Telemedicine for primary healthcare : development of a decision support framework for a clinical pull approach to telemedicine implementation

Treurnicht, Maria Jacoba (2009-11)

Final year project, 2009

Technical Report

ENGLISH ABSTRACT: Telemedicine refers to the delivery of healthcare services by means of information and communication technology (ICT). Telemedicine, being an ICT, has appealed to engineers as an opportunity for innovative development, making technology the primary driver of telemedicine development. This technology-push model where engineers pursue challenging technological goals primarily does not guarantee appropriate and quality healthcare. It is therefore also necessary to assess the true need of the population and develop a comprehensive framework to implement and develop technology only as a means and not a goal in itself. The Medical Research Council (MRC) and Stellenbosch University (SU) department of Electrical and Electronic engineering jointly developed a telemedicine workstation, specifically for primary healthcare in South Africa. This workstation ensures effective communication between healthcare facilities to capture and send diagnostic data of patients between the facilities. Although the technology-push approach followed was successful, further development of the workstation requires a clinical-pull approach to address the specific needs of the population. The purpose of this project is therefore to support decision making with respect to the future development and implementation of telemedicine workstations. A decision support framework is developed and validated using the MRC/SU telemedicine workstation as a reference. The decision support framework developed in this project can be used as a tool for developing regional telemedicine strategy. Future use of this tool requires the population of a data warehouse developed in this project by extracting, transforming and loading data from clinical data sources. The data warehouse serves as a platform for specification analysis and mathematical models to evaluate possibilities for telemedicine in the region. The data sources for this project are health information systems and patient files. Data are extracted from the patient files, transformed and loaded into a database, developed for this purpose. Data from three facilities (Grabouw Community Health Centre, Robertson- and Ceres Hospitals) in the Western Cape are used, representing a region relevant for telemedicine lementation. The data warehouse is populated from the data loaded into the database to package the data in a usable format for data analysis. Diagnosis data together with telemedicine device profiles are used in the data analysis.The possibility of telemedicine implementation at a facility is evaluated using mathematical models. Engineering economics are used to determine the economic feasibility of a basic telemedicine workstation at a chosen facility. Potential telemedicine device utilisation at this facility is evaluated using mixed integer programming. This study serves as a pilot project to develop and validate the decision support framework. The scope of this project is limited to a specific region suitable for telemedicine workstation implementation. This project is therefore not aimed to provide only general solutions for telemedicine. It is a generic tool to enable decision makers to implement telemedicine as a needs driven technology in specific regions in South Africa.

AFRIKAANSE OPSOMMING: Daar word na telemedisyne verwys as die lewering van gesondheidsorgdienste deur die gebruik van inligting- en kommunikasietegnologie (IKT). Telemedisyne, as ʼn IKT, het die verbeelding van ingenieurs aangegryp as ʼn geleentheid vir innoverende ontwikkeling wat tegnologie die primêre dryfveer vir telemedisyne wêreldwyd gemaak het. Hierdie tegnologie-druk model waar ingenieurs uitdagende tegnologiese doelwitte nastreef verseker egter nie noodwendig toepaslike en gehalte gesondheidsorg nie. Dit is nodig om die ware behoefte van die bevolking te bepaal en ʼn raamwerk te ontwikkel sodat tegnologie slegs ʼn middel tot ʼn doel bly en nie die doel op sigself nie. Die Mediese Navorsingsraad (MNR) het in samewerking met die Stellenbosch Universiteit (US) se departement van Elektriese- en Elektroniese ingenieurswese ʼn telemedisyne werkstasie ontwikkel, spesifiek vir primêre gesondheidsorg in Suid-Afrika. Hierdie werkstasie is veronderstel om telemedisyne konsultasies oor ʼn afstand te bewerkstellig, deur die vasvang en stuur van diagnostiese data tussen fasiliteite met behulp van IKT. Om aan die spesifieke behoeftes van die populasie te voldoen is dit nodig dat verdere ontwikkeling van die werkstasie op ʼn kliniese-trek benadering gebaseer word, alhoewel die volg van ʼn tegnologie-druk benadering aanvanklik geslaagd was vir die eerste iterasie van ontwikkeling. Die doelwit van die projek is om besluitneming te ondersteun met betrekking tot toekomstige ontwikkeling en implementering van telemedisyne werkstasies. ʼn Besluitnemingsondersteuningsraamwerk is ontwikkel en gevalideer aan die hand van die MNR/SU telemedisyne werkstasie as verwysing te gebruik. Die besluitnemingsondersteuningsraamwerk wat in hierdie projek ontwikkel is, is geskik om as hulpmiddel gebruik te word vir die ontwikkeling van telemedisyne implementering strategie op streeksvlak. Toekomstige gebruik van die gereedskap vereis die populasie van die datastoor wat in die projek ontwikkel is deur onttrekking, verwerking en laai van data vanuit kliniese databronne. Hierdie datastoor dien as ʼn platform vir spesifikasie analise en wiskundige modelle om moontlikhede in telemedisyne te evalueer in streeksverband. Die databronne wat vir hierdie projek gebruik is, is gesondheidsinligtingstelsels en pasiëntlêers. Data word onttrek vanuit pasiëntlêers, verwerk en gelaai in ʼn databasis wat vir hierdie doel ontwikkel is. Data van drie fasiliteite, (Grabouw daghospitaal, Robertson- en Ceres hospitale) in die Wes-Kaap word gebruik, wat ʼn streek geskik vir telemedisyne implementering is. Die datastoor word gepopuleer met data wat gelaai word in die databasis sodat data verpak kan word in ʼn bruikbare formaat vir data analise. Diagnose data tesame met telemedisyne randapparaat aanwendings moontlikhede word gebruik in die analise. Die moontlikheid van telemedisyne implementering word by ʼn fasiliteit evalueer deur middel van wiskundige modelle. Ingenieurs ekonomie word gebruik om die ekonomiese lewensvatbaarheid van ʼn basiese telemedisyne werkstasie by ʼn spesifieke fasiliteit te ondersoek. Potensiële telemedisyne randapparaat benutting by hierdie fasiliteit word evalueer met behulp van gemengde heeltal programmering. Hierdie studie dien as ʼn loodsprojek om ʼn besluitneming ondersteuningsraamwerk te ontwikkel en valideer. Die omvang van die projek is beperk tot ʼn spesifieke streek geskik vir telemedisyne implementering. Dus is die projek nie beperk tot algemene oplossings vir telemedisyne nie. Dit is ʼn generiese instrument om besluitnemers te bemagtig om telemedisyne as ʼn behoefte gedrewe tegnologie in spesifieke streke van Suid-Afrika te implementeer.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/18206
This item appears in the following collections: