Development and practice of a Telehealthcare Expert System (TES)

摘要

Objective: Expert systems have been widely used in medical and healthcare practice for various purposes. In addition to vital sign data, important concerns in telehealthcare include the compliance with the measurement prescription, the accuracy of vital sign measurements, and the functioning of vital sign meters and home gateways. However, few expert system applications are found in the telehealthcare domain to address these issues. Materials and Methods: This article presents an expert system application for one of the largest commercialized telehealthcare practices in Taiwan by Min-Sheng General Hospital. The main function of the Telehealthcare Expert System (TES) developed in this research is to detect and classify events based on the measurement data transmitted to the database at the call center, including abnormality of vital signs, violation of vital sign measurement prescriptions, and malfunction of hardware devices (home gateway and vital sign meter). When the expert system detects an abnormal event, it assigns an "urgent degree" and alerts the nursing team in the call center to take action, such as phoning the patient for counseling or to urge the patient to return to the hospital for further tests. Results: During 2 years of clinical practice, from 2009 to 2011, 19,182 patients were served by the expert system. The expert system detected 41,755 events, of which 22.9 indicated abnormality of vital signs, 75.2 indicated violation of measurement prescription, and 1.9 indicated malfunction of devices. On average, the expert system reduced by 76.5 the time that the nursing team in the call center spent in handling the events. Conclusions: The expert system helped to reduce cost and improve quality of the telehealthcare service.