Background: The high mortality in Poland due to the diseases of cardiovascular system (ca 50% of the total mortality) is the motivation for the presented work. Fight against those diseases is incorporated into e-health strategy for Poland for 2004-2006 and also into the National Program of Health. The interventional cardiology (angioplasty, sent implantation) combined with telecardiology can shorten the treatment delay and improve the outcomes of acute coronary syndrome (ACS) patients.
In Poland the interventional cardiology is performed only in big metropolitan centers to which the patients from smaller towns and rural areas need to be transported. Our system is addressed especially to those patients.
Aim: The aim of the work is the design and implementation of the prototype telecardiological system in Mazovia District (100 km radius around the capital Warsaw) with possible extension to other districts. Also improvement of cooperation among cardiological centers and rationalization of the specialized clinical resources and access to unified digital archives can be mentioned as the aims. The aim of medical importance is the reduction of time from symptoms to intervention which can possibly reduce mortality.
Methods: The overall structure of the system consists of 3 layers:
1 – reference (invasive cardiology) center, 2 – regional centers (hospitals), 3 – ambulance network. The software tools for communication among centers are Electronic Patient Record (EPR), accessible via Internet, relational data base MySQL in which EPR's are stored and expert system (ES) for risk assessment and advice on non-pharmacological and pharmacological treatment.
Result: EPR has been created up to now for over 100 patients. The data were stored in the database. ES performed risk stratification for each patient. It is based on the voting system in which risk scores such as SIMPLE, TIMI, GRACE, ZWOLLE are integrated with B-type natriuretic peptide (BNP). The patient is assigned to either low or high risk group which affects the choice of the type of treatment. ES evaluates also indications or contraindications for pharmacotherapy. Inter-rater agreement between a physician and ES was assessed by statistic kappa and was found either good (kappa 0,61-0,8) or very good (kappa 0,81-1).
Conclusion: The main elements of the system - EPR, database and ES are functioning properly. The regional centers require support in terms of staff training in EPR and database operation and also attention to the hardware, software and Internet access has to be paid for. Ambulance network is a crucial factor in improvement of healthcare of the ACS patients. Better cooperation among the regional and reference centers is required and also equipment for ECG data transmission over mobile phones.
The foreseen benefits of the system use are:
- better access to healthcare for the patients from rural areas and small towns,
- shortening the consultation time between ambulance/regional center and reference center which translates into shorter time from symptoms to intervention.