E-Health Systems Quality and Reliability: Models and Standards Anastasius Moumtzoglou European Society for Quality in Healthcare, Greece Anastasia Kastania Athens University of Economics and Business, Greece Medical inforMation science reference Hershey • New York Director of Editorial Content: Kristin Klinger Director of Book Publications: Julia Mosemann Acquisitions Editor: Lindsay Johnston Development Editor: Dave DeRicco Publishing Assistant: Jamie Snavely Typesetter: Keith Glazewski Production Editor: Jamie Snavely Cover Design: Lisa Tosheff Published in the United States of America by Medical Information Science Reference (an imprint of IGI Global) 701 E. Chocolate Avenue Hershey PA 17033 Tel: 717-533-8845 Fax: 717-533-8661 E-mail: [email protected] Web site: http://www.igi-global.com Copyright © 2011 by IGI Global. All rights reserved. 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Information storage and retrieval systems--Medicine--Evaluation. 2. Health services administration--Information technology--Evaluation. 3. Management information systems--Data processing--Evaluation. 4. Medical records--Data processing--Evaluation. 5. Medical informatics--Evaluation. I. Moumtzoglou, Anastasius, 1959- II. Kastania, Anastasia, 1965- [DNLM: 1. Medical Informatics Applications. 2. Delivery of Health Care-- trends. 3. Quality Assurance, Health Care--methods. W 26.5 E337 2011] R858.E28 2011 610.285--dc22 2010016323 British Cataloguing in Publication Data A Cataloguing in Publication record for this book is available from the British Library. All work contributed to this book is new, previously-unpublished material. The views expressed in this book are those of the authors, but not necessarily of the publisher. 220 Chapter 17 Standards in Telemedicine O. Ferrer-Roca University of La Laguna, Spain ABSTRACT For many years, medical teams working on telemedicine have made a strong effort to define thetelemedi - cine Body of Knowledge (BoK), and generate compatible standards that allow delivering telemedicine with adequate medical quality. The authors expect, after the European Commission statement on the Prague 2009 declaration, a new era for telemedicine. The essential barriers, which have already been encountered, include Literacy, Standard connectivity and Quality control. In the present chapter, the authors will address the item of Literacy regarding the type of standards in each of the topics of the Telemedicine Body of Knowledge. INTRODUCTION ogy units (UINT= Unit of informatics and new technology) of the hospitals. In 1998, we wrote, “the welfare expenses cannot If training and teaching schemes have to cope be endlessly increased, whilst an efficient health with society demands of health quality (HQ), provision system in the context of the information health equity (HE), efficient health delivery society, will mark a new trend to configure health (HED), and health security (HS) medical training care practice in the next century” (Ferrer-Roca & should devote a substantial part to e-health and Sosa-Iudicissa, 1998). telemedicine. In this century and in spite of ICT improve- The main components of the Telemedicine- ments, the provision of health at distance is not BoK as we defined in 1998 are listed in Table 1. taken as a regular medicine delivery but a “special” The health sector defines telehealth as an in- service, many times included in the new technol- tegrated term including any telematic application for health. It includes therefore any medical in- DOI: 10.4018/978-1-61692-843-8.ch017 formatics and health informatics. The interna- Copyright © 2011, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. Standards in Telemedicine Table 1. Body of knowledge of telemedicine health, that include an endless list of “e-“ words CHAPTER CONTENTS such as: e-prescription, e-assistance, e-delivery, 1 History of Telemedicine e-mail, e-patient etc. In fact, not everyone under- 2 Minimal Technical Requirements stands the same using the term of e-health and therefore it is important to define their limits. 3 Main Telemedicine Applications For the purpose of the paper we define: 4 Basic Technical Knowledge 5 Quality Control and Assessment • E-health as health in Internet, meaning ac- 6 Use and Indication of Telematic Tools in Tele- medicine: Internet cess to anything related with health with or 7 Training, including Distance Training, Telework- without quality control. ing and Teleteaching • E-health system as e-government in 8 Data Security and Privacy healthcare, meaning any citizen-health 9 Liability and Legal Aspects bodies transactions not only adminis- 10 Health Economics in Telemedicine trative but also for collection of results 11 Technology Transfer and Social Aspects (laboratory, final reports, hospital release, 12 Emerging Issues e-prescription….) • E-healthcare as telemedicine, meaning health delivery with the required qual- tional consultation carried out by the WHO in ity standards and lack of risks for patient 1997, came out with a definition of “health tele- and users including confidentiality and matics”: as a composite term for health related security. Items such as knowledge dis- activities, services and systems carried out over covery, personalized-health, etc… belong a distance by means of information and commu- to this and it is under the responsibility of nications technologies, for the purpose of global the medical doctors, medical colleges and health promotion, disease control and health care, health authorities to achieve the required as well as education, management and research quality of healthcare. for health. This also embraces the telematics in health research and health services management, The potential scope of telemedicine is therefore as well as specific applications for “telemedicine” enormous and can be summarized in four main and “tele-education in health”. In the Table 2, we aspects presented in Table 3. include a list of telehealth applications. Under each term, we can include provision or confirma- tion of diagnosis, surveillance, epidemiology, ROBOTICS & COmPUTeR ASSISTeD management, clinical and research information, meDICINe literature search and retrieval, health and wellness, health and medical educational contents. i.e. CAS / AeP8/ Intelligent devices If you take into consideration the above scheme, BACKGROUND many of the items treated in the field of tele- medicine should be taken out. For that reason, it Redefinitions for 2009 is important to define the limit of competences regarding e-administration for the healthcare Most terms previously used are outdated and items including electronic transactions or citi- substituted nowadays by the common word of e- zens’ information and advertisement from the 221 Standards in Telemedicine Table 2. Telehealth applications CATEGORY USERS 1 All forms of medicine at distance: Physicians Teleconsultations, telepathology, teleradiology, telepsychiatry, Health care professionals Teledermatology, telecardiology etc. Health care institutions Distant exploratory systems: EC1, holter etc. Medical outsourcing Robotic surgery and telesurgery and CAS2 etc. All forms of telementoring 2 Inter-institutional, patient and clinical records and information systems Health care institutions Electronic health and clinical records and data bases accessible by network Health care professionals Laboratory results access Health care workers Pathology results access Physician’s office Patient images access Researchers Text-mining and automatic disease classification /metadata annotation. Intensive care units PoC3 controlling: vital signs and other parameters 3 Public Health and Community Health Information networks (CHINS) Government Multiple-use health information networks Epidemiologists Assisted Electronic prescription (AEP) Public health professionals Health GRID for genetics, oncology, etc… Physicians offices Knowledge discovery in patho-pharmacology Pharmacies p-Health Clinics and CHINS Personal health policies 4 Tele-education and multimedia applications for health professionals University and colleges and patients and networked research data bases. Internet services. Associations Knowledge discovery. Data mining. Researchers Patient EHR access and laboratory results access. Physicians Health Care professionals Patients 5 Telemonitoring, telecare networks, Alarm systems, GPS4 location Customers PAN5 telemetric devices: Diabetes, GI endoscopy, Elderly Telephone – SMS triages Chronically ill Home-care. Disaster victims Emergency networks Accident victims Hospital PoR6