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Remote clinical examination: the key issue of telemedicine

Remote clinical examination: the key issue of telemedicine. Enrico M. Staderini Haute Ecole d'Ingénierie et de Gestion du Canton de Vaud – HES-SO Western Switzerland University of Applied Sciences Route de Cheseaux, 1 CH-1400 Yverdon les Bains (Vaud) Switzerland enrico.staderini@heig-vd.ch.

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Remote clinical examination: the key issue of telemedicine

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  1. Remote clinical examination:the key issue of telemedicine Enrico M. Staderini Haute Ecole d'Ingénierie et de Gestion du Canton de Vaud – HES-SO Western Switzerland University of Applied Sciences Route de Cheseaux, 1 CH-1400 Yverdon les Bains (Vaud) Switzerland enrico.staderini@heig-vd.ch Geneva, 6-7 December 2010 Addressing security challenges on a global scale 2

  2. How physicians are made • Information diggers • Pattern finders • Problem solvers • Alarm triggers • Direct patient interaction or • Mediated patient interaction Geneva, 6-7 December 2010 Addressing security challenges on a global scale 3

  3. Medicine not only lacks precision... • It lacks a formal methodology • Medical practice is a practice indeed! • Not a formal theory behind it Geneva, 6-7 December 2010 Addressing security challenges on a global scale 4

  4. Epistemology of diagnostics • Patient is suffering from something • Task of diagnostics is to discover it • The diagnostic process implies • Interaction & Communication • Physical measurements • A social construct • A technological construct Geneva, 6-7 December 2010 Addressing security challenges on a global scale 5

  5. The process of subject-caregiver interaction cognitive process (awareness) perceptionofsymptoms subject culturalprocess signs sensations complaint physicalinteraction discourse hypothesis probing process caregiver cultural process (discipline) hypothesized disease from a set of disease models cultural process formalizationofsymptoms shareablemedical record formalizationofdiagnosis Geneva, 6-7 December 2010 Addressing security challenges on a global scale 6

  6. Interaction in the hypothesis probing formalization of diagnosis patient care-giver decision process stimulation vector action response vector biometric device biometric device perception signs & findings Geneva, 6-7 December 2010 Addressing security challenges on a global scale 7

  7. The caregiver decision process caregiver decision process expected finding stimulation vector generator similarity stimulation vector + - perceived finding decision min expected similarity perception signs & findings formalization of diagnosis Geneva, 6-7 December 2010 Addressing security challenges on a global scale 8

  8. Interaction in the hypothesis probing formalization of diagnosis patient care-giver decision process stimulation vector action response vector biometric device biometric device perception signs & findings Geneva, 6-7 December 2010 Addressing security challenges on a global scale 9

  9. The “device only” interaction formalization of diagnosis care-giver patient decision process stimulation vector action biometric device response vector biometric device perception signs & findings Geneva, 6-7 December 2010 Addressing security challenges on a global scale 10

  10. Interaction through a telecom channel formalization of diagnosis telediagnostics care-giver teleconsultation decision process telebiometric device telebiometric device action patient stimulation vector response vector perception signs & findings Geneva, 6-7 December 2010 Addressing security challenges on a global scale 11

  11. The engineering science of medical practice • Engineering the medical practice • Formalizing a method of diagnostic reasoning (a science of diagnostics) • Syntax • Semantics • Pragmatics • Formalizing the knowledge base Geneva, 6-7 December 2010 Addressing security challenges on a global scale 12

  12. The social issue of telemedicine • What about if the communication/interaction part of the diagnostic process is technologically mediated ? • No formal training of physicians to cope with this situation • Methodology must be strengthened • Security and legal issues in data transmission are just details Geneva, 6-7 December 2010 Addressing security challenges on a global scale 13

  13. What we need • Formalism for data representation • Formalism for data transmission • Formalism for data fruition • Formalism for decision making • Formalism for action performing • Standardization and formal theory of medicine Geneva, 6-7 December 2010 Addressing security challenges on a global scale 14

  14. Modern attempts to theorize medicine from Prof. Sadegh-Zadeh • Sadegh-Zadeh K.: “Fundamentals of clinical methodology 1. Differential indication”. Artificial Intelligence Med. 1994, 6, 83-102 • Sadegh-Zadeh K.: “Fundamentals of clinical methodology 2. Etiology”. Artificial Intelligence Med. 1998, 12, 227-270 • Sadegh-Zadeh K.: “Fundamentals of clinical methodology 3. Nosology”. Artificial Intelligence Med. 1999, 17, 87-108 • Sadegh-Zadeh K.: “Fundamentals of clinical methodology 4. Diagnosis”. Artificial Intelligence Med. 2000, 20, 227-241 • Sadegh-Zadeh K.: “Fuzzy Health, Illness and Disease”. J. Med. Phyl. 2000, 25, 605-638 • Sadegh-Zadeh K.: “The Prototype Resemblance Theory of Disease”. J. Med. Phyl. 2008, 33, 106-139 Geneva, 6-7 December 2010 Addressing security challenges on a global scale 15

  15. A roadmap to telemedicine Formalizing medical reasoning Is clinical judgment computable ? Classical knowledge not appropriate Fuzzy logic may be Diagnostic and therapeutic knowledge is procedural knowledge (medical practice) on fuzzy statements Geneva, 6-7 December 2010 Addressing security challenges on a global scale 16

  16. Teaching telemedicine We have to, at university level Don't make just examples Teach methodology instead Coping with an unreachable patient Insist on the social interplay of the medical task Use (develop) standards for medical data communication Geneva, 6-7 December 2010 Addressing security challenges on a global scale 17

  17. An evolution process caregiver alone conventional semiotics 100 % invention of the stethoscope (Laennec 1816) assistive technologies invention of the telephone (Bell 1876) invention of X-ray imaging (Roentgen 1895) invention of electrocardiograph (Einthoven 1902) telemetry direct interaction with patient invention of the microprocessor (Hoff 1968) invention of 2D M-mode echocardiography (Reid 1970) teleconsultation invention of computed tomography (Hounsfield 1972) invention of the World Wide Web (Berners-Lee 1991) time Geneva, 6-7 December 2010 Addressing security challenges on a global scale 18

  18. Warnings • Medicine remains a cultural process • verify that standards and methods will comply with different social cultures • Consider the business model of the medical practice • Samaritans are not widespread ! Geneva, 6-7 December 2010 Addressing security challenges on a global scale 19

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