Momentum telemedicine service descriptions

Telecardiology Puglia (IT)

Objectives, expected outcomes, main beneficiaries

The full name of the service is “Telecardiology applied to Apulia regional 118 public healthcare network”, or Telecardiologia nel servizio di emergenza 118 della Regione Puglia.  The service helps and supports all ambulance doctors in their daily routine activity providing emergency care. Through the telecardiology service, a specialist cardiologist in the Cardio On Line Europe telemedicine service centre (CST) is available 24 hours on seven days a week for online and telephone consultations for doctors and patients alike. Anybody with a 12-lead electrocardiogram (ECG) recording can send it within three minutes to the CST and receive a consultation and assessment in real time in the same telephone call.  The telecardiology service reduces cost by avoiding inappropriate admissions, and improves the quality of life for all citizens in Puglia.

Targeted population, number of patients

The potential beneficiaries of the telecardiology service (part of the public healthcare system) include all 4,200,000 inhabitants in the Puglia region. Each may benefit from the telecardiology system in case of a cardiovascular event. In addition, the service also has private clients in other parts of Italy and beyond.

Type of telemedicine service

The telecardiology service is easy to use. In case of an emergency an ambulant doctor or anybody else who is trained can record in twenty seconds a standard 12-lead ECG, and transmit it via a normal telephone to Cardio On Line Europe.  The specialist cardiologist will, in real time, analyse the recording and, on the basis of anamnesis, share findings with the ambulance doctor and, in the same call, send a report. The ambulance operations centre then determines where to refer the patient. An online platform is available for viewing – in real-time – all electrocardiograms. The parties involved include the public healthcare system, Cardio On Line Europe, and all regional hemodynamic centres.

Set-up that was being replaced

When the service was introduced in Puglia for the first time in 2004 (a first for a public healthcare system), it filled a void. In Italy, the Puglia region is still the only region to use this service. In the first month of activity the service handled about 600 calls for ECG; today there are more than 10.000 calls for ECG every month. This reflects a high level of trust in the healthcare and in the telemedicine system.

Outcomes and results expected after introduction

Telemedicine supports the normal activity of patient care. In five years of use, the telecardiology service has contributed to cutting Puglia’s mortality rate for acute myocardial infarction by half (based on public data published by the official national epidemiology centre).  In terms of cost, the telecardiology service has produced considerable savings in term of avoidance of unnecessary care and inappropriate admissions.  The service has also helped reduce time from diagnosis to treatment:  based on a study in an important cardiology journal, the median time is 41 minutes for infarct patients.

Detailed description

Cardio On Line Europe was founded in 1996 with the mission to perform telemedicine, in particular telecardiology. In 2004, Cardio On Line Europe in accord with a pharmaceutical society and Puglia region started to deliver the telecardiology service to all points of emergency in the regional public healthcare. It consists of a device (12-leads electrocardiograph), a telemedicine service centre (CST) staffed round the clock by operators and cardiologists, and a telephone line. The CST can receive an ECG report from a specialist and deliver a consultation in the same phone call. Emergency teams find the devices and the service easy to use. Within minutes, they know whether the patient with angina pectoris or other symptoms can be placed in their home or needs to be hospitalised. Latest report data (available on shows that only 20 percent of patients calling emergency services need to be taken to the hospital, while the remaining 80 percent can be treated at home. This means real cost savings. Studies published from University of Foggia and posted on the website document cost savings, reduced time to treatment, improved clinical impact, prevention and rehabilitation as a result of the telecardiology service.

Cardio On Line Europe is certified ISO9001 for quality and ISO/IEC27001 for security of all sensible data. All software and all devices are certified as medical devices. Cardio On Line Europe staff report a high degree of dedication and passion for their work.

Operational status

The telecardiology service for regional emergency public healthcare has been working since October 2004. It was started initially with outside funding, but results have been so convincing (in terms of life quality, clinical effects and cost savings) that the Puglia region has agreed to support the service through public funds.  Cardio On Line Europe hopes to extend this telemedicine service to other regions or to extend a similar service to the chronic patients in the region (which is already being trialled in some social-health districts in Puglia).

Further information

For further information, please visit or contact:

  • Mr. Claudio Lopriore, Cardio On Line Europe General Director;
  • Mr. Giuseppe Di Giuseppe, Cardio On Line Europe ICT Director (author of this text)
  • Md. Francesca Avolio, Regional Responsible Healthcare Agency of Apulia;
  • Md. Natale Daniele Brunetti, University of Foggia (Puglia) and Cardio On Line Europe consultant.