R.WOOTTON & O.FERRER-ROCA
One of the reasons on the delay of Telemedicine acceptance is based on the limited number of rigourous scientific published papers furfilling the minimum scientific requirement of a trial .
Dificulties also dependent on the absence of a critical mass
of users ( see Chapter 11 ) that limit the value of the
statistical and cost-effective analysis. This give rise to
conclusions based on limited trials, case reports and
personal opinions of socially relevant people.
Furthermore transfer technology experiences cannot be exported
to other personal, social, political and organizational
enviroment , limiting the value even of those seriously design
pilot studies.
This chapter will introduce general rules to this minimum
requirements applied to Telemedicine
1.- CONTROLED VARIABLES
In Telemedicine studies variables are not globally controled .
The number of controled variables directly depend on scientific
background of the team carrying out the study. ie: Telecomm
variables for engineer, clinical variables for doctors,
electronic data such as image analysis and quality for
informaticians, economic variables for economists ,
organizational variables for managers ect...
Problems rise exponentially when we want to compared already
published data based on electronic devices that due to industrial
constrains we do not exactly know how they work or the exact
standards they use or even if procedures are standardized, how do
they manipulate internal data.
2,. CONTROL CASE MANAGEMENT
If global variables ( see previous pragraph ) are not
controled , will be even more difficult to find out true control
cases.
In the case of Teleradiology studies for example, control cases
are the so called " Golden Standards " , but even those
have diagnostic variabilities when submitted to well trained
radiologists.
This is particularly complex in the microscopic diagnosis done by
Pathologist or Cytologist based on experience, diagnostic schools
and subjective evaluations rising at maximum of a 85%
coincidental diagnosis on dificult cases under microscopy. This
diagnostic unagreedment link to human behaviour, have to be taken
into account , particularlly is we considered that those easy
cases that produce higher diagnostic concordance are generally
not submitted for consultation.; and when used for test beds
congruence is also very high ( near 100% ) limiting statistical
evaluations that control teleservice variables and performance .
Also trained people which diagnosis are based on images have a
highly develloped visual memory that increase the difficulties in
various round test-beds.
3.- SUFFIENT DATA FOR ANALYSIS
The term of sufficient data is directly dependent on the number of variables playing a role in the experiment.
4.- SERIOUS AND APPROPIATE STATISTICAL EVALUATION
This is directly link to the three previous points.
Neverthelless some statistical procedures are internationally
accepted as appropiate to statistically handle some the the data
obtained in Telemedicine experiences. For example :
a) ROC ( received operating curved ) is accepted to compared
diagnostic capability of images.
Part or total reproduction not allow without permission
Revisado: martes, 10 junio 1997.
Con el soporte informático y de comunicaciones
del CICEI, Universidad
de Las Palmas de Gran Canaria