Introduction

touchECG is a digital resting ECG acquisition & management solution designed by Cardioline. The Windows based application facilitates the collection of diagnostic 12/15-lead ECGs.

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An integration with ClinSpark and the ClinSpark Agent was designed based on touchECG version 3.51.13057.2.

This user guide is based on the touchECG version noted above. Newer versions of touchECG available from the vendor may not yet be compatible with the ClinSpark interface.

Pre-requisites

  1. Cardioline touchECG compatibility was added with ClinSpark Agent version 1.4. However, we recommend using Agent version 23.1 or above (https://foundryhealth.atlassian.net/wiki/spaces/DOCS/pages/3700490299/ClinSpark+Agent?src=search).

  2. Cardioline touchECG software must be installed in the PC ‘LocalAppData’ directory (example: <User>\AppData\Local\Cardioline\touchECG )

Overview

A quick walk-through video showing the basic configuration and use of touchECG.

https://vimeo.com/clinspark/touchecg

At about 5’10” into the video, it switches to a demo of advanced ECG review using a third-party proprietary add-in application called CalECG (see AMPS CalECG).

Advanced Use Cases

Demo Mode

Cardioline has designed touchECG with the ability to run in Demo mode, and thus it allows for working with simulated ECGs built into the application rather than requiring actual hardware or applying leads / procuring a simulator. Information about this can be reviewed in their service manual.

ClinSpark allows for Demo Mode to be set proactively for each invocation through global device configuration (via Devices > Configure). When set, the interface will have the user.config XML file contain the HDPLUS_SN in each invocation to be hardcoded to 'DEMO'.

When enabled, this setting will be enforced across all studies and sites in the given ClinSpark environment, and may override any local user configurations where Demo mode is disabled.

Here is the setting:

Preventing ECG data being stored on a local or shared drive

This technical walkthrough view shows the configuration required to prevent ECG data being stored on local directories - the data is ingested into ClinSpark only.

https://vimeo.com/clinspark/touchecg-autodelete

File Formats

Cardioline touchECG creates both PDF and SCP (data) files that are consumed by the interface. These files are processed locally first on acquisition PCs via the ClinSpark Agent, and also stored within timepoint details in ClinSpark.

SCP (Standard Communications Protocol)

SCP is a standardized ECG data file format that Cardioline uses for source records coming from touchECG. See also:

ClinSpark stores the source SCP files as part of each timepoint, similar to other ECG device interfaces.

These files can be directly accessed via Study > Data and selecting specific timepoint Item Group details.

Additionally, the files can also be accessed via the ECG > Review component audits, after a successful review has taken place.

As a standard approach to all ECG interfaces, ClinSpark represents these generically as ‘ECG Files’ in the application and provides the file with extension .ecg.

ClinSpark does not provide reference to the underlying data file format (SCP, XML, ISHNE, etc) of the ECG files themselves.

Note that SCP data file formats are not as common as XML, and contents cannot simply be opened by standard applications. Specific software systems that follow the published standards to open and read SCP file contents are capable of accessing the data within files. Customers with questions about the SCP ECG files should be directed at the vendor, Cardioline.

Data Workflow

Manufacturer's Reference Material

https://cardioline.com/

Watch on YouTube

https://youtu.be/yTCK2qqSRFA

Service Manual

A copy of the touchECG version 3 service manual is embedded here for your convenience…

Known Issues & Limitations

Inconsistent QTc Values

A number of ClinSpark users have reported that they have experienced certain scenarios where the QTc value presented on the ECG tracing produced by touchECG software does not match the QTc value presented in ClinSpark forms (and in the “raw” SCP outputs provided by Cardioline).

In the examples IQVIA have encountered thus far, this in manifested as an “off by one” error (see below).

image-20240802-143919.png

With regard to this issue, it’s important to understand that ClinSpark does not perform any transformation or modification to the source data provided by the Cardioline touchECG system. The ClinSpark integration simply reads these values from the SCP file and passes them into the ClinSpark form.

Also important, is that as the hardware and software vendor for the touchECG solution, Cardioline, is the “owner” of this issue. They have formally acknowledged it and expressed intent to release an update to resolve in a future touchECG software release. Any customers with questions about the root cause or further specifics on the discrepancy must reach out to Cardioline for further details.

IQVIA are only able to resolve this issue once Cardioline provides an update to their touchECG software. Once a fix is available from Cardioline, IQVIA will look to plan and schedule an updated release of the ClinSpark Agent that incorporates the changes necessary to support the fixes implemented by Cardioline. IQVIA will endeavor to make users of the Clinspark/Cardioline integration aware of the availability of these updates as appropriate.

Additional Reference Material

  1. SCP-ECG V3.0: An enhanced standard communication protocol for computer-assisted electrocardiography

    1. https://ieeexplore.ieee.org/document/7868741

  2. Standard Communications Protocol for Computer-Assisted Electrocardiography

    1. https://www.iso.org/standard/46493.html