How to make eProtocol

1. How to make eProtocol László Daragó, András Jávor Semmelweis University, Budapest

2. Outline • Telemedicine to extend the efficiency of healthcare suppliers • Telemedicine to save resources • POV’s of eProtocol • Opportunities and threats • eProtocol as regulation: „Boon and bane”

3. New circumstances, new challenges • Growing population, ageing society • Growing expectation of life • Growing possibilities of medication, incurable diseases become curable • Growing expenses of medication Resources are needed: • Doctor (staff): relocation of medical knowledge • Time • Money

4. New form of the healthcare • Radical changes in the healthcare delivery by using telemedicine • New protocols, guidelines are needed for utilizing the benefit of the telemedicine • The protocols containing rules for • Clinical Pathways, • Education, • Financing, • Legal environment, • Patient rights, • Ethical issues of the patient care

5. Barriers of the Telemedicine Applications • Reimbursement of the telemedicine-oriented care from public fund is not supportive at this time • Legal and ethical aspects are confuse • Automatic, patient-oriented decision-making is not accepted • Rigid care structure changes slowly • Educational tools are poor

6. Public access to telemedicine • Introducing of applying the telemedicine tools in not healing field, such as fitness, sport, entertainment, exists, but only for a narrow market. Healthcare utilisation needs the safety for all the participants, that is, for patient, health provider, technical assistance. • There also must be ensured economical and resource saving usage, legal and financial regularisation. • Until the health insurance accept and finance the telemedicine processes and procedures, they will not become accessible generally in healthcare and the usage rate will not guarantee the return of the investment in technology, studies, human resources.

7. Architecture of telemedicine Actors and rules Patient Order the telemedicine curing of the Health provider. Participate in the cure via the tools (sensors, data transmit and output devices) of the Agent. Health provider Cure the Patient with the tools of the agent, by the protocol of the Protocol provider. Order the Agent’s service, patient communication. Protocol provider Serve protocol interface to the Health provider, the Agent and the Patient, via the Agent. Database managing for active data. Telemedicine service agent Control the tools and data transfer in the Patient-Health provider communication by the protocol, got from the Protocol provider. Temporary data storing (for store-and-forward technique or troubleshooting). Transfer to the Protocol provider. Technological hot-line and help desk service both for the Patient and the Health provider. • Knowledge / Protocol base(1) • Guideline • eProtocol • Health knowledge base • Technology knowledge base Active database (1) Protocol provider(1) Patient(n) Telemedicina service agent(n) Health provider(n)

8. Participants of telemedicine POV of patient • In the point of view of patient, the telemedicine curing should be much more comfortable, time and money saver, and much faster than the traditional way. • In the same time the patient may worry because believing a person, that is the doctor is not the same as believing the system. • Can the patient oversee who watches, records and procedures his/her vital data? • Who can access the data, able to forward – or in a case – delete? • Does the patient have possibility to delete or encrypt his/her own data?

9. Participants of telemedicinePOV of MD (health provider) • In the point of view of the medical doctor or health provider the curing processes should be protected by the controlled and supervised eProtocols. • It gives protection for the doctor in any later legal procedures about the healing. • In the case, of health insurance financed telemedicine procedures, creating valid investment and business plans become much easier.

10. Participants of telemedicine POV or fund (health insurance) • In the point of view of the health insurance company the safety, that is the needed, adequate and eligible service has been given to the patient with the necessary and sufficient resources, should be guaranteed. • There must connect the telemedicine health service to the Patient record, that is, the insufficient procedure may not cause the growth of the cost of the cure of the patient. Or, if it did, the cost holder must be pointed.

11. Validity and Reality of data • The validity and reality, as important aspects of the telemedicine, data communication was also re-evaluated. • The validity of the forwarded data from the sensors or otherwise created input and sent data must be checked. Any individual datum may mislead the doctor at the evaluation of the status of the patient, or the technician at the reliability of the system. The traditional medical protocols contain the checking procedures or data at accepting the results. • Another question is the checking of the reality of the sent data. It is also a serious duty for the telemedicine data transfer agents. • The actors of the telemedicine service has been reported and asked about their suggestions and doubts at fitting this technique in the daily routine. They were also asked for alternatives.

12. Safe communication • The telemedicine processes must contain their included control and backup processes and systems. Single datum may appear only as part of series or element of a collection. Data packs must be collected as consistent, valuable measure results and signs. These transmitted data packs must be validated before and after the transmission. Digital signature required for the data interchange to identify the patient, the agent and the receiver, that is the health provider. It also ensures the harmless communication. • Regulation is needed to oversee and check the quality of the telemedicine procedures, actors and agents. That is the interest for both of the partners. • The reality and validity of the transmitted and received data must have high priority.

13. Phases of making eProtocol • Select the medical activity (curing). Study and analyse the healing process and its national guideline. Identify, describe and analyse the subprocesses. • Describe the data flow the of the process, to be transformed, and create its data flow diagram. Reiterate until the medical and technical teams both are satisfied with the process description. • Identify the subfunctions, to be substituted, and analyse by the aspects of I/O, supervision of the procedures. Create the data flow diagram and the flow chart of those subprocesses. Reiterate until the medical and technical teams both are satisfied with the subprocess’ description. • Describe the communication protocol of the eProtocol. • Develop, embed, test and validate the sensors. • Create eProtocol (that is modify and supplement the original guideline/protocol). • Compare the traditional guideline/protocol and the eProtocol by the point of view of patient, doctor, health insurance company and by the aspects of efficacy, duration, complications, critical times. • Explain and answer the questions of implementation. • Explain and answer the questions of operation and maintenance

15. Conclusion • As the National Guideline, eProtocol also must have a supervised and checked system for qualification and acceptance. • To apply the eProtocol the certification must renewed time by time, both in medical and financial aspects. • The technical background must be certificated too. There must be found or named an authority to realise and supervise this process. • The existence of eProtocols is necessary but not sufficient condition of the introduction of the telemedicine generally and in big amount in the daily routine, but creating them may help to avoid lot of troubles.