The OpenECG network formed in 2002, is a European initiative with global reach, which aims to lower the barriers for ECG interoperability and make digital ECGs available as part of the integrated electronic health record. Currently, SCP-ECG, the European standard for ECG record communication and storage, has been implemented by some manufacturers. However, these implementations are not consistent with each other, hindering ECG exchange, processing, and serial analysis. Furthermore, the presence of alternative ECG storage formats, proprietary or open, raises issues of harmonization and quality assurance. In the first year of its life, the OpenECG network numbers 105 committed members, while its portal and associated help desk have already provided valuable information and development support to several manufacturers and integrators. Recently, the OpenECG certification service has become available to members who may submit their ECG records for interoperability validation and SCP-ECG conformance testing. Still, only the first step for the OpenECG network has been taken. Future plans involve contributing to the definition of integration profiles for ECG-related examinations and addressing issues related to quality assurance of eHealth services in general

Bruun-Rasmussen, M

Chiarugi, Franco

Chronaki, Ce

Conforti, Fabrizio

Lees, P.J.

Macerata, Alberto

Ruiz Fernandez, R

Zywietz, Christofer

PUblication MAnagement

A Year in the Life of the OpenECG Network  
CE Chronaki
1
, F Chiarugi
1
, PJ Lees
1
, A Macerata
2
, F Conforti
2
, M Bruun-Rasmussen
3
, R Ruiz 
Fernandez
4
, C Zywietz
5
 
1
Institute of Computer Science, FORTH, Heraklion, Crete, Greece 
 
2
IFC-CNR, Pisa, Italy 
3
Danish Center for Health Telematics, Odense, Denmark 
4
RGB Medical Devices, Madrid, Spain 
5
BIOSIGNA, Hanover, Germany 
Abstract 
The OpenECG network formed in 2002, is a European 
initiative with global reach, which aims to lower the 
barriers for ECG interoperability and make digital ECGs 
available as part of the integrated electronic health 
record. Currently, SCP-ECG, the European standard for 
ECG record communication and storage, has been 
implemented by some manufacturers. However, these 
implementations are not consistent with each other, 
hindering ECG exchange, processing, and serial 
analysis. Furthermore, the presence of alternative ECG 
storage formats, proprietary or open, raises issues of 
harmonization and quality assurance. 
In the first year of its life, the OpenECG network 
numbers 105 committed members, while its portal and 
associated help desk have already provided valuable 
information and development support to several 
manufacturers and integrators. Recently, the OpenECG 
certification service has become available to members 
who may submit their ECG records for interoperability 
validation and SCP-ECG conformance testing. Still, only 
the first step for the OpenECG network has been taken. 
Future plans involve contributing to the definition of 
integration profiles for ECG-related examinations and 
addressing issues related to quality assurance of eHealth 
services in general. 
1. Introduction 
The OpenECG network is a collaborative effort that 
reaches around the world aiming to lower the barriers for 
ECG interoperability and to make digital ECGs available 
as a core part of the electronic health record (EHR)[1]. In 
the last year, new ECG devices for personal health 
management combined with ECG management systems 
exporting ECG examinations in XML, pronounced the 
need for harmonization among the various ECG formats. 
The 1st OpenECG workshop “Bridging the 
Interoperability Gap in ECG devices” held in October 
2002, made clear that significant barriers for ECG 
interoperability are: (a) the lack of awareness regarding 
existing standards, (b) the lack of tools and information 
that would lower the cost of standards implementation, 
(c) the absence of demand on behalf of the users. As a 
result, OpenECG concentrates its efforts on the typical 
10sec electrocardiogram, the most widely accepted non-
invasive cardiac examination, promoting interoperability 
among alternative ECG formats and fostering the 
consistent implementation of the SCP-ECG standard. 
In early 2003, OpenECG numbers more than 100 
members worldwide from the biomedical engineering 
community, user groups, the industry, and national health 
associations. At the same time, the steady increase in the 
access traffic of the www.OpenECG.net portal and the 
number of Internet (e.g. Google) references to the SCP-
ECG standard reflect the growing interest in ECG 
interoperability. A key role in the management of the 
OpenECG network plays the Industry Advisory Board 
(IAB) formed right after the 1st OpenECG workshop. The 
IAB consists of 7 core members out of health/industry 
associations and is currently supported by an associate 
board of 9 industry representatives. 
OpenECG has taken concrete actions to support ECG 
interoperability in the real world. The help desk of the 
portal has accepted a number of messages from 
integrators and manufacturers who requested and 
received information and guidance on how to consistently 
implement the SCP-ECG standard. Additionally, the 
“ECG record parsing & presentation by email” service 
(see section 3.1) and the online conformance testing 
service for ECG records (see section 3.2), are intended to 
help end-users and integrators by providing input from 
real implementations.   
The open source repository, which will be available to 
members at the beginning of 2004, consists of an 
annotated collection of source code modules for parsing, 
processing, and visualizing digital ECGs recordings 
including a parser and a viewer for ECG records in the 
SCP-ECG standard. Furthermore, an online service 
converting SCP-ECG files to the DICOM 3.0 
0276−6547/03 $17.00 © 2003 IEEE 17 Computers in Cardiology 2003;30:17−20.
(supplement 30) waveform standard is a first step in the 
direction of harmonizing ECG record formats. Using this 
converter, ECG records in SCP-ECG can be viewed 
using freely available DICOM waveform viewers [2]. 
Finally, OpenECG has opened a programming contest in 
which engineers from around the world may freely 
participate and compete on the implementation of ECG 
interoperability tools such as parsers, viewers, and 
converters. The best tools will be available as part of the 
open source repository. 
2. OpenECG portal 
2.1.  Members of the OpenECG network 
OpenECG membership has been granted to all the 
participants of the first OpenECG workshop and since 
then, a number application forms have been received by 
the help desk. On 10th September 2003, in the database of 
the OpenECG portal there were 114 entries and 105 
members. For every application form received, we check 
if the sender has expertise in OpenECG-related areas 
such as cardiology, electro-cardiography, open-source, 
interoperability standards, multimedia electronic health 
record, etc. and if not, additional information is 
requested. If this additional information is provided and a 
real interest is proved, then membership is granted. A low 
number of members who are really committed and 
qualified are to the best interest of the OpenECG 
network! 
All the members of the IAB have received the OpenECG 
honorary membership. Membership has also been granted 
to people with a concrete contribution to OpenECG. 
Members are mostly from Europe (Greece (21), Italy 
(14), Germany (9), Denmark (10), The Netherlands (5), 
UK (5), France (5), Austria (3), Belgium (3), Hungary 
(3), Sweden (2), Switzerland (2), Lithuania (2), Norway 
(1), Poland (1), Russia (1), Spain (3) and Turkey (2)). In 
America we have 9 members (USA (5), Canada (3), and 
Cuba (1)). Three (3) members are in Asia (China (1), 
South Korea (1) and India (1)) and finally 1 member is in 
Africa (South Africa) (see figure 1). 
Greece; 21
Italy; 14
Denmark; 10
Germany; 9France; 5
The Netherlands; 5
United Kingdom; 5
Austria; 3
Belgium; 3
Hungary; 3
Switzerland; 2
Norway; 1
South Korea; 1
South Africa; 1
India; 1
Cuba; 1
Russia; 1
Poland; 1
Turkey; 2
Canada; 3
China; 1
Spain; 3
Lithuania; 2
Sweden; 2
USA; 5
 
Figure 1. Members of the OpenECG network (9/03). 
2.2. Management of the portal 
The Help Desk has been active since August 5, 2002. 
A number of requests for assistance have been received 
by the help desk manager. Development support on SCP-
ECG implementations has been provided to ECG 
manufacturers and a series of general questions relevant 
to the SCP-ECG standard were answered. The response 
of the requestors was enthusiastic!  
The access patterns in the OpenECG portal reflect the 
increasing popularity of the site and follow the main 
events in the life of the network, the 1st OpenECG 
workshop, the opening of the programming contest, the 
publication of the tutorials and SCP-ECG test set (see 
figure 2). 
0
100
200
300
400
500
600
700
v
o
lu
m
e
9.02 10.02 11.02 12.02 1.03 2.03 3.03 4.03 5.03 6.03 7.03 8.03 9.03
date
www.openecg.net statistics
visitors visits download (MB)
OpenECG 
Workshop
Contest 
announcement
How to
SCP-ECG
SCP test set
(2002) 558 unique visitors, 1,79 per visit
(2003) 2568 unique visitors 1,63 per visit
 
Figure 2. The access pattern in the portal follows the 
main events in the life of OpenECG. 
The traffic in the OpenECG portal shows that the 
industry is particularly interested in the activities of the 
network. From the overall traffic, taking out IP addresses 
that cannot be resolved, 16% can be attributed to .com 
sites as shown in the figure bellow.  
16%
14%
13%
8%
4%
4%
3% 5%
4%
3%
2%
3%
2%
2%
1%
2%
1%
1%
1%
1%
1%
1%
9%
8%
Commercial
Italy
Network
Germany
Denmark
Poland
United Kingdom
Russian Federation
Netherlands
France
Belgium
Canada
Spain
Lithuania
Finland
Australia
Non-Profit Organizations
Japan
Norway
Taiwan
Indonesia
USA Educational
Hungary
30% from Greece 
(incl. maintenance)
20% unknown 
Most accesses for .com sites: the industry has noticed!  
Figure 3. 16% of page accesses can be traced back to the 
industry. 
3.  Member services 
3.1.  ECG record parsing and presentation 
An automated email service has been developed by 
IFC-CNR to assist users in assessing ECG recordings 
presumably stored according to the SCP-ECG standard. 
Members of the OpenECG network who have registered 
with the helpdesk to use the service, may send email to 
scp-parser@ifc.cnr.it with subject "parse submitted scp-
ecg file" attaching the ECG files they wish to visualize.  
Each ECG record file attached to the email message is 
processed by an agent that parses the SCP-ECG record 
18
and employs dedicated modules for SCP-ECG format 
interpretation and ECG signal visualization. The output 
of this process is a graphics file and a textual report. 
 
Figure 4. Automatic textual report returned by email. 
The textual report (.log file) contains section by 
section, all the information that the IFC-CNR parser was 
able to extract from the ECG record (see figure 4). This 
information includes: 
o patient data  
o manufacturer data  
o ECG measurements (if present in the ECG record) 
o the diagnostic report (if included in the ECG 
record)  
o miscellaneous file control elements  
The graphics file shows a graphical representation of 
the 12 leads of the submitted ECG record and is stored 
according to the portable network graphics (PNG) format. 
The text report and the graphics file along with the 
original ECG record are sent back to the sender via an 
automatic reply. The received ECG records are stored in 
the ECG database of IFC-CNR.  
The textual report and graphics file produced 
automatically by the email service do not serve as 
validation of the ECG format, but only as the capability 
of the IFC-CNR parser to extract information from the 
submitted ECG records. 
 
Figure 5. OpenECG portal member area. 
3.2. OpenECG certification services 
So far, safety conformance testing and device approval 
require testing of an ECG device by a notified body. Such 
institutions are in Germany, the offices of the Technische 
Uberwachungs Verein (TUV) and in the Netherlands, 
TNO. All these institutions require that the device is 
physically provided and all tests are performed by 
inspection and by respective measurements. 
Certification from the OpenECG network should not 
be considered an official certification as provided by 
approved international/national Notified Bodies. The 
OpenECG consortium does not constitute a notified body. 
The OpenECG certification service offers SCP-ECG 
conformance validation by qualified professionals and 
experts and is supported by the European Commission in 
the frame of the OpenECG project.  
The overall goal of OpenECG is “to move from 
standards in paper to standards that work in practice”. 
OpenECG is able to test automatically ECG records 
claiming to be SCP-ECG conformant. In case of ECG 
device certification, the test will not be automatic but 
through the physical submission of the ECG device itself. 
When an ECG record is validated, an OpenECG 
Certificate is sent by post and/or email, upon request to 
the OpenECG Help Desk (helpdesk@openecg.net). The 
OpenECG Certificate describes the exact conditions 
under which OpenECG certification was achieved. Since 
future improvements of the service are expected, a 
version number is included in the certificate. 
As far as ECG records are concerned, conformance 
testing applies not only to the file generated by the 
medical device, but also to the file received by an EHR 
system, which may edit information in the ECG record 
such as patient data, diagnosis, etc. The approach used for 
conformance testing addresses detailed checking of 
content and format of the data sections provided, 
including the two bytes of the CRC checksum and the 
length information of the record.  
ECG Record level conformance testing is available 
automatically through the OpenECG portal. The overall 
process involves two steps. First, the member logs into 
the members area of the OpenECG portal and selects on 
the left bar “OpenECG Certification | ECG record testing 
service.” A new window appears that prompts for a file 
upload. Then, the member selects the ECG record to be 
tested from the local file system and presses “Test.” The 
file is uploaded and tested automatically. The new page 
presented to the member includes hyperlinks to the 
format and syntax checking reports. The output reports 
may include warning and error messages. Warnings refer 
to the recommended use of the standard (mainly changes 
from version 1.0 to 1.3), while errors refer to mandatory 
requirements of the SCP-ECG standard. The format and 
the content checker are based on the specifications of 
SCP-ECG version 1.0 and 1.3. (see figures 6,7). If the 
19
test is successful, the member can proceed to the second 
phase and request an OpenECG certificate for the 
submitted ECG record via the helpdesk. 
 
Figure 6. Format checking results of an ECG record. 
If a developer or integrator needs a more detailed 
report i.e. “what have I done wrong?”  or “what do I need 
to do?” development support can be provided by the Help 
Desk. To receive development support additional 
information is required: 
1. “Claimed compliance category” (SCP-ECG 
standard). 
2. “SCP-ECG Implementation Document” with a 
detailed description of all data contained in the 
record and the (intended) format. 
 
Figure 7. Contents checking results of an ECG record. 
ECG Device level testing is available offline. In this 
case, in addition to the claimed compliance category and 
the "SCP-ECG Implementation Document", the device 
has to be physically available and be accompanied by 
appropriate documentation of the communication 
protocol and software drivers for interconnectivity.  
The manufacturer has to supply a driver for the 
communication with a device. OpenECG does not require 
disclosure of the low level details of the communication 
protocol managed by the driver. It is the driver that has to 
be able to retrieve the ECG data recording into a 
presumed SCP-ECG record, which will be provided to 
the OpenECG conformance testing service through the 
file system or a DBMS with disclosed structure. 
An analog ECG test data set will be submitted to the 
device and the output SCP-ECG records will be checked 
and compared with the original input data. For validated 
ECG devices, an OpenECG Certificate will be send by 
post and/or email, upon request to the OpenECG Help 
Desk. The OpenECG Certificate will describe the exact 
conditions under which the OpenECG certification level 
was achieved with specific reference to the manufacturer 
and model that was tested. Again, since future 
improvements of the service are expected, a version 
number is included in the certificate. 
4. Conclusions & future work 
Despite the success of the OpenECG network in the 
first year of its life, efforts to ensure ECG interoperability 
worldwide have just begun. There is a growing 
confidence that the continuous efforts of the OpenECG 
members contribute to the consistent and harmonized 
implementation of ECG standards. More specifically the 
services of the help desk, the OpenECG certification 
service and the wide availability of software that has been 
tested with ECG samples of different manufacturers will 
help to alleviate interoperability problems. 
The immediate plans of the OpenECG network 
include a programming contest for ECG interoperability 
tools, which will closes on December 31, 2003 and the 
second OpenECG workshop that aims to bring ECG 
interoperability standards to their full potential. 
Acknowledgements 
The OpenECG network is funded by the EU under 
contract IST-2001-37711. 
References 
[1] CE Chronaki, F Chiarugi, PJ Lees et al. OpenECG: a 
European Project to Promote the SCP-ECG Standard, 
a Further Step towards Interoperability in 
Electrocardiography. Computers In Cardiology 
2002;29:285-289  
[2] V Sakkalis, F Chiarugi, S Kostomanolakis, et al. A 
gateway between the SCP-ECG and the DICOM 3.0 
Supplement 30 Waveform Standard. Computers in 
Cardiology 2003, 30  
 
Address for correspondence. 
 
Catherine E. Chronaki 
Center for Medical Informatics &  
Health Telematics applications 
Institute of Computer Science – FORTH 
PO 1385,  7110 Heraklion, Crete, Greece 
Email: chronaki@ics.forth.gr 
20


A Year in the Life of the OpenECG Network

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A Year in the Life of the OpenECG Network

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