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