Introduction

The long-term electrocardiography (ECG) examination is widely utilized in the clinical field. This rule applies for long-term waveform description such as ambulatory ECG, monitoring waveforms, etc. Recently, EMR, or Electronic Medical Records, became commonly used and it strongly requires long-term ECG examination for the therapeutic purpose. However, new digitalized data of long-term ECG recorder cannot be used among different manufacturers scanner. This document intends that MFER encoded data for long-term ECG is analysed by other scanner and these are also interoperable on EMRs.

This document defines the detailed rules for electrocardiography waveform format that is encoded according to the medical waveform format encoding rules (MFER). In addition to electrocardiography waveform format encoding, there are rules for other waveforms such as standard 12-lead ECG, stress ECG, etc. that are contained in other MFER documents.

About MFER

Medical waveforms such as ECG, electroencephalography (EEG), and blood pressure waveforms are widely utilized in clinical areas such as physiological examinations, electronic medical records, medical investigations, research, education, etc. Medical waveforms are used in various combinations and document types according to the intended diagnostic purpose. For example, ECG waveforms are utilized extensively in the clinical arena, with resting 12-lead ECG being used the most. A cardiologist makes diagnoses using 10 s to 15 s ECG waveform measurements; however, longer periods are sometimes required to recognize patient heart conditions such as arrhythmia. Also, there are many other methods using ECG such as Holter ECG, physiologic monitoring ECG, stress ECG, intracardiac ECG, vectorcardiography (VCG), EEG with ECG, blood pressure with ECG, sleep polysomnography (PSG), etc. MFER can describe not only ECG for physiological examinations conducted in intensive care unit (ICU) and operating room acute care contexts, but also EEG, respiration waveform, and pulse.

— Implementation: MFER is a specialized representation for medical waveforms that removes unnecessary coded elements (“tags”) for waveform description. For example, a standard 12-lead ECG can be described simply only using a common sampling condition and the lead condition, making waveform synchronization and correct lead calculation much easier.
— Use with other appropriate standards: it is recommended that MFER only describes medical waveforms. Other information can be described using appropriate standards published by organization including HL7® 1 , DICOM® 2 , and IEEE® 3 , etc. For example, clinical reports that include patient demographics, order information, medication, etc. are supported in other standards such as HL7® Clinical Document Architecture (CDA); by including references to MFER information in these documents, implementation for message exchange, networking, database management that includes waveform information becomes simple and easy.
— Separation between supplier and consumer of medical waveforms: the MFER specification concentrates on data format instead of paper-based recording. For example, recorded ECG is processed by filter, data alignment, and other parameters, so that the ECG waveform can be easily displayed using an application viewer. However, the ECG recordings displayed as images are not as useful for other purposes such as data processing for research investigations. A design goal of MFER is that a waveform is described in raw format with as complete as possible recording detail. When the waveform is used, appropriate processing of the data is supported such as filtering, view alignment, etc. In this way, the medical waveform described in MFER can be used for multiple purposes.
— Product capabilities are not limited: standards often support only a set of requirements, so the expansion of product features can be greatly limited. MFER can describe medical waveform information without constraining the potential features of a product. Also, medical waveform display must be very flexible, and thus MFER has mechanisms supporting not only a machine-readable coded system for abstract data, but also human-readable representation.

The MFER specification supports both present and future product implementations. MFER supports the translation of stored waveform data that was encoded using other standards, enabling harmonization and interoperability. This capability supports not only existing waveform format standards but can be extended to support future formats as well.

BS ISO 22077-3:2023

Health informatics. Medical waveform format - Long-term electrocardiography

Current

Published:

30 Sep 2023