A NOVEL TELEMATICS PLATFORM FOR REMOTE MONITORING OF PATIENTS

Transcription

1 A NOVEL TELEMATICS PLATFORM FOR REMOTE MONITORING OF PATIENTS Antonios Kordatzakis 1, Kostas Perakis 1, Maria Haritou 1, Ilias Maglogiannis 2, Dimitris Koutsouris 1 1 Biomedical Engineering Laboratory, National Technical University of Athens, Zografou Campus, Athens, Greece, Tel: (+30) , fax: (+30) Dept. Information and Communication Systems Engineering, University of Aegean, Greece akorda@biomed.ntua.gr, kperakis@biomed.ntua.gr, mhari@biomed.ntua.gr, imaglo@aegean.gr, dkoutsou@biomed.ntua.gr Abstract Teleconsultation and telediagnosis are defined as the remote healthcare services provided by medical professionals, where distance is a critical factor, using ICT in order to exchange important information regarding the diagnosis, treatment and/or prevention of diseases. Several telemedicine systems have been developed over the last decade. The purpose of the present paper is to describe an innovative telematics platform, capable of handling emergency medical incidents in random locations, and emergency/chronic incidents inside healthcare environments. The platform utilizes state of the art technologies in information and communication systems, while several extension points exist so that plug-ins can easily extend the core functionality of the platform. Introduction The healthcare sector is information intensive and knowledge demanding. For this reason, e- Health solutions are of crucial importance [1]. The term ehealth came into use in the year 2000 [2]; telemedicine is only one of the areas canopied under this umbrella-term, and has been defined as the delivery of healthcare services, by remotely located healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interest of advancing the health of individuals and their communities [3]. The telemedicine and e-health area has clearly started to become an important issue for implementation, operational deployment of services and a promising market for industry [4, 5]. A wide variety of telemedicine systems have been proposed in the literature, either for emergency incidents or for homecare. Scientific approaches regarding emergency telemedicine for example include the wireless telemedicine project from the University of Maryland [6], the European Union s Ambulance [7] as well as the British Lancashire Ambulance [8], which all utilized the GSM cellular network for the transmission of the collected data. Xiao et al also presented the design of a real-time mobile telemedicine system for ambulance transport [9], while Karlsten et al, Anantharaman et al, and Rodriguez et al [10-12] have attempted dealing with emergency incidents outside the hospital area in order to enhance Emergency Pre-Hospital Care as well. For patients with chronic diseases, continuous monitoring of critical data can be both life-saving as well as self-assuring. With continuous monitoring, the treating doctors have more and timely information as regards the patients conditions and are able to provide better advice and suggest better treatment. Several research approaches have been considered. Woodward et al have proposed the use of a telemedical system comprising of a mobile telephone with sensors for patient monitoring [13]. He has also described the modular design of an interface and processor

2 for the transmission of multichannel biomedical signals over a Bluetooth to GPRS-based mobile cellular networks [14]. Johnson et al have proposed the use of a wireless cardio-respiratory telemonitoring system for in-home use, while Mendoza et al and Elena at al have provided for heart-failure patients [15-17]. The scope of the present paper is to present the architecture for the deployment of a telematics platform, capable of handling emergency medical incidents in random locations, emergency/chronic incidents inside healthcare environments and chronic incidents inside the patient s home. This platform makes use of fixed and wireless telecommunication technologies and utilises IP technology for the secure and transparent communication between the involved parties. The proposed telematics platform will constitute a revolutionary and pioneer utility for the creation of Hospital Information Systems, for the creation of information exchange systems between the patients and the healthcare providers, as well as for the provision of healthcare services via telematic support. In the following paragraphs the authors attempt to familiarise the readers with the architecture of the platform, present them the methodology utilised for the implementation of the platform, as well as provide a graphical representation of its features and functionalities. Materials and Methods The scope of the work undertaken was to utilise and take advantage of state-of-the-art information and communication technologies in order to produce a telematics platform capable of handling emergency medical incidents in random locations, emergency/chronic incidents inside healthcare environments and chronic incidents inside the patient s home. In order for the system to be viable, flexible and efficient, it should comprise of a portable patient unit, which would be responsible for the acquisition and transmission in real time or almost real time of various critical biosignals and images of the patient, through a plethora of telecommunications networks, to a portable/fixed consultation unit. The proposed platform constitutes an innovative tool in the area of e-health, and more specifically in the area of remote monitoring of patients, and comprises a combination of portable and/or fixed equipment which allow for the acquisition and transmission of diagnostically critical biosignals of the patient, such as various-lead ECG, Blood Pressure, Oxygen Saturation, Body Temperature, along with acquisition and transmission of still images of the patient (upon which annotations can be made) and/or real-time audio-visual communication between the involved parties. However, this platform also allows for future enhancements as regards the biosignals collected. Thus for example, the platform supports the collection of data from glucose measurement devices, via the development of the appropriate driver for the device. The platform s architecture abandons the typical client-server architecture which the majority of telemonitoring systems nowadays adopt, and introduces the notion of nodes. Thus, there are 3 main participating nodes in each session, which can increment during the session. The Transmission Node (TN) is responsible for the acquisition of data from the medical devices, their local display, and triggers the request for the initialisation of a medical monitoring session, in order to transmit the data to specialised medical personnel. The Monitoring Node (MN) is responsible for the reception of the Transmission node request for monitoring, for the collection of the transmitted data and for the provision of tele-consultation and tele-diagnosis. Last but certainly not least, the Administrator Node (AN), is responsible for the monitoring of all nodes, and for the dispatching of monitoring requests from Transmission nodes to Monitoring nodes, operating in automatic, semi-automatic or manual mode.

3 The platform was developed utilising the Windows Communication Foundation (WCF), a set of.net technologies for building and running connected systems [18]. WCF constitutes a new breed of communications infrastructure built around the Web services architecture providing secure, reliable, and transacted messaging along with interoperability. It is a service-oriented programming model which utilises SOAP messages for communication between two processes. A WCF client connects to a WCF service via an endpoint. Each time a TN makes a monitoring request, the AN dispatches the request to a MN, who may or may not accept it. In case he accepts the request, a dynamic Peer to Peer (P2P) network is created in which the TN and MN applications, along with several system nodes invisible to the rest of the nodes (for example a logging node) are participating and exchanging information regarding all nodes. When the TN makes a request to the TelemedicineEpisodeService (TES) for a new connection, the TES utilises the TelemedicineNodesRegistryService (TRS) in order to find an online MN and ask him whether he can or cannot satisfy the request. Once the MN replies positively, the TES sends the following messages: 1. the TN endpoint, the P2P network (to be established) address and the information that the MN will be responsible for controlling the monitoring device of the TN to the SentinelNode 2. the P2P network address to the MN 3. the Sentinel s endpoint to the TN The number and role of the invisible nodes varies according to the system configuration. Apart from the dynamic P2P network, a new channel for direct communication between the TN and the MN is also created. Four services invisible to the participating nodes are also active during a session. These services are: 1. The TelemedicineEpisodeService, which is actually the incident management service, and is activated by the TN, in order to be connected with a medical specialist. This service supports a front-end, with the help of which the AN can dispatch the monitoring requests to remote clients. 2. The Nodes Registry Service has to do with the management (insertion, deletion and update), of network nodes, and provides search capabilities based on several attributes, including node id, node description etc. as well as retrieval capabilities of these characteristics. It is utilised in order to retrieve the endpoints of MNs, so that they can be contacted in order to initiate a session. 3. The Peer Resolver Service: A peer node is an endpoint in a mesh, i.e. a named collection (an interconnected graph) of peer nodes that can communicate among themselves and that are identified by a unique mesh ID. The Peer Resolver Service is responsible for resolving a mesh ID to the endpoint addresses of the nodes in the mesh [19]. 4. The Sentinel Service is the service utilised by external (as regards the P2P network) nodes in order to communicate with internal nodes. An external node directly communicates with the sentinel service, while the service, the MN and the virtual system nodes constitute the P2P network. Thus, each message forwarded to the Sentinel Service by an internal P2P node, is forwarded to the remote node, while each message forwarded by the remote node to the sentinel service is automatically forwarded to the P2P network.

4 The following figure illustrates the various platform services, along with the various nodes participating during a session. Figure 1. Platform Architecture As mentioned earlier, the platform supports the collection of various critical (or non-critical) biosignals from standardised medical monitors, while several extension points exist so that plugins can easily extend the core functionality of the platform. Each device that acts as a biosignals source, either it is a medical monitor or a glucose meter or any other device, is characterised by a device driver, which is the sole way of communication between the device and the platform. In this sense, it constitutes an abstract, virtual device, and each physical device needs to compile a specific realisation of it in order to interconnect with the platform and utilise its end services. Each device driver offers specific device capabilities (device caps) of the corresponding device, namely its characteristics. One such capability could be for example whether the device supports periodic transmission of data or the platform needs to periodically trigger the device to request transmission of data (polling). The following figure illustrates the transmission of biosignals from the TN to the MN, as simulated by a device driver of a medical monitor, capable of recording the waveforms and arithmetic values of the patient s Heart Rate (HR), NIBP, SpO 2, Temperature and respiratory rate.

5 Figure 2. Device driver of a medical monitor Transmission of biosignals One of the main innovations of the platform is the collaboration feature, meaning that a MN can make an invitation to another MN, to acquire what is called a second expert opinion, and thus the dynamic network that had been created is enhanced with peer to peer communication. In this context, the second expert receives the same information (biosignals and images/video of the patient) as the originally invited expert node, and can assist him in the evaluation of the situation. The platform also supports other audio-visual communication amongst the participating nodes. Thus, it supports the audio communication between the TN and the MN utilising Voice over IP technologies (VoIP), as well as transmission of still images from all participating nodes, compressed by default utilising the JPEG standard. However a plethora of other image formats are also supported, such as BMP, TIFF, PNG etc. In addition, the platform is capable of the transmission of video amongst the participating nodes. Furthermore, the platform is enhanced with management utilities, for the monitoring and management of the various components of the platform and their services. With the help of these management utilities, the administrator can insert, delete or update the attributes (unique id, description, type, endpoints etc) of the all nodes that have the right to be involved in the telemedicine sessions. The proposed platform allows data transmission through various fixed (PSTN, ISDN, xdsl, LAN) and wireless (GSM, GPRS, 3G, Wi-Fi) telecommunication technologies and utilises IP technology for the secure and transparent communication between the involved equipment. However, the platform is not responsible for the establishment of a telecommunication link between the nodes and the network; this is a task of the operating system over which the platform runs.

6 Furthermore, the proposed platform allows for the interconnection and communication with Hospital Information Systems (HIS), and the update of and retrieval of data from electronic health records. In order to achieve this, the HL7 standard protocol has been utilised. These procedures comply with the requirements of security and interoperability, meaning that privacy, data accuracy, user authentication and validation are ensured, as well as the easy exchange and distribution of the medical data, either structured or not. The communication between the various components utilises standard HL7 messages, for easy maintenance and extensibility. An HL7 listener processes registered HL7 types of messages which can be extended by defining new message types and the appropriate handlers. The MN software application can retrieve and modify all patient data that is stored in the health record. More over all messages that are exchanged between all nodes during one session are logged so that sessions can be reproduced. Discussion E-Health solutions are of crucial importance. Based upon that, the authors of the paper conceived the idea of implementing a telematics platform capable of coping with a variety of incidents, whether they occur indoors or outdoors, so that healthcare provision of the future will be technologically driven and quality based. The platform is based on existing and state-of-theart technologies, such as the Internet Protocol and the.net framework. Since the ultimate scope of the platform is the transmission and management of medical data, special consideration has been paid on security issues, namely authentication, message integrity and confidentiality. The authors strongly believe that the proposed telematics platform will constitute a revolutionary and pioneer utility for the creation of Hospital Information Systems as well as for the integration of the proposed platform in existing HIS. The telemedicine and e-health area has clearly started to become an important issue for implementation, operational deployment of services and a promising market for industry, yet the ultimate scope of telemedical systems is forwarding quality in healthcare and focusing on the patient rather than the provider. Acknowledgements This work has been co-funded 70% by the European Union (EU) European Regional Development Fund (ERDF) 30% by the Hellenic Republic Ministry of Development The General Secretariat for Research and Technology (GSRT) in the framework of Measure 4.2 of the Op. Pr. Competitiveness - 3 rd Community Support Programme. References [1] Olsson S., Lymberis A., Whitehouse D. European Commission activities in e-health, Int. J. Circumpolar Health, 2004 Dec;63(4):310-6 [2] Pagliari C., Sloan D., Gregor P., Sullivan F., Detmer D., Kahan JP., Oortwijn W., MacGillivray S. What is ehealth: a scoping exercise to map the field, J Med Internet Res. 31 March 2005; 7(1):e9 [3] WHO 1998, HEALTH 21: An introduction to the health for all policy framework for the WHO European Region, Copenhagen, World Health Organisation, 1998.

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