International Journal of the Computer, the Internet and Management, Vol. 10, No3, 2002

Doctors-OnLine

C. K. Yeo, C. T. Lau, B. S. Lee

School of Computer Engineering Nanyang Technological University Nanyang Avenue S 639798 Republic of Singapore

Email: {asckyeo, asctlau, ebslee}@ntu.edu.sg

Abstract The increased mobility of rising This paper describes the design and population of cosmopolitans and tourists development of a Java web application that have heralded the need for vital and personal implements the facilities of an online clinic. information, especially financial and Emulation of face-to-face consultation and medical, to be available conveniently and co-diagnosis with other doctors are quickly. With the advent and prevalence of accomplished via multipoint video and the Internet worldwide, it seems logical that audio conferencing. Patient record and Internet offers a highly suitable conduit and appointment data management is achieved this led to the fruition and development of through JDBC 2.0 API with a relational this project, online medical diagnosis system. database. A hardware measurement kit enables vital patient health data to be The online medical diagnosis system is measured and transmitted to the patient's literally an online clinic. It allows patients to PC via Bluetooth Interface. The data is request for appointments and doctors to meet then forwarded to the doctor during a up with them via video conferencing. Thus, consultation. Presciptions are sent via it is possible for doctors and patients to email to the patient as well as to the interact visually and audibly. Moreover, the selected pharmacy so that they can be ready system also provides a kit to the patient that for collection by the patient or be delivered will measure and transmit the patient's health to the patient. Web-based user interfaces signs such as body temperature via the are generated with Java Servlet 2.2 API Internet to the doctor. This will aid in the and security is accomplished with Java doctor's assessment or diagnosis. Secure Socket Extension 1.0.2 over the Secure Socket Layer. As with any clinic, patient medical records are stored in the system and is Keywords: remote diagnosis, BlueTooth available online to both doctors and patients. interface, wireless communication, audio, However, only doctors have the permission video conferencing and the professional knowledge to update 1. Introduction such records. The patient, on the other hand,

International Journal of The Computer, The Internet and Management, Vol. 10, No3, 2002, p 15 -22 15 benefits from the ability to peruse his or her  Accept patients’ vital health signs such medical records whenever necessary. as body temperature which are sent over the Internet to the doctor for diagnosis Enhydra Java Application Server 3.01 is without patient intervention used to deploy and manage this system. The  Manage patient medical records back-end relational database employed is including diagnosis, prescription, image Inprise Interbase 6.01. Both Enhydra and and document attachments Interbase are Open Source projects. Video  Allow prescriptions to be emailed to conferencing capability is achieved with patients upon request Microsoft Netmeeting 3.01.  Keep track of both doctors and patients appointments  Include encryption technology to protect sensitive and confidential medical 2. System Architecture information

The online clinic system is designed to: This is designed as a Java web application and is based on a three-tier  Allow doctors and patients to interact architecture [1]. The architecture comprises from any place and at any time three separate logical layers, namely, the  Provide video, audio and text presentation layer, business layer and the communications to fully emulate data layer. This is illustrated in Figure 1. physical consultation

HTTP respons e HTTP Presentation Presentation Presentation request Manager Objects Layer Application Objects Session Manager Business Business Objects Layer

Data Data Objects Layer

Database Manager Database JDBC

Figure 1 Doctors-Online Application Framework

16 2.1 Presentation Layer The Enhydra Database Manager [2] is responsible for the state of a database The presentation layer contains connection, the current SQL statement being presentation objects. These objects are executed by the data object and the result to loaded and executed by the Enhydra be passed to the data layer. Java Database Presentation Manager. Connectivity (JDBC) 2.0 API is employed to communicate with the database servers. When a patient browser sends an HTTP request to the server, the Presentation The separation of business logic and Manager passes the request to the user interface add flexibility to the design of corresponding presentation object that will this web application. Multiple user interfaces be instantiated and called. The presentation can be built and deployed without changing object may further pass the data to and the business layer. Similarly, a change in the receive data from the business layer. It then data source used may only affect the data formats the data for display and generates the layer and leaves both the business and HTTP response back to the patient browser. presentation layers untouched, thereby Java Servlet API 2.2 is used for the improving maintainability and increasing generation of HTML pages. performance.

2.2 Business Layer 3. Patient Health Measurement Kit The business layer contains business objects. Business objects define the The Patient Health Measurement Kit is a application’s business logic, including wireless hardware device designed to capture algorithms and specialised functions, but not the vital health data of the patient. Figure 2 data access or display functions. It serves to shows its block diagram. It comprises a evaluate information sent by the presentation temperature sensor, an analogue to digital layer and also transform the data from the converter (ADC) to convert the sensor data layer into the appropriate form required voltage into digital values for input into the for display by the presentation layer. PC. The entire kit is controller by an 8-bit microcontroller, the AT89C51, a flash The Enhydra Session Manager creates a memory version of the MCS-51 family [3]. unique session object whenever a patient The microcontroller uses serial interface to logs on. Patient-specific information will be connect to the bluetooth development kit [4] placed in the session object by the for data transfer. Vital signs of a human application object. Both the presentation include body temperature, pulse rate and objects and business objects will make use of blood pressure. However, for this system, the session information. only the temperature measurement is implemented. The recordings of pulse rate and blood pressure have been planned for 2.3 Data Layer future implementation. The setup and Data layer contains data objects that will operation of the system is shown in Figure 3. interface with the persistent data source. In this case, the data source is a relational database.

International Journal of The Computer, The Internet and Management, Vol. 10, No3, 2002, p 15 -22 17 Thermistor Analog-to- Micro- Bluetooth Probe Digital Controller Interface Converter

Figure 2 Overview of Health Measurement Kit

At the time of appointment, the patient chronological order. Besides this, the doctor launches the Visual Basic program. The will be able to see whether a patient has program automatically directs the browser to logged in as well as the generated access the patient login page for the patient NetMeeting link and a hypertext link to the to login. The patient will then be prompted to examination page of the patient containing measure his vital signs. The controller the vital health data that was transmitted transmits the measured value to the patient’s from the Patient Health Measurement Kit. computer through the Bluetooth interface [5] The doctor will also be able to access the [6]. This reading is captured by the Visual corresponding patient’s medical records. Basic program through the RS232 serial port Such medical records can be retrieved by the which is interfaced to the Stonestreet doctor as shown in Figure 3 for discussion Bluetooth receiver. Once the readings have with the patient. stabilised, the program will be sent via the Internet to the Doctors-Online server. The When the doctor is ready to interact with server will then capture these data and the patient, he will click on the NetMeeting presents them to the doctor for diagnosis. link bringing up the NetMeeting software. The NetMeeting software on the doctor’s The login procedure is required in order computer shall ‘call’ the NetMeeting to confirm the identity of the patient in software on the patient’s computer as concern and ensure that the data is sent over determined by the IP address. If the call is a secured Internet communication channel. successful, video conferencing will be established between the doctor and the patient via ILS servers. The flow of information is shown in Figure 3. The doctor 4. Video Conferencing and Diagnosis can, in addition, establish a new video link to another doctor to co-diagnose the patient's At the same time the Visual Basic condition. program is been executed, the NetMeeting software is also activated. Once the patient Based on the health information and the has successfully logged in, the application interaction, the doctor can proceed to object determines and stores the IP address diagnose the patient. The diagnosis shall be of the patient’s computer. This address is stored as part of the patient medical record used in the generation of a NetMeeting link into the database. In order to fully implement that will be presented to the doctor in his the features of a patient’s medical records, appointment page. the doctor can choose to upload files to the database. In other words, the Doctor-Online On the appointment page of the doctor, a system will also act as a virtual hard disk. list of appointments will be displayed in This allows X-ray scans (shown in Figure 4),

18 detail medical history and other vital 5. Security information to be uploaded. The patient will be able to download these files for perusal. Due to the sensitive nature of medical However, a patient is not allowed to upload. information, security is a vital aspect of this The doctor has read, write and delete access system. Communication channels between to the attachments. The upload is done via a the patient and server and that between the POST request to the Doctors-Online server doctor and the server will be secured. Strong over Secure Sockets Layer. encryption is employed with the use of Secure Sockets Layer. This is accomplished Prescriptions are made and sent via through the provision of the export version email to the patient as well as to the of Java Secure Socket Extension 1.0.2. pharmacy selected by the patient. The patient Through the relaxing of US export laws, can either collect the prescription personally cryptically strong algorithms are made or have the prescription be delivered. available [7].

Patient Health Measurement Kit

Bluetooth Interface Visual Basic Program

Doctors Online Servers Doctor NetMeetin ILS NetMeetin Patient g g Compute Computer Servers r

Figure 3 Flow of Information between Patient and Doctor

International Journal of The Computer, The Internet and Management, Vol. 10, No3, 2002, p 15 -22 19 6. System Evaluation  The online medical records allow vital medical information of any patient to be 6.1 Commercial Potential available to doctors, wherever they may be, to aid in their diagnosis The commercial potential of this system  Invaluable to business travellers, are summarised as follows: tourists, elderly, patients who are physically immobile  Allows patients, wherever and whenever  Overcomes the problem of travelling in they may be, to seek medical attention adverse weather conditions and over from their very own doctors vast distances to seek consultation  Allows doctors and specialists who are  Allows prompt round-the-clock geographically distributed to co- healthcare services diagnose a patient's conditions  Reduces queues in clinics for trivial  Allows physical bio-medical ailments measurements to be taken and transmitted direct to doctors

Figure 4 Web-based User Interface of Doctors Online

20 6.2 Comparison with Related Systems  Ease of Use. The use of wireless technology renders the health LifeShirt [8] is a comfortable, washable mesaurement kit less cumbersome to be garment that can be worn at home, work or used. Moreover, it also allows data to be play. Sensors embedded in the LifeShirt transmitted automatically to the patient's continuously monitor 40 psychological signs PC as well as to the doctor, without the and record the data in a small recorder that need for patient's intervention unlike clips on the patient's belt. Patients can upload LifeShirt where manual uploading is data stored in the LifeShirt to an Internet- required. This seamless integration connected PC via a handheld computer. through the Internet together with the use These readings go to the LifeShirt Data of video conferencing can thus fully centre, a high-security website where staff emulate a face-to-face consultation. physicians can analyse the data and make it available for online viewing by the doctor and his patient. 7. Conclusion Micropaq [9] is an ambulatory patient monitor from Welch Allyn Protocl Inc. It is a The feasibility of implementing an patient worn telemetry monitor with the online clinic is demonstrated with the display, alarms and parameters of a Doctors Online system. The system is standalone portable vital signs monitor. The designed as a Java web application with a Micropaq monitor is principally designed for modular three-tier architecture to increase use in cardiac care with ambulatory patients flexibility, facilitate maintenance and connected wirelessly to Protocol's network improve overall performance. Doctors- and a central nursing workstation. It can be Online has been designed to facilitate patient used as a portable or spot-check monitor on to remotely consult his family doctor at any hospital medical-surgical floors or as a basic time from any place. Consultation is effected transport monitor when critical patients are via audio and video conferencing to fully moved from one hospital department to emulate physical consultation. Discussion another. with doctors other than the family doctor is accomplished via multipoint audio/video Although the patient health communications. Physical examination is measurement toolkit proposed pales in facilitated by providing patients with a kit to features and complexity when compared to measure health signs such as body LifeShirt and Micropaq, the Doctors-Online temperature as well as through video. system as a whole has the following Measured data is transmitted directly to the advantages in addition to the commercial doctor via Internet. Security is maintained potential mentioned above: with the use of Secure Socket Layer (SSL).

 Low Cost. Only basic vital signs such There is room for improvement in the as body temperature, pulse rate and blood system. For instance, code reusability can be pressure are required for minor medical improved by the use of Enterprise Java diagnosis. These limited requirements, Beans (EJB) and reduce video conferencing coupled with low-cost components make dependence on platform and browser by the hardware affordable for the patients. offering more diverse conferencing choices other than NetMeeting.

International Journal of The Computer, The Internet and Management, Vol. 10, No3, 2002, p 15 -22 21 REFERENCES

[1] Programmer to Programmer. Professional Java Server Programming. Wrox Press Ltd. 1999. USA.

[2] Ian Evans, Laurel Klein, Michael Maceri, C. Rand McKinney. Getting Started with Lutris Enhydra. Lutris Technologies, Inc. 2000. USA. Online document available at http://www.lutris.com/documentation.

[3] I. Scott MacKenzie, The 8051 Microcontroller, Prentice Hall, 1999.

[4] Stone Street Bluetooth Development Kit, http://www.stonestreetone.com/bluetooth /products/bdk/

[5] Bluetooth Special Interest Group, Specifications of the Bluetooth System version, 1.0B, vol. 1 and 2, http://www.bluetooth.com, Dec 1999.

[6] Brent Miller, Chatschik Bisdikian, Bluetooth Revealed - The Insider's Guide to an Open Specification for Global Wireless Communications, Prentice Hall, 2001.

[7] Java Secure Socket Extension, http://www.java.sun.com/products/jsse.

[8] LifeShirt, http://ww.vivometrics.com/Products/prod ucts_flash.html.

[9] Micropaq, http://www.protocol.com/company/press/ 000309micropaq.asp.