remote clinical examination: the key issue of telemedicine
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Remote clinical examination: the key issue of telemedicine. Enrico M. Staderini Haute Ecole d'Ingénierie et de Gestion du Canton de Vaud – HES-SO Western Switzerland University of Applied Sciences Route de Cheseaux, 1 CH-1400 Yverdon les Bains (Vaud) Switzerland [email protected]. - PowerPoint PPT PresentationTRANSCRIPT
Remote clinical examination:the key issue of telemedicine
Enrico M. StaderiniHaute Ecole d'Ingénierie et de Gestion du Canton de Vaud – HES-SO
Western Switzerland University of Applied SciencesRoute de Cheseaux, 1
CH-1400 Yverdon les Bains (Vaud) [email protected]
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How physicians are made
Information diggersPattern findersProblem solversAlarm triggers
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Direct patient interaction
orMediated patient interaction
Medicine not only lacks precision...
It lacks a formal methodology
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Medical practice is a practice indeed!
Not a formal theory behind it
Epistemology of diagnostics
Patient is suffering from somethingTask of diagnostics is to discover it
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The diagnostic process implies– Interaction & Communication– Physical measurements
A social constructA technological construct
The process of subject-caregiver interaction
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sensations
cognitive process (awareness)
perception of symptoms
cultural process
complaint
subject
discourse
cultural process(discipline)
shareable medical record
formalization of symptoms
cultural process
hypothesized disease from a set of disease models
hypothesis probing process
caregiver
physical interaction
formalization of diagnosis
signs
Interaction in the hypothesis probing
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patientdecisionprocess
stimulation vector
response vector
perception
biometricdevice
biometricdevice
signs & findings
formalization of diagnosis
action
care-giver
The caregiver decision process
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stimulation vectorstimulation vector
generator
perception
perceived finding
expected finding
similarity
min expected similaritydecision
formalization of diagnosissigns & findings
caregiver decision process
+-
Interaction in the hypothesis probing
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patientdecisionprocess
stimulation vector
response vector
perception
biometricdevice
biometricdevice
signs & findings
formalization of diagnosis
action
care-giver
The “device only” interaction
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patientdecisionprocess
stimulation vector
response vector
perception
biometricdevice
biometric device
signs & findings
formalization of diagnosis
action
care-giver
Interaction through a telecom channel
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patient
decisionprocess stimulation
vector
response vectorperception
telebiometric device
signs & findings
formalization of diagnosis
action
telebiometric device
care-giver teleconsultation
telediagnostics
The engineering science of medical practice
Engineering the medical practice
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Formalizing a method of diagnostic reasoning (a science of diagnostics)– Syntax– Semantics– Pragmatics
Formalizing the knowledge base
The social issue of telemedicine
What about if the communication/interaction part of the diagnostic process is technologically mediated ?No formal training of physicians to cope with this situation–Methodology must be strengthened– Security and legal issues in data
transmission are just details
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What we need
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Formalism for data representationFormalism for data transmissionFormalism for data fruitionFormalism for decision makingFormalism for action performing– Standardization and formal theory of
medicine
Modern attempts to theorize medicine from Prof. Sadegh-Zadeh
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• Sadegh-Zadeh K.: “Fundamentals of clinical methodology 1. Differential indication”. Artificial Intelligence Med. 1994, 6, 83-102
• Sadegh-Zadeh K.: “Fundamentals of clinical methodology 2. Etiology”. Artificial Intelligence Med. 1998, 12, 227-270
• Sadegh-Zadeh K.: “Fundamentals of clinical methodology 3. Nosology”. Artificial Intelligence Med. 1999, 17, 87-108
• Sadegh-Zadeh K.: “Fundamentals of clinical methodology 4. Diagnosis”. Artificial Intelligence Med. 2000, 20, 227-241
• Sadegh-Zadeh K.: “Fuzzy Health, Illness and Disease”. J. Med. Phyl. 2000, 25, 605-638
• Sadegh-Zadeh K.: “The Prototype Resemblance Theory of Disease”. J. Med. Phyl. 2008, 33, 106-139
A roadmap to telemedicine
Formalizing medical reasoningIs clinical judgment computable ?Classical knowledge not appropriateFuzzy logic may beDiagnostic and therapeutic knowledge is procedural knowledge (medical practice) on fuzzy statements
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Teaching telemedicine
We have to, at university levelDon't make just examplesTeach methodology insteadCoping with an unreachable patientInsist on the social interplay of the medical taskUse (develop) standards for medical data communication
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An evolution process
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dire
ct in
tera
ction
with
pati
ent
100
% conventional semiotics
invention of the stethoscope(Laennec 1816)
invention of the telephone (Bell 1876)
invention of X-ray imaging (Roentgen 1895)
invention of electrocardiograph (Einthoven 1902)
invention of 2D M-mode echocardiography (Reid 1970)
invention of computed tomography (Hounsfield 1972)
invention of the microprocessor (Hoff 1968)
invention of the World Wide Web (Berners-Lee 1991)
telemetry
teleconsultation
assistive technologies
caregiver alone
time
Warnings
Medicine remains a cultural process– verify that standards and methods will comply
with different social cultures
Consider the business model of the medical practice– Samaritans are not widespread !
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