The telemedicine system to increase patient’s access to specialised cardiac care for assisting remote diagnosis.

Triegaardt, M. (2010-10)

Final year project, 2010

Technical Report

ENGLISH ABSTRACT: Cardiology refers to the specialised study of heart disorders and is a focused field of knowledge practiced by cardiologists. Due to the specialised nature of cardiology, treatment is not given as idely and effectively in populated and under-resourced areas, like South Africa. In the public health sector there are too many cardiac patients and not enough doctors with the necessary expertise to attend to their needs. Cardiac specialists that are situated only in urban areas in South Africa, cannot attend to the needs of all the rural cardiac patients Therefore, cardiac specialists assist rural doctors in diagnosing patients remotely. The assistance currently offered is not optimal and patients do not get the needed tertiary specialist care that is available in urban areas. For specialists to provide assistance they have to fully understand they patient’s medical condition and therefore all the necessary patient data has to be transferred to the specialist. The various factors limiting the transfer of patient data and therefore also the patient’s access to tertiary care cardiac is the patient’s location relative to the specialist, the methods used to communicate patient data, human error in the diagnostic process, the complex nature of the diagnostic data , limited data transfer capabilities, the cost and the limitations of technology used. For the purpose of this study Tygerberg hospital will be used as the tertiary hospital and Eben Dönges hospital in Worcester as the rural hospital. The current situation at both hospitals was assessed and the structure used for communication between the two institutions was documented. It was found that the technology is being used to share patient data, such as faxes and telephone calls, results in an unnecessarily protracted process. The restrictions which limit the current system were identified. It was found that outdated technology is used to share patient data because there is no faster communication network and because patient data is complex and files are large. The existing and potential technology was explored to formulate alternatives namely: electronic transfer of files in DICOM format; compressing the DICOM files with MPEG and JPEG before electronic transfer; implementing a PACS intranet between hospitals; and lastly to use DICOM viewers on workstations to view the DICOM patient data. Ultimately, the possible solutions and their feasibility were explored using the Analytical Hierarchy Process (AHP) to illustrate that a DICOM viewer in conjunction with a PACS intranet is the best solution to increase a remote patient’s access to a specialist’s knowledge. If a PACS in conjunction with a DICOM viewer is implemented the effectiveness of data transfer procedure is increased, since data is always accessible via the PACS intranet and the DICOM viewer Chapter: Synopsis iv software allows post processing of DICOM files. The duration of the procedure is decreased for the doctor at Eben Dönges hospital, since files are automatically transferred to the central PACS server after study is completed; and for the specialist at Tygerberg Hospital time is saved since he can view the diagnostic images on a mobile device. The biggest cost for the solutions will be to implement a network between the hospitals and to acquire the PACS software license. The DICOM viewer software is free to download. The alternative is user-friendly since minimal effort has to be made to transfer data and the DICOM viewer user interface is simple to operate. This option enhances secondary and tertiary education most since DICOM files can be viewed on any standard of the self hardware with a DICOM viewer installed. Ethical or legal issues can develop with exchange of confidential patient information, but due to patient data only being connected to the patient MRN in the PACS system of Tygerberg, no patient’s confidentiality will be breached.

AFRIKAANSE OPSOMMING: Kardiologie verwys na die gespesialiseerde studie van hart-kwale en is 'n gefokusde veld van kennis beoefen deur kardioloë. As gevolg van die gespesialiseerde aard van kardiologie, word behandleing nie gegee so effektief soos moontlik in areas soos Suid-Afrika, waar daar hoë bevolkingsgetalle min hulpbronne, is nie. Inopenbare gesondheidsorg sektor is daar is te veel kardiale pasiënte, en nie genoeg dokters met die nodige kundigheid om aan hul behoeftes te voorsien nie. Kardiale spesialiste wat in Souid Afrika slegs in stedelike gebiede geleë is, kan nie aandag gee aan die behoeftes van al die landelike kardiale pasiënte nie. Daarom ondersteun kardioloë landelike dokters om kardiale pasiënte te diagnoseer en te behandel oor ‘n afstand. Die hulp wat tans aangebied word vir plattelandse dokters is nie optimaal nie en pasiënte kry nie die nodige tersiêre spesialis sorg wat beskikbaar is in stedelike gebiede nie. Vir spesialiste om ondersteuning en hulp te offer moet dit moontlik wees om die pasiënt se kondisie ten volle te verstaan en daarvoor moet al die nodige pasiënt data oorgedra word na die spesialis. Die verskillende faktore wat die oordrag van pasiënt data n dus die toeganklikheid vir pasiënt na tertiêre kardiale sorg beperk is die patient se plasing relatief tot die van die spesialis die beperking tot toegang van inligting; beperkte inligtingskommunikasie moontlikhede; die komplekse aard inligting; kostes; en die beperking tot tegnologie gebruik. Vir die doel van hierdie studie sal Tygerberg-Hospitaal gebruik word as die stedelike hospitaal en Eben Dönges-hospitaal in Worcester as die landelike hospitaal. Die huidige kommunikasie tussen die twee hospitale was geassesseer en gedokumenteer. Dit was bevind dat die tegnologie wat tans gebruik word om pasiënt data te kommunikeer, soos faks en telefoonoproep, die proses onnodig verleng. Die beperkings op die huidige sisteem was geïdentifiseer en dit was bevind dat die huidige tegnologie gebruik nie op datum is nie. Dit is as gevolg van ’n tekort aan ’n vinniger kommunikasie netwerk, die kompleksiteit van patient data, asook die grootte van die data dokumente. Die tegnologie beskikbaar was ondersoek om alternatiewe kommunikasiemetodes te ondersoek. Die kommunikasiemetodes ondersoek sluit in, elektronies dokumentoorplasing in DICOM formaat. Die dokumente word verklein na MPEG en JPEG formaat voordat elektroniese oorgrad plaasvind. So word ‘n PACS intranet tussen hospitale geïmplimenteer. Laastens, word DICOM viewers gebruik op werkstasies om DICOM pasiënt data te bestudeer. Uiteindelik is die moontlike oplossings en hul geloofwaardigheid ondersoek deur gebruik te maak van Analytical Hierarchy Process (AHP), om te dui dat ‘n DICOM viewer saam met ‘n PACS intranet die beste uitweg gaan bied om pasiënte in landelike gebeide se toegang tot spesialis sorg te verbeter. Die kombinasie van ‘n PACS intranet en ‘n DICOM viewer verbeter die effektiwiteit van die data oordragproses. Dit word moontlik gemaak, want die PACS intranet sorg dat data altyd bekombaar is, terwyl die DICOM viewer sagteware toelaat dat die DICOM dokumente na die tyd opgelaai word. So, word die tydsduur van die proses in Eben Dönges Hospitaal verminder, want nadat die studie voltooi is, word die dokumente onmiddelik gestuur na die sentrale PACS ontvanger. Die duur van die proses word net so verminder vir die Tygerberg dokter wat toegang het tot fotos wat diagnosering kan vermaklik. Die meeste van die kostes verbonde sal gaan om die netwerk tussen die twee hospitale te implimenteer, en om ‘n PACS sagteware lisensie te bekom. Daar is geen kostes verbonde om DICOM viewer sagteware om af te laai nie. Die uitweg is maklik gebruikbaar, want dit is eenvoudig om data oor te plaas en DICOM viewer interaksie is eenvoudig om te gebruik. Dit verbeter sekondêre en tertiêre opvoeding die meeste, want die DICOM dokumente kan bekom word deur enige standaard van eie hardeware en gekonnekteer word deur Wi-Fi. Etiese en wetlike probleme kan ondervind word met die mededeling van pasiënt data, maar omdat pasiënt data slegs op die Tygerberg pasiënt MRN in die PACS sisteem gelaai is, voorkom dit dat pasiëntevertroue verbreek word.

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