Health Telematics (AIM) Final Report


	Updated: Feb 1, 97
TELEGASTRO

Telematics technology for harmonising and promoting quality in gastroenterology

Project Code: A2037

Project value: 896 KECU

EC contribution: 896 KECU

No of partners: 5

No of countries: 5

Duration: 36 months

Contact:
Prof. Ole Winding
Univ. Copenhagen
Inst. of Forensic Medicine
Fr. V's vej 11
DK-2100 Copenhagen, Denmark
Tel.: +45-35-32.61.85
Fax: +45-35-32.61.50

Overview

TELEGASTRO aims to gather, organise and encapsulate the state of the art knowledge in several aspects of digestive and abdominal disorders. The model used to arrive to this product is generalisable to other medical domains as a true template. The method used by the consortium, involving the medical profession in the development of the product, guarantees the acceptance and future use. The tuning of the system has been assured via evaluation of National boards, existing groups, and monitored installations, plus an expansion beyond the EU, thanks to the involvement of the World Organisation of Gastroenterology.

Purposes, goals, objectives

The goals and achievements of the project are : 1) relevant (updated) information in a specific clinical situation can be accessed in a relative short time (minutes). 2) it enables users to increase their ability to deal with and manage a specific clinical situation. 3) it is appropriate to different types of health care users, and answers their perceived needs.

Methods used

The basic idea of the TELEGASTRO - project is to involve actively the clinicians in an iterative process to accomplish consensus on definition of terminology, recommendations for data to be collected, criteria for judging severity of diseases and outcome, and to present the consensus views on three disks which can be easily accessed during clinical work and with an updating facility. The programme can also be used for teaching purposes. Without the clinicians involvement this kind of information/learning material will never be accepted, in a clinical setting. Gastroenterology is used as template/model for all other medical specialities.

Results, exploitations, demonstrator

Main Results

The TELEGASTRO Project addresses two of the most fundamental problems in clinical practice today.

For the doctor, the clinical medical course is finite, the teaching faculty is finite and the amount to learn has exploded - so that it is no longer possible to "know the whole of medicine", even within a single speciality as gastroenterology.

For the Community, there is a different problem. As long as different centres and individuals use different criteria to assess health care, it is not possible to make valid comparisons or assessments across institutions, countries or continents.

The TELEGASTRO program is designed to provide solutions to these problems. It is designed to secure(in specific areas of gastroenterology) consensus amongst senior clinicians concerning "good clinical practice" and criteria by which the good clinical practice can be promoted and assessed. The TELEGASTRO Project then is designed to present a compendium of these views on "good clinical practice" to young doctors and others via a Telematics Product and to assess the reaction to the resulting computer programs.

The TELEGASTRO suite of programs cover selected areas of gastroenterology including acute abdominal pain, inflammatory bowel disease, upper gastroenterology bleeding, dyspepsia, jaundice, oesophagitis, and upper gastrointestinal cancer. The programs present consensus views concerning criteria for diagnosis, extent and severity of disease, minimum datasets, definitions of terminology, indicators of performance, and indications for high technology investigation and operation. The programs are available in both MS-DOS and Windows formats and include information sections, data recording sections, and teaching programs based on the consensus views of over 500 experts. The programs are flexible, allow inclusion of local expertise and up-date and permit either quick scanning or detailed browsing.

The evaluation of the TELEGASTRO programs is believed to have set new standards

An independent International Evaluation Panel of the highest quality has been created - and has directed the evaluation. Alpha testing, Beta testing, and remote site testing have been completed. Further testing of the product has continued in the hands of approximately 500 users. Results have shown that the product functions as designed, enables users to secure specific clinical information rapidly, and has also demonstrated ability to enhance clinical performance levels.

The prototype has now been distributed to over 150 institutions in 42 countries. The prototype has been networked within a single hospital to 100 terminals, and within a University to over 300 users. The prototype has been instituted in both MS-DOS and Windows formats on a variety of hardware platforms.

The demonstrator shows a number of modules from the TELEGASTRO and allied programs as follows.

1. The original TELEGASTRO MS-DOS program for information - to be distributed to countries where high technology is not available
2. A similar TELEGASTRO program in Windows format, suitable for the majority of institutions within the European Union.
3. The G.I. View teaching programs for the same clinical areas, embedded within the TELEGASTRO product by courtesy of the Research Committee of the World Organisation of Gastroenterology.
4. A prototype version of the "ELITE" program (Education and Learning about I.T. in Europe) - along with a suite of additional teaching programs.

The TELEGASTRO program has a world lead in terms of providing individual clinicians with access to expert opinion rapidly and effectively.

The potential benefits of this are two-fold (as described earlier).

First, such provision of access to expert opinion enables inexperienced users to deliver "better than excepted" clinical care. There is already evidence that the TELEGASTRO program enables "better than anticipated" clinical care to be delivered.

Second, data from the TELEGASTRO program facilitates comparisons between centres, enabling multi-centre trials to be carried out more easily and comparisons to be made more readily of the process and outcome of clinical care. This too has already been demonstrated. A number of multi-centre studies are already underway.

It should be noted these benefits are not theoretical or potential. They are actual achievements of the project.

Finally, it is reasonable to suggest that the TELEGASTRO methodology can be used as a template for other clinical areas.

Future Plans

The next four years period has been considered by the TELEGASTRO partners and the following general strategy has been adopted. By the end of 1998, the TELEGASTRO product (subject to resource provision) is intended to have the following characteristics.

The product will cover most (and hopefully all) of the areas relating to routine Gastroenterological practice, thereby providing a true departmental system
The product will be available in various national languages and in a variety of formats ranging from simple MS-DOS programs to multi-media versions (enabling individual users to select the most appropriate format)
The product will have attained significant market penetration being distributed to (or available by network to) the majority of potential European users
The product will have shown tangible impact on the delivery of (and the evaluation of) health care across the European Union.

These are challenging goals. However, both the TELEGASTRO project team and the World Organisation of Gastroenterology Research Committee believe them to be realistic and achievable based on the current development of the prototype, and the highly favourable reaction to it of the various users.

List of Deliverables

Year 1

Document: Current Clinical State of Art (3/S/I)
Operational Requirement Specs. (6/S/I)
Preliminary Clinical Consensus Document (8/S/I)
Final Consensus Document (clinical) (12/S/I)
System Design Specification (12/S/I)

Year 2

System Program Specification (3/S/I)
Prototype package (3/P/R)
Preliminary Results Evaluation (6/R/I)
Implications Document for Final Product (12/R/I)

Year 3

Revised Telematics Product Demonstrator (9/P/R)
Final Evaluation Comments (10/R/I)
Final Telematics Product (12/R/P)
Final Telematics Product (Demo Version) (12/T/P)
Final Project Report (12/R/I)
State of the art review. Digestive Endoscopy/Cancer/Oesophogeus (3/R/R)
User Specifications for Different Target Groups (3/R/R)
Brief operational requirement System Design Spec. Windows Version (4/R/R)
Prototype Expanded Program - Clinical (6/P/R)
Prototype Windows Version (6/P/R)
Revised Program/Digestive Diseases Endoscopy (12/P/R)
Revised Windows Version (12/P/P)
Demonstrator versions of all revised programs (12/P/P)

List of Participants

Prof. Christian Ohmann Univ. Düsseldorf - Theoretische Chirurgie Moorenstrasse 5 D-4000 Düsseldorf, Germany Tel.: +49-211-311.61.42 Fax: +49-211-34.22.29	Prof. Francis T. de Dombal (deceased) University Leeds - Clinical Inf. Science 22, Hyde Terrace Leeds LS2 9LN, U.K. Tel.: +44-532-33.49.61 Fax: +44-532-42.90.78
Dr. Ari Hasman University of :Limburg Bouillionstraat 3 PO Box 616 NL-6200 MD Limburg, The Netherlands Fax: +31-43-67.10.52	Prof. Paolo Bianchi University of Milan Institute of Medical Science Via F. Sforza 35 I-20212 Milano, Italy Tel.: +39-2-55.18.49.42 Fax: +39-2-55.01.21.11



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