Telematic Tools Requirements for Statistical Data seen by Epidemiological and Health Economical Point of View

(Excerpts from a report at the Berlin G7 oncology meeting on Dec. 1^st 1997)

O. Goldschmidt, H. Brunner, K. Lauterbach

University of Cologne (Germany)/ Institute for Health Economics, Medicine and Society

Summary:

At the moment general practitioners (GPs) and many hospitals are using old systems, platforms and software for their data and billing management. We can assume that there are (relatively) more patients using home computers and the WWW than practitioners. Concerning the WWW there is lack of a common structure, quality or any kind of co-operation regarding the different providers of internet services. There are a lot of new challenges getting the different telematic projects structured now. It is necessary to find a kind of platform of communication that have to be worked on in the next years. After some investigations in the new technologies there are great chances to reduce costs and improve quality in delivering health care. If the safety, data and economical requirements are considered from the early beginning, it should be possible to find promising solutions.

Status quo:

At the moment general practitioners (GPs) have old systems, platforms and software for their nursery management. Only 63% of 120,000 GPs were using computers in 1996 in Germany. We can assume that there are (relatively) more patients getting information from the WWW by home computers than practitioners. Furthermore - there is lack of a common structure, quality or any kind of co-operation regarding the different providers of internet services.

It can easily be seen that the most important task of computer systems in a hospital is billing and patient data management for administrative processes.

What is needed?

• technical standards (protocol, platform, security)
• a basic platform (e.g. using WWW with restricted log-in) for different telematic services
• menus and easy guidance through WWW-sites
• co-operation between providers of telematic services
• co-operation between health care providers
• solutions about financing such a platform on the long run
• solutions about making such a platform interesting for GPs and their limited willingness to pay for non-profitable technology
• a common starting point for projects like the G7-oncology-project that has to be followed up by the means of CQI (continuing quality improvement)

What are the challenges of a platform solution?

• medical information databases (pharmaceutical data, treatment and diagnostic guidelines) can be served
• journal, literature and references can be accessed
• intelligent treatment and diagnosis systems can be installed
• patients data can be exchanged (CT images, x-ray and more)
• depending on the political state of acceptance, data means every possible data that could be exchanged (at the moment a multiple server database with a complete patients’ chart can’t be implemented - safety ...)
• skilled information for patients (video clips, images, abstracts on medical treatment or diagnosis ...)

The challenge of shared databases between hospitals and GPs? [7]

• in-house and GP-treatment are getting linked
• emergency treatment can be improved by getting more information about a patient
• besides a peer review useless repeated diagnostics can be avoided
• quality improvement (GPs get more information about the treatment than by a letter)
• communication between the hospital information system and the nursery information system is faster (letter takes days to months)
• a real individual case-management can be easily arranged
• more flexible use of diagnostic instruments (MR, CT...) by improved timetable management

Examples for cost-reducing challenges of telematic services: [2]

• interactive and online-data exchange for technical or medical data is especially needed in aeronauts and cosmonauts [DLR-paper Cologne]
• home-monitoring for patients (SID-risk babies, "heart-patients") meets the same purpose and becomes even more cost-effective when thinking about rural areas "outback" (patients can stay at home instead of hospitalisation - "quality of life")
• communication between rural physicians and university experts can improve treatment and fasten diagnostic information
• next to video/internet-conferences expert-guided computer-assisted operations or endoscopy improves local quality and saves money/time for experts/patients moving to other places
• remote data entry - especially interesting in clinical trials (costs of monitoring,...)

Finally some of the most important aspects of basic requirements - when talking about network solutions and integrating telematic tools into a kind of structured design - should be summarised:

Requirements for statistical data in telematic services are: [5]

• standardised databases and data-management
• lists, numbers and codes are preferred in opposition to text-data
• security of the data must be guaranteed

Requirements from the health economical point of view:

• technical (hard- and software, transfer-protocols) standards reduce compatibility difficulties and costs for translation
• a platform model appears to be the best solution
• easy-to-handle technology avoids high teaching costs and increases acceptance/ compliance in patients and physicians

Requirements for quality management purposes:

• guidelines, medical information and given references must be the results of Evidence-based criteria, general consensus and have to be updated regularly

Besides these general requirements - fitting for many projects - there are some more interesting health economical analyses to do (to evaluate such a system, its acceptance and outcome).

As health economical tools:

• cost-minimisation-analysis [find cheaper alternative of a treatment/method]
• cost-effectiveness-analysis [compare costs and effectiveness]
• cost-utility-analysis [adding aspects of quality-adjusted life years to CEA]
• cost-benefit-analysis [measuring everything in money-values e.g. willingness to pay for a treatment (difficult for medical problems)]

can be used for evaluation.

Health economical analysis is based on:

• precisely defined questions and aspects of what is to be analysed
• precise description of alternatives
• incremental [make different procedures comparable] and sensitivity [find possible mistakes and test alternative aspects of your first assumption] analysis
• description and substantiation [costs, benefit, utility and effectiveness]
• discussion and substantiation [methods and criteria chosen in your analysis]

There are a lot of challenges getting the different telematic projects structured. It is necessary to find a kind of platform of communication that have to be worked on in the next years. This article should encourage using telematic tools. After some investigations in the new technologies there are great chances to reduce costs and improve quality in delivering health care. There is no guarantee of having success. If the requirements are considered as shown above from the early beginning, then it should be possible finding promising solutions. Co-operation with other health care providers can help building a new standard of medical communication.

References: