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Design Considerations for the Development of a National Prototype for Quality Assurance in Telecardiology

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Design Considerations for the Development of a National Prototype for Quality Assurance in Telecardiology G. Loudos, A. Kastania, S. Demarias, E. Magos, M. Paavonen, – PowerPoint PPT presentation

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Title: Design Considerations for the Development of a National Prototype for Quality Assurance in Telecardiology


1
Design Considerations for the Development of a
National Prototype for Quality Assurance in
Telecardiology
  • G. Loudos, A. Kastania, S. Demarias, E. Magos, M.
    Paavonen,
  • J. Dimakopoulos, C. Davos, C. Boudoulas and S.
    Kossida

Foundation for Biomedical Research of the Academy
of Athens, Bioinformatics Group, Soranou Efesiou
4, 11527, Athens, Greece
2
Outline
  • Short Introduction to Telemedicine and
    Telecardiology
  • Quality assurance in Telecardiology
  • Design considerations for quality assured
    services
  • The e-???f???? project
  • Conclusions

3
Short Introduction to Telemedicine
  • Telemedicine refers to the use of electronic
    information and communication technologies to
    provide and support health care when distance
    separates the participants
  • It is perceived as having the potential to
    improve the accessibility and quality of health
    care delivery, while lowering costs
  • Telemedicine covers a wide range of applications
    from simple diagnosis to surgery and patient
    follow up

4
Short Introduction to Telecardiology
  • Telecardiology is the practice of cardiology,
    which utilizes telecommunications and
    signal/image compression technologies to
    manipulate tele-data during monitoring of
    cardiac patients from their home or office and
    for remote consultation between cardiologists as
    well as between general practitioners and
    cardiologists

5
Why Telecardiology
  • Although new diagnostic and treatment methods are
    available, the current way of life leads to
    continuous increase in the number of heart
    failures, which are estimated to be doubled
    within the next 40 years!
  • The relatively simple characteristics of ECG and
    blood pressure and their high prognostic value,
    make them perfect candidates for telemedicine
    applications
  • Nowadays, a number of compact systems for
    transfer of cardiac signals from patients to
    cardiological centers are commercially available,
    communication protocols have been proposed and
    significant experience exists

6
Some examples of Telecardiology
7
Bibliography status on Telecardiology
  • Lack on Telecardiology application literature
  • Assessment about Telecardiology application are
    hard to find
  • 61 articles regarding telemedicine applications
    on cardiology specialty were found in PubMed from
    1992 to 2004
  • 79 yesterday ?

8
Quality Assurance In Telecardiology
  • A Telecardiology information system must
    guarantee the quality of services and the
    capability to collect and evaluate the results of
    telecare
  • Optimization of a Telecardiology service
    incorporates quality and reliability assurance of
    telemetry
  • The need for quality assured services requests a
    careful study, assessment, evaluation,
    improvement and/or modification of existing
    quality assurance models, in order to adopt a
    prototype for national and possibly wider
    application

9
Why do we need quality assurance models
  • in order to measure quality
  • in order to improve quality

10
What is Quality?
  • Quality is a complicated denotation, since it
    means different things to different people
  • Until now, there is not a general quality
    definition
  • Thus, there cannot be even one measure of
    quality, acceptable to everyone.
  • In order to evaluate and/or improve quality, it
    is necessary to define the quality aspects of
    interest and to decide, how they will be measured
  • When quality is determined in a measurable way,
    it is easier to make other people understand your
    opinion and correlate their denotations to yours
  • In conclusion, quality is correlated to end goals

11
Design Considerations
12
Define participants in Telecardiology services
Participants in Telecardiology Services
People
Hardware
Software
Individuals
Organizations
Dedicated equipment
Infrastructure
Communication network
Patients Doctors Providers Technologists

Equipment Software Data compression Medical
Record
Sensors Holters Blood Pressure
Units Computers
13
Assess quality
  • Define what quality is in services, equipment
    and software
  • Decide who assesses quality
  • The success or not of Telecardiology relies on
    the acceptance of all possible participants and
    the obvious improvements that it introduces in
    their work or quality of life.
  • Criteria of success must be determined depending
    on the feedback of Telecardiology users and
    suppliers as well
  • Understand acceptance of new (mainly information)
    technologies

14
Modification or design of quality assurance models
  • DeLones McLeans Management Information
    Systems (MIS) used 6 variables to measure
    success
  • System Quality
  • Information Quality
  • System Use
  • User Satisfaction
  • Organizational Impact
  • Individual Impact

15
Hebert Telehealth Evaluation Framework
16
Hebert Telehealth Evaluation Framework
  • The following three questions illustrate an
    evaluation strategy
  • When introducing Telehealth technology, what are
    the expected relationships among
    structure-process outcome?
  • How does using the technology compare to the
    process of traditional care?
  • Are the outcomes of using the technology
    understood for clients, providers and
    organizations?

17
Perceived usefulness towards professional status
  • Items assessing perceived usefulness towards
    professional status
  • IT may enable other non-physicians to complete my
    work activities
  • IT may lower others perceptions of my degree of
    skill and knowledge of my own work activities
  • IT may give non-physicians better understanding
    of my practice
  • IT may result in greater external review of my
    peers
  • IT may lower non-physicians reliance on my
    independent work activities
  • IT may lower non-physicians trust in
    professional peer review
  • IT will require greater emphasis on quality
    standards of my work activities

18
e-???f???? project
  • Project e-Hrofilos a strategy for improvement
    of quality and reliability of Telecardiology
    funded by the Regional Operational Program in
    Attica from National and European Union Resources
  • Partners
  • Foundation of Biomedical Research of the Academy
    of Athens
  • Intracom
  • Netsmart
  • Evaluation and implementation of the previously
    mentioned models and standards

19
e- ???f???? directions
  • Theoretical
  • Development of a National Prototype for Quality
    Assurance in Telecardiology
  • Standards SCP-ECG, HL-7, ISO 9126, IEEE/MIB
    standards, etc
  • Technical
  • Set up a e-???f???? server at IIBEAA
  • ECG signal compression and processing etc
  • Clinical
  • Assessment in patients

20
Conclusions
  • In order to improve Quality and Reliability of
    Telecardiology a large number of sensitive
    factors, like cost-effectiveness, efficacy,
    patient satisfaction and clinical outcomes have
    to be evaluated and improved
  • Various models and standards have been proposed
    as guidelines, in order to optimize Telemedicine
    services
  • Extended study, evaluation, implementation and
    modification of these standards is carried out in
    the framework of the Project e-???f???? a
    strategy for improvement of quality and
    reliability of Telecardiology
  • The end goal of this effort is the design of a
    well validated National Prototype for Quality
    Assurance in Telecardiology

21
Design Considerations for the Development of a
National Prototype for Quality Assurance in
Telecardiology
  • G. Loudos, A. Kastania, S. Demarias, E. Magos, J.
    Dimakopoulos,
  • C. Davos, C. Boudoulas and S. Kossida

Foundation for Biomedical Research of the Academy
of Athens, Bioinformatics Group, Soranou Efesiou
4, 11527, Athens, Greece
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