Developing high-quality asynchronous store-and-forward telemedicine systems (ASFTSs) remains a challenge. However, there is no accepted understanding as to what are the important quality characteristics for this type of software system and/or what defines a mature software process for producing high-quality ASTFSs. Through adopting a multi-step research methodology, we define a quality model for ASFTSs indicating relevant quality characteristics and their priority for this specific type of software system based upon ISO/IEC 25010. We, then, propose an extended software process capability/maturity model based on ISO/IEC 15504 and ISO/IEC 12207 to meet these particular quality requirements. The resulting model can be used to both guide the development and the evaluation of such systems. We expect that the availability of such a customized model will facilitate the development of high-quality ASFTSs, reducing related risks and improving the quality of telemedicine services.

1. Tailoring Software Process
Capability/Maturity
Models for Telemedicine Systems
GQS – Software Quality Group
INCoD – National Institute of Science and Technology for Digital Convergence
Christiane Gresse von Wangenheim
Aldo von Wangenheim
Jean C. R. Hauck
Fergal McCaffery
Luigi Buglione

2. UFSC At a glance
Federal University of Santa Catarina
Florianópolis/Brazil [http://www.ufsc.br]
• 48 Master courses
• 38 PhD courses
• 62 Undergraduate courses
• EUR 268 million annual budget
• 25,737 Undergraduate students
• 8,543 Graduate students
• 34,280 Students
[http://www.youtube.com/watch?v=V6E1Z5DEuvk]
INCoD is a reference institute for excellence in research, validation
and dissemination to support digital convergence. [http://www.incod.ufsc.br]
The Software Quality Group focuses on scientific research, development and
transfer of SE models, methods and tools. [http://www.gqs.ufsc.br]

3. STT - Santa Catarina State Integrated
UFSC Telemedicine and Telehealth Network
Several modalities:
Radiology
Cardiology
Dermatology
State-wide service with more than
2 million exams realized
http://www.youtube.com/watch?v=3ZqG-
https://www.telemedicina.ufsc.br/rctm/ T2_QBI&feature=plcp

4. Engineering At a glance
www.eng.it
www.eng.it

5. DKIT At a glance
Dundalk Institute of
Technology is a 90 acre
campus situated between
Dublin and Belfast (each
approximately 50 miles
away).
The Institute consists of 4
Schools:
1. Business & Humanities
2. Informatics & Creative
Arts
The Regulated Software Research Group which is 3. Engineering
part of LERO (the Irish Software Engineering 4. Health & Science
Research Centre) is part of the School of
Informatics & Creative Media

6. Agenda
• Introduction
Telemedicine
Store and Forward I PERSONALLY
• Motivation DO NOT USE
Quality Challenge AGENDAS FOR
• SPCMMs TALKS WITH
Software Process Capability/Maturity Models
LESS THAN 1H
• Research Method
Steps
DURATION –
• Quality Characteristics but that’s a
personal opinion
Asynchronous Store-and-Forward Telemedicine Systems
• SPCMM for ASFTS
Capability/Maturity Dimension
Process Dimension
• Conclusions & Next Steps
• Questions

7. Introduction Telemedicine
Telemedicine event can be:
Synchronous (real time): requires the presence of both parties at the
same time and a communication link between them that allows a real-
time interaction to take place
Asynchronous (store-and-forward) : involves acquiring medical data and
transmits this data to a medical specialist for assessment offline.
Timeline

8. Introduction Telemedicine
Telemedicine event can be:
Synchronous (real time): requires the presence of both parties at the
same time and a communication link between them that allows a real-
time interaction to take place
Asynchronous (store-and-forward) : involves acquiring medical data
and transmits this data to a medical specialist for assessment offline.
Timeline
Jean Carlo R. Hauck 8

9. Introduction Telemedicine (store-and-forward)
A typical Workflow of asynchronous Telemedicine:
2. Data sent 3. Specialist
electronically analyses the
examination
1. A patient is
examined
Telemedicine Server
5. Requesting physician provides a
diagnosis and continues the patient’s
treatment. 4. Findings become
available

10. Introduction Telemedicine (store-and-forward)
NAO
A typical Workflow of asynchronous Telemedicine: ESTA MEIO
REDUNDANTE ESSE
SLIDE COM O
2. Data sent 3. Specialist
electronically ANTERIOR?? analyses the
examination
1. A patient is
examined EU SUGIRO DE
INCLUIR UM SLIDE
SOBRE O STT PARA
MOSTRAR QUE
SABEMOS DO QUE
Telemedicine Server
ESTAMOS FALANDO-
5. Requesting physician provides a talvez ja no inicio – veja o
diagnosis and continues the patient’s slide que inclui…
treatment. 4. Findings become
available

11. Motivation Quality Challenge
Telemedicine has the potential to solve diverse problems in modern
health care
Its quality remains a challenge considering their potential impact on
human health:
Does a radiologist at a central medical center, receive images with the proper
resolution to effectively provide a correct examination result?
Are the patient’s data and information protected against access of non-authorized
persons?
Will there be no erroneous mix ups of examination results to patients?

12. SPCMMs Software Process Capability/Maturity Models
Capability/maturity models are well established in practice as a
successful means for improving software intensive organizations
Variety of software process capability/maturity models has been
developed for different domains/sectors etc. in recent years
Process capability/maturity models are repositories of “Best Practices”
software engineering knowledge

13. SPCMMs Software Process Capability/Maturity Models
[Adapted from (ISO/IEC, 2003)]

14. SPCMMs Software Process Capability/Maturity Models
Indicate the ability to achieve
business objectives, in relation
to process attributes associated
with processes of each maturity
level
[Adapted from (ISO/IEC, 2003)]

15. SPCMMs Software Process Capability/Maturity Models
set of processes to acquire,
supply, develop, operate,
evolve and support software -
grouped into categories of
related activities
[Adapted from (ISO/IEC, 2003)]

16. SPCMMs Software Process Capability/Maturity Models
Process dimension:
“what is done”
Capability/maturity dimension:
“how well a process is done”
[Adapted from (ISO/IEC, 2003)]

17. Research Method Steps
AQUI FALTA
UM ULTIMO
STEP:
PROPOSAL
OF SPCMM

18. Quality Characteristics Asynchronous Store-and-Forward Telemedicine Systems

19. SPCMM for ASFTS Proposing a SPCMM
The LEGO Approach
1. MCM Repository
1. MCM Repository 2. Process Architecture
2. Process Architecture
3. Mappings &
3. Mappings & 4. Appraisal Method
4. Appraisal Method
Comparisons
Comparisons
Source: Buglione L., Gresse von Wangenheim C., Hauck J.C.R., Mc Caffery F.,
The LEGO Maturity & Capability Model Approach, Proceedings of 5WCSQ, 5th
World Congress on Software Quality, Shanghai (China), Oct 31- Nov 4 2011

20. SPCMM for ASFTS Proposing a SPCMM
TRIM method
Source: Hauck J.C.R., Gresse von Wangenheim C., McCaffery F., Buglione L., Proposing an ISO/IEC 15504-2 Compliant Method for Process Capability/Maturity Models
Customization, PROFES – 12th International Conference on Product Focused Software. Development and Process Improvement, Italy, 2011

21. SPCMM for ASFTS Capability/Maturity Dimension
Capability Levels – ISO/IEC 15504-2 “as is”
Maturity Levels – ISO/IEC 15504-2 “as is”

22. SPCMM for ASFTS Process Dimension

23. Conclusions Final words and next steps
TOO MUCH WORDS –
Based on identified quality characteristics we propose a software
CAN YOU REDUCE
process capability/maturity model for the development and OF
THE AMOUNT
maintenance of ASFTSs
TEXT?
SPCMM-ASFTS is based on ISO/IEC 15504 and its process dimension
is developed by extending ISO/IEC 12207 through several processes
related to quality characteristics considered essential and/or important
in the context of ASFTSs
This model has the potential to guide the development and evaluation
of high-quality ASFTSs by indicating and prioritizing relevant non-
functional requirements and indicating processes relevant to mature the
development of ASFTSs
A step forward to provide a better understanding of the development of
ASFTSs potentially contributing to the improvement of the quality of
such systems as a basis for an improvement of telemedicine services

24. Questions? Our Contact Data
Jean Carlo R. Hauck
jeanhauck@gmail.com
jeanhauck@incod.ufsc.br
C. Gresse von Aldo von Fergal Luigi
Wangenheim Wangenheim McCaffery Buglione
UFSC UFSC DKIT Engineering.IT/ETS
gresse@inf.ufsc.br awangenh@inf.ufsc.br fergal.mccaffery@dkit.ie luigi.buglione@eng.it