A decision support system for telemedicine needs assessments in South Africa

[摘要] ENGLISH ABSTRACT:The various applications of Information and Communication Technologies (ICTs) in healthcare are increasinglyeffective to improve the cost-effectiveness and quality of healthcare service delivery. Telemedicine is such anapplication, using ICTs to provide health services over a distance. Since 1997, the South African Department ofHealth has invested large amounts of capital to implement telemedicine systems in South Africa.Unfortunately, telemedicine programs have had little success since, leading to many workstations standingdormant.Telemedicine implementation decision making that is based on insufficient evidence is identified as one of theunderlying problems that cause telemedicine programs to fail. It is proposed that implementation decisionsshould be based on quantifiable evidence regarding the potential benefits of telemedicine. A decision supportsystem is developed that can be used to quantify potential benefits and plan telemedicine implementationprograms accordingly.The decision support system is modelled and demonstrated using data from the Eastern Cape public healthsector. The first phase of the system guides decision makers to identify potential telemedicine benefits as wellas data sources that can be used to measure these benefits. The system is scoped to focus on the application oftelemedicine to support patient referrals between hospitals. Data sources are considered accordingly, withelectronic health record (EHR) data proving to be a feasible primary source for needs assessments, howeverlimiting the benefits that can be quantified.The analysis of the needs assessment is included in the second phase of the decision support system. Data areextracted, transformed and loaded into a data warehouse from where it can be analysed. The system includesthree analysis steps to: map referral patterns, analyse potential benefits of telemedicine programs anddetermine cost-effective telemedicine solutions by allocating equipment at different hospitals. Analysistechniques used in the system include Pareto analysis, economic analysis, linear programming and the use of agenetic algorithm.It is proposed that the potential benefit results and equipment allocation algorithm be used to plantelemedicine programs for continuous evaluation. The final phase of the system therefore guides decisionmakers to use the results for implementation planning as well as evaluability assessments, for futuremanagement and evaluation of telemedicine programs.The decision support system is validated using patient referral data from the Western Cape public healthsector. The case study proved that the system is applicable to the real-world and could be a valuable tool fordecision makers to base telemedicine implementation planning on quantifiable evidence.The limitation on size and quality of both the Eastern Cape and Western Cape data sets, caused that the fullpotential of the system could not be demonstrated and validated. It is recommended that the quality standardsof EHR referral reports be improved, to ensure more accurate benefit results. Future work is recommended toinclude qualitative needs assessments in the scope of the decision support system, hereby increasing theamount of benefits to be assessed. Although it is expected that the developed system is capable to supporteven better resolution decisions with more detailed data sets, the system developed in this study provedalready adequate for improved implementation decision making. This could lead to higher success rates oftelemedicine programs and ultimately better quality healthcare for all.

[发布机构] Stellenbosch University