Some methodological issues in telemedicine: systems, modeling and evaluation

Telemedicine, including the provision of telematic health care services, is already playing a significant role in transforming the practices of health care delivery and has the potential to bring about what is truly the "hospital without walls". However, if this potential is to be fully realised, it is vital that proper systemic and systematic methodologies be adopted for the design, development and evaluation of telematic health care systems. This paper addresses a number of such methodological issues. First, in relation to specification and design, it is shown how systems-based models can and do offer a paradigm for tackling these stages of system development. The role of the telematic system as an extension of the feedback processes involved in clinical activity can be clearly portrayed and the full range of system users and other stakeholders identified. Evaluation must be seen as an integral part of the system cycle, with again models being central to a process that can be treated in terms of evaluability, formative evaluation and summative evaluation. Evaluation criteria can be divided into a necessary sub-set, where a Boolean model may be adopted, and an additional set to provide sufficiency, where a Bayesian approach may provide a means of combining dissimilar measures of performance. The relevance and applicability of the methodological concepts discussed are illustrated with reference to the EU-funded health care telematic project HOMER-D. This involves the specification, design, implementation and evaluation of a telematic system to support home or satellite haemodialysis services.