A framework for web-based networks for health care professionals
M.A. Johansen, H. Jacobsen, T.M. Burkow, I. Nordrum, K. Fossen
National Centre of Telemedicine, Norway
The situation faced by medical professionals in a country like Norway are often long distances between hospitals and clinics, and the departments can be relatively small, with only a few professionals in each discipline. The goal of our project has been to offer an infrastructure that makes it easier for medical professionals located at different places to co-operate and exchange information. This infrastructure can typically be used for distance learning, second opinion and telemedicine consultations. Benefits from an infrastructure like this could be less isolation for the professionals, and improved diagnostic services. We will focus on the special problems faced in a medical environment such as the one described above, and why using web technology is an interesting solution. An overview of the system architecture is also given.
Benefits from using web technology
The software solutions and hardware equipment available at the medical departments and clinics, and the personal experience with using computer systems varies a lot. Web technology offer a great benefit when used in such an environment since, the receiver of information only needs a web browser in order to use the system, and the user interface is rather easy to get familiar with. Due to the fact that the typical medical professional has relatively little experience with using computer systems, the simplicity of the user interface is an important factor.
The architecture of the system consists of two major components; the Medical Information and Diagnostic (MID) base and the telemedicine workstation (figure 1). The Telemedicine workstation (TMW) is just an extension of the medical professionals' ordinary workstation, and it consists of a web browser and a multimedia acquisition unit, which interfaces the medical equipment attached to the station. Depending of which profession in question, equipment for grabbing for instance pictures will be attached to the station.
Figure 1: System architecture
The MID-base is realized as a web site with restricted access, it is only accessible for authorized users, and it includes functionality such as a consultation service (second opinion) and a case file archive.
By using web-technology we can realize second opinion in a new and more efficient way. Second opinion is when one medical professional consults one or several other colleagues for diagnostic support. A consultation for second opinion is prepared by using the web interface. The pictures that are to be included in the consultation are acquired using the acquisition unit, and accessible by the browser through a common API. The common API gives the flexibility to use different systems for acquisitions. The consultation will be published to the MID-base, and the receiver(s) will be notified, typically by an email containing the URL. The receivers are now free to make comments on the web, and all of them can in an easy and structured way see the answers from the other ones.
An alternative to using the web for second opinion could be to use an email system (1). This solution is less attractive due to several reasons. One is the problem mentioned earlier with different environments, and the receiver might not have the needed software to view pictures included. Also, an email system gives a less structured way to make comments, and it is not so easy to get an overview of the answers given by other colleagues.
The privacy and security requirements for patient sensitive information, such as name, address and date of birth, is higher than for information in most traditional web based systems. It is not enough only to have proper access control to the system, ensuring that only authorized members can access the service, the information also has to be transferred in a secure way over the network. Even though the technology seems to be satisfying, the legislation in a country can be a problem. If a solution is not allowed, the problem has to be solved in another way. One solution can be to use ordinary telephone to communicate the patient sensitive information.
Based on the architecture defined, a system for medical professional in the field of pathology is under development by an external third part. The system is expected to be ready this summer. In another upcoming project the architecture will be used for making a system for ophthalmologists.
Based on our experience, web technology is a good candidate for use in a medical environment for several reasons. It is easy to use, several of the users are already familiar with the technology, the compatibility problem due to different hardware and software solutions at the hospitals is eliminated (as long as they can run a web browser), and the required investments are very low.
- Nordrum I, Amin A, Isaksen V, Johansen M, Ludvigsen JA. Still image consultations via e-mail in surgical pathology. A study of diagnostic accuracy. Adv Clin Path 1998; 2: 154-156 Proceedings IV European Congress of Telepathology.