalar electrocardiograms. Computers and Biomedical
Research 5:629-653
Garcia R, Breneman GM, Goldstein S (1981) Electrogram computer analysis.
Practical value of the IBM Bonner-2 (V2MO) program. J. Electrocardiology
14:283-288
Rautaharju PM, Ariet M, Pryor TA, et al. (1978) Task Force III: Computers in
diagnostic electrocardiography. Proceedings of the Tenth Bethesda Conference,
Optimal Electrocardiography. Am. J. Cardiol. 41:158-170
Bailey JJ et al (1974) A method for evaluating computer programs for
electrocardiographic interpretation
I. Application to the experimental IBM program of 1971. Circulation 50:73-79
II. Application to version D of the PHS program and the Mayo Clinic program
of 1968. Circulation 50:80-87
III. Reproducibility testing and the sources of program errors. Circulation
50:88-93
Endou K, Miyahara H, Sato (1980) Clinical usefulness of computer diagnosis in
automated electrocardiography. Cardiology 66:174-189
Bertrand CA et al (1980) Computer interpretation of electrocardiogram using
portable bedside unit. New York State Journal of Medicine. August
1980(?volume):1385-1389
Jack Buchanan
Cardiology and Biomedical Engineering
University of North Carolina at Chapel Hill
(919) 966-5201
decvax!mcnc!ecsvax!jwb
mcmillan@eosp1.UUCP (Tobias D. Robison) (02/27/84)
I worked in the field of ECG analysis in the mid 1970's. ECG analysis programs (such as Bonner's) have a very hard time doing the necessary pattern recognition on ECG wave forms. Once they have approximately recognized wave types, they do MUCH better than any human being at quantifying the characteristics of abnormal wave forms. In 1974, the Bonner program was already considered more accurate than good human cardiologists in certain respects, and less likely to pronounce a good heart bad (or vice versa) athan average cardiologists. Obviously when there is an abnormality, the ECG program output will be carefully overread by a cardiologist. In this process, the ability of the human to recognize patterns, plus the quantifying data produced by the software and hardware produce excellent results. ECG systems can be seriously effected by signal noise (even 60 hertz AC noise). In the 1970's I was aware of at least one case where an ECG bureau really should have shut down, rather than supply ECg reports that it knew were seriously compromised by noise-sensitive ECG hardware. ECG systems developed at a culturally suitable time. The middle-aged cardiologists still like to make extra money by overreading routine ECG charts. Younger cardiologists usually don't care to spend their time this way and appreciate the time saved by ECG systems. In general, a cardiologist is always required to check an ECG system's report, to avoid gross machine error. In the 1970's, no company really made money from ECG analysis systems. The market was extremely sensitive to new technologies. No manufacturer could simply deliver working systems. All were required to adopt larger storage devices, faster minicomputers, improved analysis software, and ancillary software for report editing, databases of reports, comparing ECG's on the same patient, etc. The required rate of development in order to do business killed almost everyone financially. - Toby Robison allegra!eosp1!robison decvax!ittvax!eosp1!robison princeton!eosp1!robison (NOTE! NOT McMillan; Robison.)
marcel@uiucdcs.UUCP (marcel ) (02/28/84)
#R:ecsvax:-204300:uiucdcs:32300020:000:914
uiucdcs!marcel Feb 27 11:06:00 1984
Ivan Bratko, of the Josef Stefan Institute in Ljubljana, Yugoslavia, has
recently achieved some remarkable results. With the aid of computer
simulation he has built an expert system capable of diagnosing multiple
simultaneous heart malfunction causes from ECG outputs. This was a
significant contribution to medical science, since for the class of failures
he treated, there was no known method of diagnosing anything more complicated
than a single cause.
His work will be printed as a monograph from the newly-formed "International
School for the Synthesis of Expert Knowledge" (ISSEK), which will have its
first meeting this summer. ISSEK is an affiliation of computer science labs
dedicated to the automatic generation of new knowledge of super-human quality.
(Membership of ISSEK is by invitation only).
Marcel Schoppers
U of Illinois @ Urbana-Champaign
{ pur-ee | ihnp4 } ! uiucdcs ! marcel