presentasjonen inneholder animasjoner derfor er det ikke utskriftsvennlig! implementing of a...
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Presentasjonen inneholder animasjoner derfor er det ikke utskriftsvennlig!
Implementing of a Personal Web Server based, Open Architecture for a Straightforward e-Patient e-Physician Communication Link
eHealth Instant Messenger
Enrico M. Staderini – Mariangela MagnantiNasjonalt Senter for Telemedisin – Tromsø – Norway
Tor Vergata University of Rome – Rome – Italy
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
Motivations
• Most telemedicine applications are delivered as results of high level projects which often end up into single implementations (not replicated nor replicable elsewhere)
• Most of the possible users, as physicians, patients and communities, are presently not easily reached by telemedicine applications and services, although rapidly increasing
• Spreading of telemedicine applications is hampered by the high cost of each ”ad hoc” (not ”ad ok” !) application, having a very specialized scope
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
Project
• Change today’s concept of telemedicine à la carte
• Boost the telemedicine fast food concept
• Develop a download&run telemedicine application software with the aim of freely distribute it so that third party institutions or companies may readily start delivering a service based on it
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
The fast food telemedicine
• Low cost or free
• Easily available
• Most generic to allow for many possible services
• End user upgradable/customizable
• End user serviceable
• e.g. follow the GNU General Public License
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
The eLege (e-Physician) project
• Basically an Instant Messaging system
• Working under dynamic IP, ADSL broadband connections
• Working under the Windows operating system
• Compatible with standard (IE, Mozilla) as well as specialized (JAWS) web browsers
• Requiring elementary user skills: at least being able to switch on the computer, connect and surf the web
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
What are Instant Messengers
• Programs which allow the user to maintain a list
of people (often called a contact list) that he/she
wishes to interact with. The user can send
messages to any of the people in the list, as long
as that person is online.
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
Instant Messengers today
• Yahoo Messenger
• MSN Messenger
• AOL Instant Messenger
• ICQ
• Trillian
• VoIP services: Skype
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
What kind of messages Instant Messengers deal with
• Instant messages
• Chat
• Web links
• Images
• Sounds
• Files
• Talk
• Video
• Streaming content
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
eHealth Instant Messengers?
• Instant messages - Send notes/alarms/prescriptions back and forth between a physician and a patient
• Chat - Create a custom chat with patients, relatives, caregivers, physicians, nurses, rehab people
• Web links - Share links to favorite web sites for patient education, e-learning
• Images - Look at an image of the patient or findings or medical images or home site images
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
eHealth Instant Messengers?
• Sounds – Record/Send/Play sounds (lung/heart sounds, voice)
• Files - Share files by sending them directly to correspondents (EKG, medical records)
• Talk - Use the Internet instead of a phone
• Video – Bidirectional video communication
• Streaming content - Real-time or near-real-time news (continuous patient monitoring)
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
internet
wireless sensors
secure, dynamic web pages
HTML POSTed messages & data
http web browser
http web browser
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
”eLege” Instant Messenger (eLegeIM) connections
SERVER
CLIENTS
Static IP
Dynamic IPs
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
What’s at the core of eLegeIM• A client software
program runs on any client computer (both physicians and patients)
• A server software program runs on the server computer
• On the server computer a data base is maintained with all the users registered to the service
• Only nicknames and passwords are stored here (optionally user’s category too)
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
How the various actors register on the server
• Registering can be performed by an on-line or by an off-line procedure to the entity managing the server
• The entity managing the server computer has rights to include or exclude users (a fee may be applied): a business model is defined
• Registered users can join the Instant Messaging system eLegeIM as soon as they go on-line after switching on the computer
• Users may be subdivided into categories (patients, relatives of a particular patient, physicians, administrative people, general public)
• Users have rights and services according to the category they belong to (other restrictions/extensions may be applied)
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
How a given client joins the eLegeIM system
• Client and server programs are used as in any other Instant Messenger system (with a secure –SSL proprietary protocol)
• Client and server programs are made freely downloadable
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
Nickname Password IPnumber Expiry
Lege wsekj1 31/03/2006
Per rghx38 31/03/2006
Linda aldufykl 31/03/2006
Client’s machine(physician)
Lege, wsekj1
160.85.120.34
160.85.120.34
OK
IP server machine
Physician joins the serverPhysician joins the server
160.85.120.34160.85.120.34OK
eLegeClient.exeeLegeClient.exe
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
Nickname Password IPnumber Expiry
Lege wsekj1 160.85.120.34 31/03/2006
Per rghx38 31/03/2006
Linda aldufykl 31/03/2006
Client’s machine(patient)
Linda, aldufykl
172.94.212.27
172.94.212.27
OK
IP server machine
Patient joins the serverPatient joins the server
172.94.212.27172.94.212.27OK
eLegeClient.exeeLegeClient.exe
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
How a given client (physician) gets the IP number of a particular client
• The physician has (on his/her computer) the real names and nicknames of his/her patients in the eLegeIM community
• A DHTML local hosted web page ask the server (by means of the client software program) the IPs of each patient the doctor wants to come into contact with
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
Nickname Password IPnumber Expiry
Lege wsekj1 160.85.120.34 31/03/2006
Per rghx38 31/03/2006
Linda aldufykl 172.94.212.27 31/03/2006
Lege, wsekj1, Linda?
Patient’s machinePatient’s machine(Linda)(Linda)
Linda 172.94.212.27
IP server machineIP server machine
Physician’s machine
““eLegeDHTML”eLegeDHTML”
eLege.eLege.rreses
eLegeClient.exeeLegeClient.exe
eLegeeLege.r.reqeq
172.94.212.27
OK
SKIP NEXT
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
Nickname Password IPnumber Expiry
Lege wsekj1 160.85.120.34 31/03/2006
Per rghx38 31/03/2006
Linda aldufykl 172.94.212.27 31/03/2006
Lege, wsekj1, Per?
Patient’s machinePatient’s machine(Per)(Per)
switched off or notswitched off or notconnected to the webconnected to the web
Per offline
IP server machineIP server machine
Physician’s machine
““eLegeDHTML”eLegeDHTML”
eLege.eLege.rreses
eLegeClient.exeeLegeClient.exe
eLegeeLege.r.reqeq
--------------
OK
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
Nickname Password IPnumber Expiry
Lege wsekj1 160.85.120.34 31/03/2006
Per rghx38 31/03/2006
Linda aldufykl 172.94.212.27 31/03/2006
Lege, wsekj1, Audny?
Patient’s machinePatient’s machine(Audny)(Audny)
not registered tonot registered tothe eLegeIM servicethe eLegeIM service
Audny unknown
IP server machineIP server machine
Physician’s machine
““eLegeDHTML”eLegeDHTML”
eLege.eLege.rreses
eLegeClient.exeeLegeClient.exe
eLegeeLege.r.reqeq
OK
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
What’s built on top of IP manager system: eLegeIM
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
internet
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
• biomedicaldata/signals
• messages
third partysoftware
special I/O raw files
PHPsoftware
dynamicweb pages
Abyss web server Stunnel SSL server PHP server
HTML pages
• monitoring• counseling• prescriptions• alarms
webbrowser
PHPsoftware
internet
posted data
https protocol
externalHTML
andlocal
DHTMLpages
webbrowser
• biomedicaldata/signals
• messages
• monitoring• counseling• prescriptions• alarms
HTML POSTto
PHP software posted data
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
How a given physician gets in contact with a particular patient
• The local DHTML web page displays the list of patients with the respective IPs if they are on-line in the eLege community
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
How a given physician gets in contact with a particular patient
• The doctor starts surfing each patient’s personal website hosted on each patient’s computer
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
Conclusions• e-Health Instant Messenger
• Resolves dynamic IPs problems with security
• Establishes a bidirectional communication link between the various actors
• Realizes a community of actors on a dynamic IP structure like that in common ADSL broadband end-user link
• Interfaces at webpage level to the patient and the physician
• It needs no special effort to be operated or configured
• Building block open for any kind of customization
Staderini-Magnanti: Tromsø Telemedicine and e-Health Conference 2006
Thanks
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