Telemedicine Services: from Idea to Implementation
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Abstract
Background
New ways to cope with the increasing number of elderly and people with chronic diseases who need care need to be found. As there are high expectations of Information and Communication Technology (ICT) many ICT initiatives have been developed. However 75% of these fail to survive the research phase. This brings us to the question, how to realize successful telemedicine applications. This paper describes a method involving three key elements for the realization of successful telemedicine applications and shows the results of this method for one specific application, a myofeedback based tele-treatment service for treatment of patients with chronic pain (MYOTEL).
Method
The methodology discerns three key matters: clinical content, design and outcome.
Clinical content; care services for patients with chronic diseases aim at increasing levels of functioning. As such telemedicine services need to monitor aspects of the patient's functioning and to provide feedback about this to the patient. Promising parameters are general physical activity and muscle activation patterns. Concerning the feedback, this requires choices about the content of the information, the modality and timing of feedback.
Design; it appears that the different stakeholders involved speak different languages, that there is a lack of knowledge about aspects related to acceptance and a lack of good methods to define user requirements. Scenario based requirements analysis is promising to overcome these barriers.
Outcome: Evaluation of telemedicine services in everyday clinical practice should be performed according a staged approach, starting from technical performance and user satisfaction to large scale clinical studies with multiple end points.
Results
Applying this method to MYOTEL shows
Clinical content:
MYOTEL is based on the fact that subjects with chronic pain differ in their muscle activation patterns, reflected in a decreased ability to relax. As such treatment could consist of monitoring the level of muscle relaxation and providing feedback to the patient with the aim to enable them change
Design
A scenario was developed describing the people, their roles and activities, the functions of the application and its context of use. Subsequently functional requirements were defined. Most important are:
- monitoring should focus at muscle relaxation,
- feedback should be provided in case muscle relaxation is insufficient,
- the system should be usable during every day tasks,
- people should able to put on and take off the system themselves,
- the system can be worn under the clothes
- feedback should be private
- teleconsultations can partly replace face to face contacts.
Outcome
The first evaluation trial (N=10) showed that the application was technical stable, that pain and disability decreases and that patients were satisfied with the remote counselling but less satisfied with the technical functioning. The second a large scale multicentre clinical trial (n=138) with the improved service showed that Myotel is as effective as usual care and that the time investment of the professionals reduces with 20%.
Conclusion
Results of this study showed that using this method, telemedicine applications can be developed that have potential to make health care more effective, efficient and accessible.
New ways to cope with the increasing number of elderly and people with chronic diseases who need care need to be found. As there are high expectations of Information and Communication Technology (ICT) many ICT initiatives have been developed. However 75% of these fail to survive the research phase. This brings us to the question, how to realize successful telemedicine applications. This paper describes a method involving three key elements for the realization of successful telemedicine applications and shows the results of this method for one specific application, a myofeedback based tele-treatment service for treatment of patients with chronic pain (MYOTEL).
Method
The methodology discerns three key matters: clinical content, design and outcome.
Clinical content; care services for patients with chronic diseases aim at increasing levels of functioning. As such telemedicine services need to monitor aspects of the patient's functioning and to provide feedback about this to the patient. Promising parameters are general physical activity and muscle activation patterns. Concerning the feedback, this requires choices about the content of the information, the modality and timing of feedback.
Design; it appears that the different stakeholders involved speak different languages, that there is a lack of knowledge about aspects related to acceptance and a lack of good methods to define user requirements. Scenario based requirements analysis is promising to overcome these barriers.
Outcome: Evaluation of telemedicine services in everyday clinical practice should be performed according a staged approach, starting from technical performance and user satisfaction to large scale clinical studies with multiple end points.
Results
Applying this method to MYOTEL shows
Clinical content:
MYOTEL is based on the fact that subjects with chronic pain differ in their muscle activation patterns, reflected in a decreased ability to relax. As such treatment could consist of monitoring the level of muscle relaxation and providing feedback to the patient with the aim to enable them change
Design
A scenario was developed describing the people, their roles and activities, the functions of the application and its context of use. Subsequently functional requirements were defined. Most important are:
- monitoring should focus at muscle relaxation,
- feedback should be provided in case muscle relaxation is insufficient,
- the system should be usable during every day tasks,
- people should able to put on and take off the system themselves,
- the system can be worn under the clothes
- feedback should be private
- teleconsultations can partly replace face to face contacts.
Outcome
The first evaluation trial (N=10) showed that the application was technical stable, that pain and disability decreases and that patients were satisfied with the remote counselling but less satisfied with the technical functioning. The second a large scale multicentre clinical trial (n=138) with the improved service showed that Myotel is as effective as usual care and that the time investment of the professionals reduces with 20%.
Conclusion
Results of this study showed that using this method, telemedicine applications can be developed that have potential to make health care more effective, efficient and accessible.
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