title: A telesurveillance system with automatic electrocardiogram interpretation based on support vector machine and rule-based processing.
abstract: BACKGROUND
  Telehealth care is a global trend affecting clinical practice around the world. To mitigate the workload of health professionals and provide ubiquitous health care, a comprehensive surveillance system with value-added services based on information technologies must be established.
  
  
  OBJECTIVE
  We conducted this study to describe our proposed telesurveillance system designed for monitoring and classifying electrocardiogram (ECG) signals and to evaluate the performance of ECG classification.
  
  
  METHODS
  We established a telesurveillance system with an automatic ECG interpretation mechanism. The system included: (1) automatic ECG signal transmission via telecommunication, (2) ECG signal processing, including noise elimination, peak estimation, and feature extraction, (3) automatic ECG interpretation based on the support vector machine (SVM) classifier and rule-based processing, and (4) display of ECG signals and their analyzed results. We analyzed 213,420 ECG signals that were diagnosed by cardiologists as the gold standard to verify the classification performance.
  
  
  RESULTS
  In the clinical ECG database from the Telehealth Center of the National Taiwan University Hospital (NTUH), the experimental results showed that the ECG classifier yielded a specificity value of 96.66% for normal rhythm detection, a sensitivity value of 98.50% for disease recognition, and an accuracy value of 81.17% for noise detection. For the detection performance of specific diseases, the recognition model mainly generated sensitivity values of 92.70% for atrial fibrillation, 89.10% for pacemaker rhythm, 88.60% for atrial premature contraction, 72.98% for T-wave inversion, 62.21% for atrial flutter, and 62.57% for first-degree atrioventricular block.
  
  
  CONCLUSIONS
  Through connected telehealth care devices, the telesurveillance system, and the automatic ECG interpretation system, this mechanism was intentionally designed for continuous decision-making support and is reliable enough to reduce the need for face-to-face diagnosis. With this value-added service, the system could widely assist physicians and other health professionals with decision making in clinical practice. The system will be very helpful for the patient who suffers from cardiac disease, but for whom it is inconvenient to go to the hospital very often.
authors.affiliation: National Taiwan University, Graduate Institute of Biomedical Electronics and Bioinformatics, Taipei, Taiwan.
authors.forename: Te-Wei
authors.identifier: http://orcid.org/0000-0002-4371-6936
authors.initials: TW
authors.lastname: Ho
authors.forename: Chen-Wei
authors.identifier: http://orcid.org/0000-0001-9583-7476
authors.initials: CW
authors.lastname: Huang
authors.forename: Ching-Miao
authors.identifier: http://orcid.org/0000-0002-3145-0798
authors.initials: CM
authors.lastname: Lin
authors.forename: Feipei
authors.identifier: http://orcid.org/0000-0001-7147-8122
authors.initials: F
authors.lastname: Lai
authors.forename: Jian-Jiun
authors.identifier: http://orcid.org/0000-0003-4510-2273
authors.initials: JJ
authors.lastname: Ding
authors.forename: Yi-Lwun
authors.identifier: http://orcid.org/0000-0002-8936-9570
authors.initials: YL
authors.lastname: Ho
authors.forename: Chi-Sheng
authors.identifier: http://orcid.org/0000-0002-0158-7232
authors.initials: CS
authors.lastname: Hung
keywords: ECG classification; electrocardiogram; support vector machine; telehealth care; telesurveillance system