presentasjonen inneholder animasjoner derfor er det ikke utskriftsvennlig! implementing of a...

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


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


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


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


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.


Instant Messengers today

• Yahoo Messenger

• MSN Messenger

• AOL Instant Messenger

• ICQ

• Trillian

• VoIP services: Skype


What kind of messages Instant Messengers deal with

• Instant messages

• Chat

• Web links

• Images

• Sounds

• Files

• Talk

• Video

• Streaming content


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


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)


internet

wireless sensors

secure, dynamic web pages

HTML POSTed messages & data

http web browser

http web browser


”eLege” Instant Messenger (eLegeIM) connections

SERVER

CLIENTS

Static IP

Dynamic IPs


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)


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)


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


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



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



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



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


eLegeeLege.r.reqeq

172.94.212.27

OK

SKIP NEXT



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




eLege.eLege.rreses


eLegeeLege.r.reqeq

--------------

OK



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




eLege.eLege.rreses


eLegeeLege.r.reqeq

OK


What’s built on top of IP manager system: eLegeIM


internet


• 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


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


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


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


Thanks

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