Our medical station starts with a navigation bar, which birng easy and fast access to every module or utility wich application offers. As can be seen, application is window based, user friendly and very intuitive, in order to minimise the learning curve and to gain users, often not so keen to use new and innovative software.
fig. 1
New work strategies must be devolped in using the applicatios. The applications helps the physicians on their usual and traditional work, but new "ways of working" can be developed and created, most of them co-operative work. The use of new and powerful tools in signal processing and networking would imrpove the work and benefits of the users.
We are going to describe the several modules that comprise the application.
- The ECG visualisation and revision tool allows picking a disk file coded according to the European Standard ENV-1064, developed by the CEN TC 251 about coding ECG for transmission. The module is ready for conversion routines from another proprietary coding schemes under request. Once the file is opened, we can visualise the existent data, the ECG wave, add a report or mark characteristic points on the ECG(3).fig. 2
- Acquisition module is autonomous in order to guarantee portability, because is one of the very few with low level access. Our prototype accesses a National Instruments acquisition card, the AT-MIO-16E-10 using Windows drivers provided by manufacturer. It use is fully integrated with the visualisation module, and user is transparent. It stores a standard coded ECG.
- Transmission module is a collaborative tool between different stations. The Medical Station Network can be set as a hierarchic structure, where Primary Care Centres can acquire an ECG and send it to their Head dependant Hospital to revise and ask for diagnostic, without the needing for the patient to travel. This hierarchy can be flexible, as every Primary Care Attention Centre can select the hospital or physician to check the ECG, if allowed. This module complements the communication modules.fig. 3
- Conference and videoconference allow different users of Medical Stations to speak among them. Communication is vital in remote resource control, and advisable in usual work at Station. The Medical Station allows specifying which utility to use, the developed one or a commercial one. This communication module complies ITU H.263 standard, in order to guarantee compatibility with most video conference commercial software.
- Electronic mail has the same aim, i.e. ease the communication among users. Again, looking for integration and user comfort, commercial e-mail reader can be used instead of the e-mail reader brought in application.
- A more new application on telemedicine arena is remote control of medical stations. These tools allow an authorised NEMESIS user to acquire ECG onto remote stations, aided by a non-medical assistant. Collaborative tools, such as videoconference, are vital. Cardiologist can acquire and retrieve the ECG from a distant patient, aided with videoconference to supervise the positioning of the electrodes. This remote control is only available if an authorised user is in the station, and only allowed if no user is working or using the remote station. This kind of super-user must specify the IP address of the remote computer and the password. Then access is granted.
- Previous tools imply that some user have more privileges than other users. To guarantee the right use and avoid the abuse of these privileges users access must be controlled and verified. Identity is the key to enable the several modules. Identity log is kept for every user in order to maintain accurate record of every action. Security and safety are also observed. Integrity is checked at two levels: TCP/IP protocols guarantee data integrity by itself, and data received and stored at hard disk has a Check Redundancy Code (CRC) appended, which is checked on every write/read operation. Encryption is another user-transparent module, because it runs every time a file is sent trough the network. Public key cryptography is used, with a 40-bit RSA algorithm. Most of the programming tools are available at Sun´s Java site
- A very helpful and useful tool is knowledge database access. These databases are broadly literature quoted, but very few are available nowadays in Spain, being most of them proprietary and local databases with no standard access provided. The developed tool is just only a web browser, with selected bookmarks covering database access in web. Bookmarks are made in pure HyperText Mark up Language (HTML), so they can be imported into other commercial browsers. Discussion forii are accessed via browser as Internet News services.
- In this age of information society, Hospitalary Information Systems (HIS) and Computer Patient Records (CPR) are primary targets on Medical Informatics. The European Standardisation Committee (CEN) is working on these standards, but real world consists on several isolated and proprietary patient databases, most of them without graphic support and regarding only a small medical area. This tool was implemented with a proprietary format, waiting for a standard that unifies every kind of data.
- Sending/Receiving ECG files implies a queue managing tool, most of times transparent to users but inevitable to assure the right operation of the system.fig. 4
Recent implantation of intelligent cards in Spanish Health Offices for both patient identity and physician identification has led to a new module development. This module relies on the hardware, so the commercial application provided with card reader is used. Result data is carried to patient record or physician identity(4).
