This article is focused on description and evaluation of telemedical benefits for the users and participants in medical services, that work in conditions of telepracticing. It is dedicated to a newly introduced software solution for the purposes of distant medical consultation and diagnostic processes in Bulgaria that has been exploited for 6 months period and evaluated by 20 users in 2 hospitals

Mihova, Polina

Penjurov, Ilia

Petkov, Asen

Vinarova, Jivka

New Bulgarian University Scholar Electronic Repository

 1  MILESTONE BEFORE/AFTER ANALYSIS OF TELEMEDICINE IMPLEMENTATION P.Mihova1, J. Vinarova 2, A.Petkov3, I.Penjurov4 Department of biomedical sciences, NBU, Sofia, 1618, Bulgaria 3Military Medical Academy, Bulgaria 1pmihova@nbu.bg, 2jvinarova@nbu.bg, 3asssen2000@yahoo.com,4penjurov@nbu.bg    Abstract: This article is focused on description and evaluation of telemedical benefits for the users and participants in medical services, that work in conditions of telepracticing. It is dedicated to a newly introduced software solution for the purposes of distant medical consultation and diagnostic processes in Bulgaria that has been exploited for 6 months period and evaluated by 20 users in 2 hospitals.  Key words: Medical informatics, Telemedical Information System, Telemedicine, e-Health. Introduction The new healthcare area is a conjunction of doctors, hospitals, medical centers, financial experts, insurance experts in one virtual system, where the object, purpose, stock and instrument for healthcare management and politics is the information. It is the fundamental element that allows separate functional issues to interact.  Telemedical Information System (TIS) forms the basis for telemedicine and healthcare services and posses attributes like Hospital information system, Electronic patient record, picturearchiving and communication system and distant learning applications.  The purposes of TIS can be defined as:  Registration of key information at the data source   Ensures a platform for automatic processing of information   Facilitates the data transmission   Commits versions of evidence-based practical solutions   Assures confidentiality of personal data   Assists the patients to manage and control their own health   The main purpose of this paper is to propose and develop an analytical comparative table, that explores the period before implementation of a telemedical system and afterwards. We have examined the opinions of several user types – doctors and practitioners, emergency help participants, hospital managers, patients and their families. The parameters selection is combination between money expenses both for patients and hospitals, time expenditures for patients and doctors, data lost, healthcare opportunities and disease prevention. After introducing and experiment with the system for 4 months we have developed and give an opportunity to the hospital stuff to evaluate patient adoption of this new way of treatment, the hospital managers and the clinicians, that practiced with it. We have generally 69 questions, separated into 8 groups fro 7 patients, 18 doctors and 2 hospital managers. The results show that 4/5 from the questioned patients have positive attitude and don’t feel embarrassment because of the missing face-to-face contact. On the other hand, the doctors point out the positive factors of this modern method of work, a conclusion that is verified by the answers – 90%.         2 Before  After Transfer to the hospital  Instant consultation  Only one expert  More experts  Paper archive Digital Data base+  Paper archive Lost in transferring papers  Digital record at 2 places  More expenses for patients/relatives  Least expenses for patients/relatives Multitude visits  Reduction of visits  Experts time expenses Only when necessary  Healthcare in hospital  Healthcare at home Isolation of experts  Improvement of relationships in professional sphere  Expenses of the hospital for: Only when necessary  - specialists  Only when necessary  - transfers and ambulances  Only when necessary  - time Only when necessary  - technology Single but with permanent reimbursement  Lost of time for the patients  Only when necessary Limited disease prevention  Unlimited  Patients access to specialists to the local place  Patients access to specialists  to a national level  Need for personal direct contact with a specialist from national level Immediate distant consultation  Limited free time for experts  Augmentation of  creative work  We can describe and generalize the benefits of the telemedical process, exploring the point of view of each of the participants in it, as:   Benefits according to the practicing doctors o Fewer security risks for transfers and external consultation o Shorter waiting times (or reduced delays) to see specialists o Access to better quality specialists and to specialty care not previously available o Fewer acts of inmate aggression, or use of force by guards, due to improved mental health services o Fewer grievances about health care or mental health care. o Advancements in delivery of services o New facilities  o New models for clinical trials with distant participants   Benefits according to the hospital manager o new business perspectives  Benefits according to the patients o home health services o no travelling o no expenses for the family o individual services o new quality of life o disease prevention Through specialized information in TIS are joined technologies, methodic, legal issues, standards, that guarantee the working capacity of the system. By exploring studies of successful telemedical applications, we have described conditions operating during the process of implementation that are important for its outcome, i.e., what are the characteristics of telemedical services that have been successfully implemented in routine clinical practice.  3   Our findings and comparative analysis support the literature, which argues that telemedicine is an experimental and usually unnecessary development that only would affect the routine practice. Based on the published experience we have developed a table, where are discussed positive factors and negative characteristics of both practicing models – standard medical and telemedical. Beyond doubt are the information lost, mistakes and time delay that could be performed in the course of applying standard medical procedures without involvement of computer system, and vice versa in telemedical practice, there is lack of political and institutional will, there are high requirements for good computer literacy and more competencies than standard.   Organizational difficulties are situated in the deep interrelationship of technical, social, legal and human aspects of implementing and adopting telemedical solutions. Conversely, success involves handling these complex, heterogeneous elements that are expressed in controversies and solved through social negotiation.  Conclusion  Telemedical applications introduced into routine practice are typically characterised by the following features: 1) telemedicine is seen as a benefit, 2) telemedicine is seen as a solution to political and medical issues, 3) telemedicine supports and performs collaboration between promoters and users, 4) issues regarding organizational and technological arrangements are successfully addressed, and 5) the future of this service is deeply discussed and considered. More research efforts on the complex conditions that arise when technology is introduced should be encouraged. Last, but not least, a debate should be initiated in the professional medical community about this new feature, its evaluation criteria, methods of exploring the outcome results and exploitation opinions, that would speed up the introducing telemedicine in routine operation.  References [1.] Vinarova J., P.Mihova “Medical informatics”, ISBN 13:  978-954-535-515-8,  NBU, Sofia, 2009 [2.] Mihova P. “Telemedical functions of medical information system” – philosophy doctors development, NBU, Sofia, 2009  4 [3.] Владзимирський А.В., „Оценка эффективности телемедицины”, ISВN 978-966-335-031-8, Донецк 2007 [4.] Jordanova M., F. Lievens, International Development and Evolving Dimensions in Telemedicine  (WORLDVIEW), http://www.ehealthonline.org  [5.] Mahau M., P.Whitten, A.Allen, E-Health, Telehealth and Telemedicine, A guide to start-up, ISBN:0-7879-4420-3, Jossey-bass, 2000 [6.] Mihova P., Telemedicine software Teleconsult – design, exploitation and results, Том 6, №2, "Ukrainian Journal of Telemedicine and Medical Telematics", ISSN 1811-1688 (Online), ISSN 1728-936X (Print) [7.] Pagliari C.,Design and Evaluation in eHealth: Challenges and Implications for an Interdisciplinary Field, http://www.jmir.org/2007/2/e15 [8.] http://www.ncjrs.gov/telemedicine/c3a.html  [9.] http://www.ortcc.org/PDF/BenefitsofTelemedicine.pdf  [10.] http://www.implementationscience.com/content/2/1/25     

Milestone Before/After Analysis of Telemedicine Implementation

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