G. Loudos , A. Kastania, S. Demarias, E. Magos, M. Paavonen,

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-Ηρόφιλος project • Conclusions

3. Short Introduction to Telemedicine • Telemedicine refers to the use of electronicinformation and communication technologies to provideand support health care when distance separates theparticipants • It is perceived as having the potential toimprove the accessibility and quality of health caredelivery, 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 AssuranceIn 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 • DeLone’s & McLean’s Management Information Systems (MIS)used 6 variables to measure success: • System Quality • Information Quality • SystemUse • 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. Items assessing perceived usefulnesstowards professional status IT may enable other non-physiciansto complete my work activities ITmay lower other’s perceptions of my degree of skill and knowledge of my own work activities IT may give non-physiciansbetter understanding of my practice IT may result in greaterexternal review of my peers IT may lower non-physicians’reliance on my independent workactivities IT may lower non-physicians’trust in professional peer review IT will require greateremphasis on quality standards of my workactivities Perceived usefulness towards professional status

18. e-Ηρόφιλος project • Project «e-Hrofilos: a strategy for improvement of quality and reliability of Telecardiology» funded by the Regional Operational Program in Attica from National andEuropean 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- Ηρόφιλος 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-Ηρόφιλος 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-Ηρόφιλος: 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