PULSE-FHIR: Platform for Unified Labeled Signals of Electrocardiograms in FHIR
DOI:
https://doi.org/10.5753/jisa.2026.7446Keywords:
HL7 FHIR, Interoperability, Electrocardiography (ECG), IoMT, Health Information Systems, Web-based Visualization, Data StandardizationAbstract
This work presents PULSE-FHIR, an open-source web platform that integrates Fast Healthcare Interoperability Resources (FHIR)-compliant electrocardiogram (ECG) recordings with temporally synchronized visualization of clinical and AI-generated annotations. PULSE-FHIR supports multi-lead display, including 12-lead ECG recordings, flexible temporal navigation, and the overlay of beat-level annotations from reference databases, such as MIT-BIH, or neural network outputs. Additionally, it interfaces with FHIR servers, such as HAPI-FHIR, using SMART on FHIR when authentication and authorization are required. Precise alignment of raw signals and annotation markers enables direct comparison of AI classifications with reference labels, supporting ECG review and validation workflows in Internet of Medical Things (IoMT) ecosystems. The manuscript details the system architecture, FHIR representations for ECG signals and annotations, the implementation of the visualization interface, and experimental validation using MIT-BIH recordings. Results demonstrate effective temporal synchronization and rendering latencies below 200 ms for complete one-minute ECG records. The evaluation also indicates the importance of incremental retrieval strategies for handling long-term ECG recordings. A QR code links to a demonstration video and the project source code on GitHub.
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