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
enrico.staderini@heig-vd.ch
Geneva, 6-7 December 2010
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How physicians are made
Information diggers
Pattern finders
Problem solvers
Alarm triggers
Geneva, 6-7 December 2010
Direct patient
interaction
or
Mediated patient
interaction
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Medicine not only lacks precision...
It lacks a formal
methodology
Medical practice is a
practice indeed!
Not a formal theory
behind it
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Epistemology of diagnostics
Patient is suffering from something
Task of diagnostics is to discover it
The diagnostic process implies
– Interaction & Communication
– Physical measurements
A social construct
A technological construct
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The process of subject-caregiver interaction
cognitive process
(awareness)
perception of
symptoms
subject
cultural
process
signs
sensations
complaint
physical interaction
discourse
hypothesis probing
process
hypothesized disease from
a set of disease models
caregiver
cultural process
(discipline)
cultural
process
formalization of
symptoms
shareable medical
record
formalization of
diagnosis
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Interaction in the hypothesis probing
formalization
of diagnosis
caregiver
decision
process
stimulation
vector
action
patient
biometric
device
perception
Geneva, 6-7 December 2010
response
vector
biometric
device
signs & findings
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The caregiver decision process
caregiver decision
process
expected finding
+
-
similarity
perceived finding
decision
stimulation vector
generator
stimulation vector
min expected
similarity
perception
signs & findings
Geneva, 6-7 December 2010
formalization of
diagnosis
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Interaction in the hypothesis probing
formalization
of diagnosis
caregiver
decision
process
stimulation
vector
action
patient
biometric
device
perception
Geneva, 6-7 December 2010
response
vector
biometric
device
signs & findings
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The “device only” interaction
formalization
of diagnosis
caregiver
decision
process
perception
Geneva, 6-7 December 2010
action
biometric
device
stimulation
vector
patient
response
vector
biometric
device
signs & findings
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Interaction through a telecom channel
formalization
of diagnosis
telediagnostics
caregiver
decision
process
teleconsultation
action
stimulation
vector
telebiometric
device
perception
Geneva, 6-7 December 2010
telebiometric
device
patient
response
vector
signs &
findings
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The engineering science of medical practice
Engineering the medical practice
Formalizing a method of diagnostic
reasoning (a science of diagnostics)
– Syntax
– Semantics
– Pragmatics
Formalizing the knowledge base
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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
Formalism for data representation
Formalism for data transmission
Formalism for data fruition
Formalism for decision making
Formalism for action performing
– Standardization and formal theory of
medicine
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Modern attempts to theorize medicine from
Prof. Sadegh-Zadeh
•
•
•
•
•
•
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
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A roadmap to telemedicine
Formalizing medical reasoning
Is clinical judgment computable ?
Classical knowledge not appropriate
Fuzzy logic may be
Diagnostic and therapeutic knowledge is
procedural knowledge (medical
practice) on fuzzy statements
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Teaching telemedicine
We have to, at university level
Don't make just examples
Teach methodology instead
Coping with an unreachable patient
Insist on the social interplay of the medical
task
Use (develop) standards for medical data
communication
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direct interaction with patient 100 %
An evolution process
conventional
semiotics
caregiver alone
invention of the stethoscope
(Laennec 1816)
assistive technologies
invention of the telephone
(Bell 1876)
invention of X-ray imaging
(Roentgen 1895)
invention of electrocardiograph
(Einthoven 1902)
telemetry
invention of the
microprocessor (Hoff 1968)
invention of 2D M-mode
echocardiography (Reid 1970)
invention of computed
tomography (Hounsfield 1972)
teleconsultation
invention of the World Wide
Web (Berners-Lee 1991)
time
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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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