How to make eProtocol
László Daragó, András Jávor
Semmelweis University, Budapest
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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”
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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
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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
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Clinical Pathways,
Education,
Financing,
Legal environment,
Patient rights,
Ethical issues of the patient care
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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
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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.
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Architecture of telemedicine
Knowledge / Protocol base(1)
•Guideline
•eProtocol
•Health knowledge base
•Technology knowledge base
Protocol provider(1)
Telemedicina service agent (n)
Health provider (n)
Active database (1)
Patient (n)
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.
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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?
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Participants of telemedicine
POV 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.
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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.
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Validity and Reality of data
• The validity and reality, as important aspects of the
telemedicine, data communication was also reevaluated.
• 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.
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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.
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Phases of making eProtocol
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2.
3.
4.
5.
6.
7.
8.
9.
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 13
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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.
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