Today, in the course of FòrumCIS , LivingLabs have explained the methodology applied to the field of health.
Unfortunately, there has been streaming, and I think also no picture.
LivingLabs Talking about health is particularly collaborative, multidisciplinary teams of peer-to-peer, the maturity cycle of development, both outside-in (product or service) and inside out (product or service already exists).
Emphasize take nothing for granted, to ask the user not only what you need but what you want and measure the GAP, the techniques of "interrogation" to get to discover which is the real aspiration of the users are part of the methodology, always thinking about innovation key 360 º means any actor of the value chain of healthcare can be a source of innovation.
I hope you enjoy the presentation as much as I make them. :-)
Today, within the Forum AeroTelecom I was asked to a presentation to discuss telemedicine ...
The truth is that the type of event (and because I received a specific request to that effect), I decided to look at the topic from an aviation perspective.
But the issue was what sector: civil aviation, military, sports, parachute ...
end I decided to look at the stars in the presentation of PodCamp project and spoke of species ...
So the choice was clear: telemedicine, in the vicinity of a manned mission a. .. Mars.
I asked my good friend helps María García-Puente, the legendary @ bibliovirtual , which was responsible for searching the available evidence in this area, and that without their help would have been impossible to implement the paper .. . Thank you, Mary!
Although it has been recorded on video, do not know when it will be available, so here is the storytelling:
live on a planet called Earth, which besides being our home, is the spaceship World's Greatest ... revolves around the sun for about 365 days and accompanies our star the journey of giving back to the Milky Way galaxy, a journey of 200 million years.
on this planet takes place throughout our life cycle, and can say that we explored as possible of the world ...
And there was a time when the man raised his eyes to heaven ... and decided to go to the moon ... a project born in the Cold War era, due to the struggle for supremacy between the U.S. and the USSR, and winning the U.S. ... at that time, 41 years ago, survive a variety of devices that have undoubtedly changed the world: from Velcro humble to the microprocessor.
At that moment is when large-scale experiments with pulse sensors, temperature, biological speaking channels ... the man was helpless in one of the most hostile and there was a need to protect it, it was also necessary to measure the effects of spaceflight on the human body.
just the Apollo program, and created the need for a reusable transportation system can be used to build a permanent human settlement in space ... thus was born the Space Shuttle.
And after the experience of Skylab, Salyut and Mir, establishing the International Space Station ... and there is a permanent human settlement in orbit ... The target this time is not the moon, we know that is a wasteland ...
The destination is called Mars ...
Mars, one of the inner planets, at a distance that varies between 56 and 400 million miles from Earth ... smaller than our planet with lower gravity of Earth.
mission parameters are
Duration of 879 days, 619 in Martian soil
Crew 8 astronauts
Propulsion chemical / ion / nuclear
The health risks of the mission find them in the slide number 9, which will highlight the psychosocial risks, low gravity, high-energy radiation and the inaccessibility of health centers.
Psychosocial risks are obvious, and even adjusting for personality profiles, the forced coexistence of so many people in a confined space tempranopuede or later trigger a conflict.
As for inaccessibility, in slide 13 we remember the story of Dr. Jerri Nielsen, an Antarctic explorer, detected breast cancer after a biopsy in the hardest winter Antarctic, and the impossibility of being able to evacuate, the Air Force parachuted equipment and tools necessary to enable self-administer chemotherapy ... was evacuated for several weeks.
In our case, the spacecraft is between 56 and 400 million km, with an average transmission time round about 20 minutes ...
On the other hand, low gravity causes a loss of muscle mass that may reach 40%, so it is vital to maintain a fitness routine.
We also talk about the inevitable body sensors, but we need something more advanced and allows us to prevent risks ... slide 15.
talked about two projects:
Help4Mood , which allows the detection of mood, a project originally dedicated to patients with major depression, in development and could be implemented smoothly in an environment as described
MedCat , an expert system dedicated to the management of chronic diseases, but also by characteristics could be used on an interplanetary mission.
Here you have the presentation, and I hope you enjoy it as much as I have made provision ... :-)
The truth is that seen from a medical point of view, the reasoning is impeccable.
To me, as a retired computer professional from the front line, I would dig a little deeper.
first say that both the design and usability of existing health information systems in our country leaves much to be desired and that from the viewpoint of human interface, are closer to the designs of the 80 that what is customary in the year 2011 ... and is not a problem of presenting information in character mode or windows ... is much deeper.
is a problem not only is A or B, only 0 and 1 ... There fuzzy, there are thesaurus, and exists mostly dialogue ...
Unfortunately, in our country, there are many clinical information systems "billet" unfriendly little usable, aggregates, cumbersome ...
Finding the balance between the requirements of the health administration for statistical purposes, management control or usability is not incompatible with HCE designs are really professional in mind.
therefore be avoided where after a multimillion-euro investment professionals HCE just going to word processing and paper.
addition, when consensus within a committee of clinical documentation, it was decided that the history is recorded (or stops recording) any item, the modification and adaptation of electronic medical records should not be more complex and more expensive than the printing request forms.
And this point is vital, because the clinical record is a living, adaptable, is THE tool, the reference point in order to effectively treat a patient.
draw power, not be curtailed by a series of drop-down fields with fixed values, or underlying the system so you can find the information needed without restricting the ability of professionals to develop and record a clinical course, are some of the challenges today's designers have healthcare information systems, apart from interoperabilities which may be required both departmental systems (laboratory, imaging, pharmacy and telemedicine systems), as Regional Health Record systems (such as GSP Aragon or Catalunya HCCC), the NHS or the framework epSOS .
combinations
local thesaurus thesaurus systematic global level, such as UMLS , coupled with semantic search mechanisms on the clinical course, can help both hospital librarians to improve the level of definition search when doing any type of epidemiological study, use of terminology such as SNOMED-CT ... is a more rational balance between the needs of the manager and the clinician.
The problem is not scanned or not, the problem is that what we do digitize obsolete technical resources, from a design you have in mind the manager and not professional.
The problem is also growing clinical repositories "as is" are much more than a longitudinal file of medical records ... these archives are the repository of organizational knowledge.
Thus, we must go much further in terms of structured recording information as it is understood today: we must start thinking about archetypes, as important is the absolute information we collect, as the context in which it is collected ... important is to know the values \u200b\u200bof TAM and TAM patient as the instrument with which to perform this action, and if the patient was standing, sitting, or lying, to give a simple example ... standards such as EN/ISO13606 mark us as a way forward in this case.
And yet even so, be islands, areas where the scan can not because the cost and usability of discarded ... stay spreadsheets and text documents, so also the repository must be accommodated to increase the clinical documentation in a format document, that is, it can not be changed once issued.
There is another small detail, not just negligible: this is usual to implement health information systems without a prior process reengineering, and not seen from an ICT perspective ... when the underlying processes are inefficient when walking free redundancy, when running the task because he always has done so "for no better reason at all, implement ICT without prior optimization is to make it run faster inefficiency, nothing more, an effective process reengineering, organizational and clinical save more than a dissatisfaction and making everyone's work more efficiently.
These are the limits of truth ... and lack a long, long way to go, right.
Photo: real picture of a microphone scanned in one end. :-)
Given that María José has "picked up the gauntlet" :-), I will discuss the legal basis governing telemedicine services in Europe and Spain.
Thus, the document " Telemedicine for the Benefit of Patients, healthcare systems and Society," published in November 2008 and introduced the legal basis governing the deployment and use of telemedicine services in Europe, and it is recommended that by the end of 2011 , states should have adapted their legislation to cover such practices.
In fact, according to the summary document Trend Map 2010 TicSalut (in Catalan), pages 24 to 26 and I'll do a translation into Castilian, as it collected at these pages are in accordance with purpose of the post, the European legislation varies from country to country.
One of the major problems has been to integration processes within the workflow care telemedicine is the lack of regulation of this practice, mainly due to the legal vacuum on issues like the validity of a diagnosis made in a teleconsultation, certification of equipment, sensors, systems and other related information such as the provision of such disservice and especially reimbursement: who pays for these services, based on what measure and how to pay?.
Although from the European Union have issued a series of directives, such as the 95/46EC , apply in the case of patients' rights in cross-border health The 90/385EC implantable medical devices, and 93/42EC Discussion general practitioners, the reality is that among the EU member countries there has been no legislative developments to accompany the development of these services.
Thus, countries like Germany have no specific regulations but have a set of regulations in one way or another governing the sector. In fact, in this country we find that:
Article 291st of SGB V (German regulatory framework of Social Security) provides that the reference infrastructure for eHealth is gematik, health insurance card.
Article 67 of SGB V sets the log transformation role in electronic record. Article 291st
7-7 º in Book V provides for the refund
The data protection laws of each Länder (similar but not identical) have direct application in telemedical services.
The tele among professionals (consulting) are governed by the law of the medical profession.
One obstacle is the professional code of conduct, which specifies that NO can be diagnosed if no examination of the patient made a face, which means that services can be deployed tele telemonitoring or treatment, but not teleconsultation.
expressly authorizes the patient who has access and who is not in your medical record.
This scenario is different from other countries like the U.S., do have adequate legislation, and therefore provides a security framework for a smooth of these services.
The consults with clinicians in other states, and the definition of who is ultimately responsible for the process.
The prohibition of on-line requirements.
The existence of a contract between professional and patient.
Telemedicine services are considered a health benefit more, subject to the same regulations as other conventional healthcare services.
So the news that France adopted in mid-October ( decree October 19, 2010 ) specific legislation to regulate telemedicine is a very clear signal that the countries most advanced in this field of EU later or earlier, follow these steps also a homologous legislation.
What introduce this legislation?
The definitions of the services that are part of the group telemedicine.
certification of health professionals operating this systems
unambiguous identification end-to-end patient -
The certification of the components (hardware and software) the class that is involved in the process of providing a telemedicine service.
The reimbursement: who pays, how metrics, who pays
specific dates are subject to the health administration
Training, if required, the patient in the use of devices partners.
legal coverage of all involved in providing telemedicine services .
specifically spoken of psychologists in providing this services.
From the formal point of view, there is no specific development of telemedicine and telecare services, and significant barriers in the case of remote diagnosis, which simply and from a legal point of view can not be implement because current legislation states that the physician must be present at the bedside at the time of diagnosis.
On the other hand, in healthcare settings such as Catalan, mostly agreed, it is necessary to clearly define the concept reimbursement between all actors involved: the capitation where the patient resides and effecting center delivery.
Therefore, and for the issue at hand, we are talking about telecribaje ... sent an image, the dermatologist makes a presumptive diagnosis and clinical trial is to the patient call to his office to issue a definitive diagnosis.
I must say that a i2Cat development team is already working on the definition of an image capture app compatible with the practice of teledermatology using store and forward transmission of clinically relevant information (image / video / audio / text) to a secured environment for electronic medical record (accessible via web services and digital signature), using protocols for exchanging clinical documents and HL7 CDA as José María specifications.
is important to also explain that different methods are commonly used evaluation of telemedicine services, being commonly applied in Catalonia (over 200 deployments of telemedicine and telecare in the area) the methodology MAST (Model for Assessment of Telemedicine) .
