A Data Model for Teleconsultation in Managing High-Risk Pregnancies: Design and Preliminary Evaluation

Abstract

Background: Teleconsultation is a guarantor for virtual supervision of clinical professors on clinical decisions made by medical residents in teaching hospitals. Type, format, volume, and quality of exchanged information have a great influence on the quality of remote clinical decisions or tele-decisions. Thus, it is necessary to develop a reliable and standard model for these clinical relationships.

Objective: The goal of this study was to design and evaluate a data model for teleconsultation in the management of high-risk pregnancies.

Methods: This study was implemented in three phases. In the first phase, a systematic review, a qualitative study, and a Delphi approach were done in selected teaching hospitals. Systematic extraction and localization of diagnostic items to develop the tele-decision clinical archetypes were performed as the second phase. Finally, the developed model was evaluated using predefined consultation scenarios.

Results: Our review study has shown that present medical consultations have no specific structure or template for patient information exchange. Furthermore, there are many challenges in the remote medical decision-making process, and some of them are related to the lack of the mentioned structure. The evaluation phase of our research has shown that data quality (P<.001), adequacy (P<.001), organization (P<.001), confidence (P<.001), and convenience (P<.001) had more scores in archetype-based consultation scenarios compared with routine-based ones.

Conclusions: Our archetype-based model could acquire better and higher scores in the data quality, adequacy, organization, confidence, and convenience dimensions than ones with routine scenarios. It is probable that the suggested archetype-based teleconsultation model may improve the quality of physician-physician remote medical consultations.

Keywords: clinical archetype; clinical decision-making; pregnancy; remote consultation.

Figure 1

Designed model for teleconsultation, based on clinical decision-making archetype.

Figure 2

One of the subsets of designed model for premature rupture of membrane (PROM; the last biometric ultrasound). AFI: amniotic fluid index; EFW: estimated fetal weight; AC: abdominal circumference; FL: femur length; BPD: biparietal diameter; HC: head circumference.