Introduction - ECG Acquisition and Automated Remote Processing - page 12

population to get the requisite health-care service in time. As results, mortality
rates in districts are many times larger than cities in developing nations.
To address this problem, e-health services through telemedicine technology
have been set up in many developing nations to use the ICT for providing the
health-care facilities. The basic objective is to connect a rural PHC to a city-based
hospital for curative and preventive care of patients through expert advice. Suc-
cessful implementation of the telemedicine technology requires fulfillment of
some basic facilities, given as
1. A dedicated, reliable, cost-effective, and nationwide communication link which
will connect the rural clinics with one of the city-based hospitals.
2. Appropriate communication gadgets and compatible health-care/diagnostic
equipments for the transmission of patients' pathological data and images
through the communication link.
3. Presence of a paramedic or physician at rural health clinic who is conversant
with the operation of telemedicine equipments. For city-based hospitals, this is
not a big problem since most of the specialist doctors are computer literate.
Among the mentioned issues, the use and implementation of the communica-
tion network are the most important criteria, since it is also related to nationwide
communication policies of some governments. In Indian scenario, the beginning of
telehealth services occurred in mid-1980s. Apollo Telemedicine Enterprises Ltd.
(ATEL), a non-profit organization in India, initiated their first modern telemedi-
cine facility at a village called Aragonda in Chitoor district of Andhra Pradesh. In
addition to general physicians, some specialist doctors were trained and deployed.
The project started with an ultrasound, CT scan, ECHO, an incubator, and auto-
mated ECG machine to serve 40 beds of the hospital and a population of 5,000.
Connectivity to specialty hospital in Chennai was provided with a simple webcam
and ISDN telephone lines. Now the facility equipped with VSAT link caters the
need of 24 surrounding villages and a population of 50,000, with specialty centers
set up in Hyderabad, Chennai, and other Apollo group of hospitals in India. The
128 kbps ISDN connectivity to Hyderabad is backed up by a 2 Mbps VSAT link.
Later on, Sriharikota and Aragonda were directly connected to Chennai specialty
center through a VSAT of 2 Mbps connection through Indian Space Research
Organization (ISRO). But for all practical reasons, villages can be easily connected
using ISDN lines. In the eastern India, Calcutta and Guwahati are two consultation
centers that are linked to Hyderabad directly, through a dedicated ISDN line each
[ 17 , 18 ]. A detailed description of telemedicine practice, standards, and protocols
used in Indian context is described in [ 19 ]. The state of telemedicine in some
developing nations is described in [ 20 - 23 ].
Telecardiology, a specialized branch of telemedicine, involves transmission of
ECG data and other related information to a remote expert for cardiac checkup. In
clinical practice, the ECG data are compressed at the acquisition end to enhance
the channel efficiency of the communication link. The practice of telecardiology
started early in the nineteenth century when W. Einthoven, the inventor of ECG,
investigated the transmission of ECG over telephone lines. This was because the