CARNet's project Telemedicine in Heart Electrostimulation was presented to the public on 1 July, 1998, at the Faculty of Electrical Engineering and Computer Science of the University of Zagreb. Visitors at the Split Faculty of Electrical Engineering were able to follow and participate in the event via a videoconferencing system. The project was presented by Mr. Bozidar Ferek-Petric, B.Sc. (E.E.), Deputy Project Manager.

The Telemedicine in Heart Stimulation project aims to create a functional model of a system, which would allow reliable remote control and programming of heart electrostimulators. Results achieved through the project so far were presented. Following a brief introduction, the transfer of an EKG signal between Split and Zagreb via the Internet was demonstrated, as well as the remote control and adjustment of a heart electrostimulator. For this purpose, software specially developed as part of the project was used. After the system testing conducted the previous day, this transfer of an EKG signal via the Internet was the first of its kind in history.

The presentation of the results achieved by the Telemedicine in Heart Stimulation project demonstrated that CARNet's networking infrastructure might be used successfully for telemedicine needs. Especially the remote control of heart electrostimulators may increase the overall security of the patient dramatically, and provide the means necessary to allow checkups to be conducted at local clinics as well, and not only at specialized institutions. The first remote control and adjustment of a heart electrostimulator implanted in a patient is planned for September.

Within the Telemedicine in Heart Stimulation project, a Web server offering information from the field of telemedicine was developed, and a database of Croatian patients with implanted heart electrostimulators was set up.

So far, CARNet has set up several projects related to medicine. More information about them may be found at CARNet's Web server (http://www.carnet.hr/projects/). Directed by Professor Ivo Cikes, D.Sc., the Telemedicine in Heart Electrostimulation project is conducted in cooperation with the Medical School, University of Zagreb, and the Cardiovascular Department, Rebro University Teaching Hospital, Zagreb.

The aim of your project, among other things, is to envisage and create a technical solution, which will allow reliable remote control and reprogramming of heart electrostimulators via the Internet. What motivated you in defining this goal and how far is its achievement?

Mr. Bozidar Ferek-Petric: We were motivated by the care for patients entirely dependent on stimulation, and especially for children. In my 17 years of experience with these patients, I have learned that the clinical follow-up conducted every six months can not offer absolute security to the patients, while a more frequent follow-up schedule burdens both the patients and the electrostimulation centres.

Having completed the phase of basic research, and the results achieved now make possible the development of a practical device for common use. If the project is supported by significant investment, which would finance the development of such a device, we could expect first clinical testing of a new telecontrol device within two years.

Providing adequate technical solutions, is the conduct of such operations via the Internet safe for the patient, or is it less safe than today's method?

Mr. Bozidar Ferek-Petric: The main goal of this method is to increase the security of the patient. The question could be rephrased: Can a connection break endanger the security of the patient? The answer is: Never! Modern electostimulators have built-in security mechanisms for bridging a communication break with the programmator. Such connection breaks do happen regularly during almost any control operation, when the programming head moves randomly. Even an accidental power failure, when the programmator is suddenly shut down during the control process, can not have any effect on the patient. This means that the basic technical solutions are already provided. Even though, in the first phase, we are only planning the follow-up of patients at clinics, there is no reason not to conduct a follow-up even at the patient's home.

Is CARNet's networking infrastructure adequate for telemedicine, especially for the work you are engaged in?

Mr. Bozidar Ferek-Petric: CARNet has the special advantage that it is a non-profit and non-commercial network, but created, organized and maintained by the best professionals our Universities offer. Through step-wise introduction of ATM technology, as dictated by financial circumstances, the networking infrastructure will be significantly technically improved, while, at the same time, the unsurpassed component in CARNet's name - academic research - will remain decisive, as the electrostimulation centres are also part of university teaching hospitals since they represent state-of-the-art medicine.

One of the things achieved through your project was the establishment of the CroPace database, containing data on patients with heart electrostimulators. Why was the development of this database significant for your telemedicine project?

Mr. Bozidar Ferek-Petric: The main elements in controlling a heart electrostimulator are reliable data on the patient, the electrostimulation system, programming settings, and the patient follow-ups. Most of this data is technical in nature - the electrostimulation parameters, for example, are actually measured in electrotechnical units.

As an example I will cite something everyone can understand easily: the question of the life of an electrostimulator. One of the main elements checked is the voltage of the battery of the electrostimulator, which indicates how long the electrostimulator will last, i.e., when an operation to exchange it will be required. Some fifty technical parameters describe the functioning of the electrostimulation system. This data needs to be saved, but it also needs to be available to everyone conducting patient follow-ups, be it at electrostimulation centres, or via telemedicine. It is a great advantage that all of the centres in Croatia (10 of them) use one common piece of software, so that they are able to exchange all data freely. In the future, we must also plan a common distribution database, provided that all centres be connected into one network.